Tennessee Physician Ebook Continuing Education

Table 10: Oral Opioids for Acute Pain in Opioid-Naïve Adults Medication Available Oral Strengths Moderate Pain

(Continued)

Severe Pain Clinical Considerations

Tablets: 37.5 mg/325 mg

1 to 2 tablets PO every 6 hours needed

1 to 2 tablets PO every 4 hours as needed

Only FDA-approved for 5 days or less of treatment of acute

Tramadol- acetaminophen • Ultracet Ibuprofen- hydrocodone • lbudone • Reprexain • Vicoprofen • Xylon

pain. Maximum dose: Eight tablets/24 hours.

Tablets: 5 mg/200 mg 7.5 mg/200 mg 10 mg/ 200 mg

1 tablet PO every 4 to 6 hours as needed

FDA-approved for short-term, acute, severe pain (<10 days). Do not exceed 5 tablets/day.

Ibuprofen-oxycodone (Only available as generic)

Tablets: 5 mg/400 mg

1 tablet PO every 6 hours

Do not exceed 4 tablets/24 hours. The duration of therapy should not exceed 7days. Increasing doses do not improve efficacy and results in increased adverse effects. Limit codeine to no more than 60 mg/dose. Do not exceed 360 mg codeine/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. Utilized only for severe, acute pain; not a first-line acute pain agent. Start with a low dose and titrate carefully.

Codeine (Only available as generic)

Tablets: 15 mg, 30 mg, 60 mg

15 to 60 mg PO every 4 hours as needed

Hydromorphone * • Dilaudid

Tablets : 2 mg, 4 mg, 8 mg Oral solution: 5 mg/5 mL

2 to 4 mg PO every 4 to 6 hours as needed

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

10 to 30 mg PO every 4 hours as needed

Oxycodone* • Oxaydo • Roxicodone • Roxybond

Capsules: 5 mg Tablets: 5 mg

5 to 15 mg PO every 4 to 6 hours

Utilized only for severe, acute pain; not a first-line acute pain agent. Start with low a dose and titrate carefully.

7.5 mg 10 mg 15 mg 20 mg 30 mg 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 4 to 6 hours as needed

Maximum dose (<75 years): 400 mg/day. Maximum dose (75 years and older): 300 mg/day.

*Note: Avoid extended-release formulations and long-acting opioids in acute pain.

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Book Code: TN24CME

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