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.
The conversion factor for daily oral opioids to Hysingia: • Hydrocodone: 1 • Oxycodone: 1
• Titrate dose by 10 to 20 mg every 3 to 5 days as needed.
• 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 opi- oids, as this will result in overestimation and possible fatal overdose. During treatment with extended- release for- mulations, immediate- release formulations may be required for breakthrough pain. In opioid-tolerant patients, the dose and dura- tion of pain relief will vary depending on the patient's tolerance. Commonly used for breakthrough pain in pa- tients receiving around-the-clock hydromor- phone. The conversion factor for daily oral opioids to Exalgo: • Hydromorphone: 1 • Codeine: 0.06 • Hydrocodone: 0.4 Do not use to convert Exalgo to other opioids, as this will result in overestimation and pos- sible fatal overdose. During treatment with extended- release for- mulations, immediate- release formulations may be required for breakthrough pain. Commonly used for breakthrough pain in pa- tients receiving around-the-clock morphine. • Methadone: 0.6 • Oxycodone: 0.4 • Oxymorphone: 0.6
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 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 • 12 mg • 16 mg • 32 mg
• Morphine,
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
10 to 30 mg PO every 4 hours as needed.
immediate release
Morphine, extended- release tablets • Arymo ER • Morphaond MS • Contin
Tablets: • 15 mg • 30 mg • 60 mg • 100 mg • 200 mg
Conversion from immediate- release morphine: • Calculate total daily morphine dose; give half every 12 hours or one-third every 8 hours. • Adjust dosage every 1 to 2 days based on complete daily morphine requirements.
Conversion ratios from other opioids to ex- tended-release morphine formulations have not been defined. During treatment with extended-release for- mulations, immediate-release formulations may be required for breakthrough pain.
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