Table 7: Common Opioids for Chronic Pain Management
Available Oral Strengths
Medication
Dosage
Clinical Considerations
Capsules: • 10 mg • 20 mg • 30 mg • 40 mg • 60 mg • 80 mg • 100 mg • 200 mg Capsules: • 5 mg Tablets: • 5 mg • 7.5 mg • 10 mg • 15 mg • 20 mg • 30 mg
Morphine, extended- release capsules
Conversion from immediate release morphine: • Calculate total daily morphine dose and give orally once daily • Adjust dosage every 1 to 2 days (Kadian) or 3 to 4 days (Avinza) based on total daily morphine requirements. Initiate: • 5 to 15 mg PO very 4 to 6 hours.
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.
• Avinza • Kadian
Oxycodone, immediate release • Oxaydo • Roxicodone • Roxybond
Commonly used for breakthrough pain in patients receiving around-the-clock oxyco- done.
Oral solution: • 5 mg/5 mL • 20 mg/5 mL • 100 mg/5 mL
• Oxycodone,
Tablets: • 10 mg • 15 mg • 20 mg • 30 mg • 40 mg • 60 mg • 80 mg
Conversion from immediate release oxycodone: • Calculate total daily oxycodone dose. • Divide into two equal amounts and give orally every 12 hours. • Titrate the total daily oxycodone dose by 25% to 50% every 1 to 2 days. Conversion from immediate- release oxycodone: • Calculate total daily oxycodone dose. • Divide into two equal doses. • Give orally every 12 hours; titrate the total daily oxycodone dose by 25% to 50% every 1 to 2 days.
Due to drug interactions, particular drugs may need to be avoided, or dosage adjustments may be necessary. During treatment with extended-release for- mulations, immediate-release formulations may be required for breakthrough pain. To convert from fentanyl transdermal patch to oxycodone: • 10 mg PO every 12 hours for each 25 mcg/ hour fentanyl transdermal patch beginning 18 hours after removal of the fentanyl transdermal patch. Due to drug interactions, certain drugs may need to be avoided, or dosage adjustments may be necessary. Use an alternate medication for patients who require a dose less than 9 mg. Maximum dosage limit: 288 mg/day (equiva- lent to 320 mg oxycodone HCI). During treatment with extended- release for- mulations, immediate- release formulations may be required for breakthrough pain. Only for severe pain requiring an opioid an- algesic when alternative therapy has been in- adequate.
extended-release tablets
• OxyContin
Capsules: • 9 mg • 13.5 mg • 18 mg • 27 mg • 36 mg
Oxycodone (as a base), extended-release capsules • Xtampza
Oxymorphone, immediate-release tablets • Opana
Tablets: • 5 mg • 10 mg
5 to 20 mg PO every 4 to 6 hours as needed.
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Book Code: RPUS3024
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