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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