APRN Ebook Continuing Education

Table 9. Common Opioids for Chronic Pain Management continued Medication Available Oral Strengths Dosage

Clinical Considerations

Hydrocodone, extended-release tablets • Hysingia ER

Tablets: 20 mg 30 mg 40 mg 60 mg 80 mg 100 mg 120 mg

Initiate: • 20 mg every 24 hours • Titrate dose by 10 to 20 mg every 3 to 5 days as needed

Conversion factor for daily oral opioids to Hysingia: • Hydrocodone: 1 • Oxycodone: 1

• Methadone: 1.5 • Oxymorphone: 2 • Hydromorphone: 4

• Morphine: 0.5 • Codeine: 0.15 • Tramadol: 0.1

Do not use it to convert Hysingia 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. 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.

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 the total daily hydromorphone dose and give orally once daily • Titrate dose by 4 to 8 mg every 3 to 4 days as needed

Oral solution: 5 mg/5 mL

Hydromorphone, extended- release tablets • Exalgo

Tablets: 8 mg

The conversion factor for daily oral opioids to Exalgo: • Hydromorphone: 1 • Codeine: 0.06 • Hydrocodone: 0.4

12 mg 16 mg 32 mg

• 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

Initiate: • 10 to 30 mg PO every 4 hours as needed

Oral solution: 10 mg/0.5 mL 10 mg/5 mL 20 mg/5 mL 20 mg/5 mL 100 mg/5mL

Morphine, extended-release tablets • Arymo ER

Tablets: 15 mg 30 mg 60 mg 100 mg 200 mg

Conversion from immediate-release morphine: • Calculate the total daily morphine dose; give half every 12 hours or one-third every 8 hours • Adjust dosage every one to two days based on complete daily morphine requirements Conversion from immediate-release morphine: • Calculate the total daily morphine dose and give orally once daily • Adjust dosage every one to two days (Kadian) or three to four days (Avinza) based on total daily morphine requirements

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. 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.

• Morphaond • MS Contin

Morphine, extended-release capsules

Capsules: 10 mg 20 mg 30 mg 40 mg 60 mg 80 mg

• Avinza, • Kadian

100 mg 200 mg

Page 24

Book Code: AUS3024

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