Table 7: Common Opioids for Chronic Pain Management
Available Oral Strengths
Medication
Dosage
Clinical Considerations
Hydromorphone, immediate release
Tablets: • 2 mg • 4 mg • 8 mg
As the first opioid or in patients not opioid tolerant: • Tablets: 2 to 4 mg. PO every 4 to 6 hours. • Oral solution: 2.5 to 10 mg PO every 3 to 6 hours. Conversion from immediate release hydromorphone: • Calculate total daily hydromorphone dose and give orally once daily. • Titrate dose by 4 to 8 mg every 3 to 4 days as needed.
In opioid-tolerant patients, the dose and duration of pain relief will vary depending on the patient's tolerance. Commonly used for breakthrough pain in patients receiving around-the-clock hydromorphone.
Oral solution: • 5 mg/5 mL
Hydromorphone, extended-release tablets • Exalgo
Tablets: • 8 mg • 12 mg • 16 mg • 32 mg
The conversion factor for daily oral opioids to Exalgo: • Hydromorphone: 1 • Codeine: 0.06 • Hydrocodone: 0.4 • Methadone: 0.6 • Oxycodone: 0.4 • Oxymorphone: 0.6 Do not use to convert Exalgo to other opioids, as this will result in overestimation and possible fatal overdose. During treatment with extended- release formulations, immediate- release formulations may be required for breakthrough pain. Commonly used for breakthrough pain in patients receiving around-the-clock morphine.
Morphine, immediate release
Tablets: • 15 mg • 30 mg Oral solution: • 10 mg/0.5 mL • 10 mg/5 mL • 20 mg/5 mL • 20 mg/5 mL • 100 mg/5mL
10 to 30 mg PO every 4 hours as needed.
Morphine, extended-release tablets • Arymo ER • Morphaond MS • Contin
Tablets: • 15 mg • 30 mg • 60 mg • 100 mg • 200 mg
Conversion from immediate- release morphine: • Calculate total daily morphine dose; give half every 12 hours or one-third every 8 hours. complete daily morphine requirements. Conversion from immediate release morphine: • Calculate total daily morphine dose and give orally once daily • Adjust dosage every 1 to 2 • Adjust dosage every 1 to 2 days based on days (Kadian) or 3 to 4 days (Avinza) based on total daily morphine requirements. Initiate: • 5 to 15 mg PO very 4 to 6 hours.
Conversion ratios from other opioids to extended-release morphine formulations have not been defined. During treatment with extended-release formulations, immediate-release formulations may be required for breakthrough pain.
Capsules: • 10 mg • 20 mg • 30 mg • 40 mg • 60 mg • 80 mg • 100 mg • 200 mg Capsules: • 5 mg Tablets: • 5 mg • 7.5 mg • 10 mg • 15 mg • 20 mg • 30 mg
Morphine, extended-release
Conversion ratios from other opioids to extended-release morphine formulations have not been defined. During treatment with extended-release formulations, immediate-release formulations may be required for breakthrough pain.
capsules • Avinza • Kadian
Oxycodone, immediate release • Oxaydo • Roxicodone • Roxybond
Commonly used for breakthrough pain in patients receiving around-the-clock oxycodone.
Oral solution: • 5 mg/5 mL • 20 mg/5 mL • 100 mg/5 mL
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