Table 5. Oral Opioids for Acute Pain in Opioid-Naive Adults Medication Available Oral Strengths Moderate Pain
Severe Pain Clinical Considerations
Oxycodone– acetaminophen*
Tablets: • 2.5 mg/325 mg • 5 mg/325 mg • 7.5 mg/325 mg • 10 mg/325 mg Oral solution: • 5 mg/325 mg per 5 mL Tablets: • 37.5 mg/325 mg
1 to 2 tablets PO every six hours as needed.
1 to 2 tablets PO every four to six hours as needed.
• Dosage limited by acetaminophen maximum dose (4,000 mg/day [from all sources]).
• Endocet • Percocet • Primlev • Roxicet • Xolox
Tramadol– acetaminophen • Ultracet Ibuprofen– hydrocodone • lbudone • Reprexain • Vicoprofen • Xylon Ibuprofen– oxycodone (only available as generic) Codeine (only available as generic)
1 to 2 tablets PO every six hours needed.
1 to 2 tablets PO every four hours as needed. 1 tablet PO every four to six hours as needed.
• Only FDA-approved for five days or less for treatment of acute pain. Maximum dose: Eight tablets/24 hours.
Tablets: • 5 mg/200 mg • 7.5 mg/200 mg • 10 mg/200 mg
• FDA-approved for short-term, acute, severe pain (<10 days). Do not exceed five tablets per day.
Tablets: • 5 mg/400 mg
1 tablet PO every six hours.
• Do not exceed four tablets/24 hours. • The duration of therapy should not exceed seven days.
Tablets: • 15 mg, 30 mg, 60 mg
15 to 60 mg PO every four hours as needed.
• A decrease in incremental efficacy and an increase in adverse reactions with increasing doses. Limit codeine to no more than 60 mg/dose. Do not exceed 360 mg codeine within 24 hours. • Metabolism of codeine to morphine (its active form) varies between patients; drug interactions may affect response. • Used only for severe, acute pain, not as a first-line acute pain agent. Start with a low dose and titrate carefully.
Hydromorphon* • Dilaudid
Tablets: • 2 mg, 4 mg, 8 mg
2 to 4 mg PO every four to six hours as needed. 10 to 30 mg PO every four hours as needed.
Oral solution: • 5 mg/5 mL
Morphine* (only available as generic)
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/5 mL
• Utilized only for severe, acute pain; not a first-line acute pain agent. Start with a low dose and titrate carefully.
Oxycodone* • Oxaydo • Roxicodone • Roxybond
Capsules: • 5 mg Tablets: • 5 mg • 7.5 mg • 10 mg • 15 mg • 20 mg • 30 mg
5 to 15 mg PO every four to six hours.
• Utilized only for severe, acute pain; not a first-line acute pain agent. Start with a low dose and titrate carefully.
Oral solution: • 5 mg/5 mL • 20 mg/5 mL • 100 mg/5 mL
Tramadol (Ultram)
Tablets: 50 mg
1 to 2 tablets PO every four to six hours as needed.
• Maximum dose (age <75 years): 400 mg/day. • Maximum dose (age 75 years and older): 300 mg/ day.
*Avoid extended-release formulations and long-acting opioids to address acute pain.
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