What is a key principle of opioid use when performing an equianalgesic conversion?

A key principle of opioid use during equianalgesic conversion is to reduce the calculated dose by approximately 25% for cross-tolerance. When a patient is switched from one opioid to another, their sensitivity to the current opioid may not translate directly to the new opioid due to differences in potency and individual variability in metabolism. This reduction in dose accounts for the likelihood that the patient's previous tolerance may not apply fully to the new opioid, effectively addressing the risk of overdose or adverse effects.

In practice, utilizing a conservative approach—such as the 25% reduction—is essential for patient safety. This adjustment is based on clinical experience and research indicating that cross-tolerance can vary significantly among individuals. Hence, starting with a lower dose helps ensure that the patient receives adequate pain management while minimizing risks associated with opioid toxicity.

Other options, such as doubling the existing dose or maintaining it, do not consider the variations in tolerance that can occur when switching opioids, which could place the patient at higher risk for inadequate analgesia or overdose. Eliminating the medication is impractical in the context of managing pain in patients who require continued opioid therapy.