Table 7: Common Opioids for Chronic Pain Management
Available Oral Strengths
Medication
Dosage
Clinical Considerations
Oxycodone, extended-release tablets • OxyContin
Tablets: • 10 mg • 15 mg • 20 mg • 30 mg • 40 mg • 60 mg • 80 mg
Conversion from immediate release oxycodone: • Calculate total daily oxycodone dose. • Divide into two equal amounts and give orally every 12 hours. • Titrate the total daily oxycodone dose by 25% to 50% every 1 to 2 days. Conversion from immediate- release oxycodone: • Calculate total daily oxycodone dose. • Divide into two equal doses. • Give orally every 12 hours; titrate the total daily oxycodone dose by 25% to 50% every 1 to 2 days.
Due to drug interactions, particular drugs may need to be avoided, or dosage adjustments may be necessary. During treatment with extended-release formulations, immediate-release formulations may be required for breakthrough pain. To convert from fentanyl transdermal patch to oxycodone: • 10 mg PO every 12 hours for each 25 mcg/hour fentanyl transdermal patch beginning 18 hours after removal of the fentanyl transdermal patch. Due to drug interactions, certain drugs may need to be avoided, or dosage adjustments may be necessary. Use an alternate medication for patients who require a dose less than 9 mg. Maximum dosage limit: 288 mg/day (equivalent to 320 mg oxycodone HCI). During treatment with extended- release formulations, immediate- release formulations may be required for breakthrough pain. Only for severe pain requiring an opioid analgesic when alternative therapy has been inadequate.
Capsules: • 9 mg • 13.5 mg • 18 mg • 27 mg • 36 mg
Oxycodone (as a base), extended- release capsules • Xtampza
Oxymorphone, immediate-release tablets • Opana Oxymorphone, extended-release tablets • Generic only
Tablets: • 5 mg • 10 mg
5 to 20 mg PO every 4 to 6 hours as needed.
Tablets: • 5 mg
Conversion from immediate release oxymorphone: • Calculate total daily oxymorphone dose; divide into two equal doses and give orally every 12 hours. • Titrate by 5 to 10 mg/ dose every 3 to 7 days as needed.
Conversion factor for daily oral opioids to oxymorphone, extended-release: • Oxymorphone: 1 • Hydrocodone: 0.5
• 7.5 mg • 10 mg • 15 mg • 20 mg • 30 mg • 40 mg
• Oxycodone: 0.5 • Morphine: 0.333 • Methadone: 0.5
Do not use it to convert oxymorphone, or extended-release 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. Only for severe pain requiring an opioid analgesic when alternative therapy has been inadequate. Maximum dose of tapentadol immediate release is 700 mg/ day on day one and 600 mg/day thereafter.
Tapentadol, immediate- release tablets
Tablets: • 50 mg • 75 mg • 100 mg
Initiate: • 0 to 100 mg PO every 4 to 6 hours. • A second dose may be administered as soon as 1 hour after the first dose if pain control is not achieved. • Titrate dose as needed to the maximum dose. Conversion from immediate release tapentadol: • Calculate total daily tapentadol dose. • Divide into two equal doses and give orally every 12 hours. • Titrate by no more than 100 mg/day every 3 days.
Tapentadol, extended- release tablets • Nucynta ER
Tablets: • 50 mg • 100 mg • 150 mg • 200 mg • 250 mg
There are no established dosage ratios for direct conversion from other opioids to tapentadol. Generally, recommended to start at 50 mg PO twice daily and titrate by no more than 100 mg/day every 3 days. The maximum dose of tapentadol extended-release is 500 mg/day (250 mg PO twice daily).
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