Table 7. Common Opioids for Chronic Pain Management
Available Oral Strengths
Medication
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 three to five days as needed.
The 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
Please do not use this information 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. 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 this information 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.
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 four to six hours. • Oral solution: 2.5 to 10 mg PO every three to six hours. Conversion from immediate-release hydromorphone: • Calculate the total daily hydromorphone dose and give it orally once daily. • Titrate dose by 4 to 8 mg every three to four days as needed.
Oral solution: • 5 mg/5 mL
Hydromorphone, extended-release tablets • Exalgo
Tablets: • 8 mg • 12 mg • 16 mg • 32 mg
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
Initiate: • 10 to 30 mg PO every four hours as needed.
Morphine extended- release tablets • Arymo ER
Tablets • 15 mg • 30 mg • 60 mg • 100 mg • 200 mg Capsules: • 10 mg • 20 mg • 30 mg • 40 mg • 60 mg • 80 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 it 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.
• Morphaond • MS Contin
Morphine, extended- release capsules
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.
• Avinza • Kadian
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Book Code: AUS3024
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