Table 7: Common Opioids for Chronic Pain Management
Available Oral Strengths
Medication
Dosage
Clinical Considerations
Oxymorphone, extended-release tablets • Generic only
Tablets: • 5 mg • 7.5 mg • 10 mg • 15 mg • 20 mg • 30 mg • 40 mg
Conversion from immediate re- lease oxymorphone: • Calculate total daily oxymorphone dose; divide into two equal doses and give orally every 12 hours. • Titrate by 5 to 10 mg/dose every 3 to 7 days as needed.
Conversion factor for daily oral opioids to oxy- morphone, extended-release:
• Oxymorphone: 1 • Hydrocodone: 0.5 • Oxycodone: 0.5 • Morphine: 0.333 • Methadone: 0.5
Do not use it to convert oxymorphone, or extended-release to other opioids, 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. Only for severe pain requiring an opioid an- algesic when alternative therapy has been in- adequate. Maximum dose of tapentadol immedi- ate release is 700 mg/day on day one and 600 mg/day thereafter. There are no established dosage ratios for di- rect conversion from other opioids to tapent- adol. Generally, recommended to start at 50 mg PO twice daily and titrate by no more than 100 mg/day every 3 days. The maximum dose of tapentadol extended- release is 500 mg/day (250 mg PO twice daily). Recommended initial Duragesic based on dai- ly morphine dose: • Morphine 60 to 134 mg/day PO: Fentanyl transdermal patch 25 mcg/hour. • Morphine 135 to 224 mg/day PO: Fentanyl, transdermal patch 50 mcg/hour. • Morphine 225 to 314 mg/day PO: Fentanyl transdermal patch 75 mcg/hour. • Morphine 315 to 404 mg/day PO: Fentanyl transdermal patch 100 mcg/hour. • Morphine 405 to 494 mg/day PO: Fentanyl transdermal patch 125 mcg/hour. • Morphine 495 to 584 mg/day PO: Fentanyl transdermal patch 150 mcg/hour. • Morphine 585 to 674 mg/day PO: Fentanyl transdermal patch 175 mcg/hour. • Morphine 675 to 764 mg/day PO: Fentanyl transdermal patch 200 mcg/hour. • Morphine 765 to 854 mg/day PO: Fentanyl transdermal patch 225 mcg/hour. • Morphine 855 to 944 mg/day PO: Fentanyl transdermal patch 250 mcg/hour. • Morphine 945 to 1034 mg/day PO: Fentanyl transdermal patch 275 mcg/hour. • Morphine 1035 to 1124 mg/day PO: Fentanyl transdermal patch 300 mcg/hour. Do not convert fentanyl transdermal patch- es to other opioids, 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.
Tapentadol, immediate- release tablets
Tablets: • 50 mg • 75 mg • 100 mg
Initiate: • 0 to 100 mg PO every 4 to 6 hours. • A second dose may be administered as soon as 1 hour after the first dose if pain control is not achieved. • Titrate dose as needed to the maximum dose. Conversion from immediate re- lease tapentadol: • Calculate total daily tapentadol dose. • Divide into two equal doses and give orally every 12 hours. • Titrate by no more than 100 mg/day every 3 days. Conversion from a different opi- ate agonist to Duragesic: • Convert the previous 24-hour opioid analgesic requirement to an equianalgesic morphine dose. • Use conversion chart to determine Duragesic initial dosage. • Change the patch every 72 hours. • May titrate ate initial dosage after 3 days (72 hours). • Subsequent dose titrations should be made no more frequently than every 6 days. Monitor patients closely for respiratory depression the first 24 to 72 hours after initiating therapy or dose escalation Supplemental doses may be required
Tapentadol, extended- release tablets • Nucynta ER
Tablets: • 50 mg • 100 mg • 150 mg • 200 mg • 250 mg
Fentanyl, transdermal patch (72-hour) • Duragesic
Patch Strength • 12 mcg/hour • 25 mcg/hour • 37.5 mcg/hour • 50 mcg/hour • 62.5 mcg/hour • 75 mcg/hour • 87.5 mcg/hour • 100 mcg/hour
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