Table 7: Common Opioids for Chronic Pain Management
Available Oral Strengths
Medication
Dosage
Clinical Considerations
Methadone, immediate release • Dolophine, Methadose
Tablets: • 5 mg • 10 mg
Conversion from a different opi- ate agonist to methadone: • 30 to 40 mg/day (divided into 2 to 3 doses). • Titrated every 5 to 7 days in doses of 5 to 10 mg/day.
Due to the unique properties of methadone, dosage ratios for direct conversion to metha- done are variable and can be inconsistent be- tween patients. The duration of action of methadone is 4 to 8 hours, while the elimination half- life ranges from 8 to 59 hours. Increased monitoring for delayed adverse ef- fects (i.e., respiratory depression) is required, especially during the first 24 to 72 hours after initiation or dose increase. The potency of methadone increases with re- peated dosing. Immediate- release opioids may be required for breakthrough pain.
Oral solution: • 5 mg/5 mL • 10 mg/5mL
* Note : While many ER/LA opioid analgesics are FDA-approved (at specific dosages) for opioid-naïve or non-opioid-tolerant patients, current guidelines for chronic pain management do not recommend these products to patients (Dowell et al., 2016); therefore, those doses are not provided in the table. It is recommended to stop all other around-the-clock opioid drugs upon initiation of a new ER/ LA product. Equianalgesic dosing of opioids
Opioid medications have differing potencies. When converting from one opioid medication to another, it is critical to understand the equivalent analgesic (equianalgesic) dose to ensure continued efficacy without untoward side effects (see Table 8). The dose, administration route, and therapy duration must be considered.
Multiple opioid conversion charts are available. Clinicians must consider individual patient factors and the characteristics of the opioid medications and delivery systems when converting be- tween opioid products. Closely monitor patients following con- version for efficacy and potential adverse effects.
Table 8: Opioid Equianalgesic Table (Stanford College of Medicine, 2022)
Approximate Equianalgesic Oral Dose
Approximate Equianalgesic Intravenous Dose
Medication Morphine
Conversion Factor to Oral Morphine Parenteral morphine is 3 times as potent as oral morphine. Oral oxycodone is roughly 1.5 times more potent than oral morphine. Oral hydrocodone is roughly 1.5 times more potent than oral morphine. Oral hydromorphone is about 4 to 7 times as potent as oral morphine. Parenteral hydromorphone is 20 times as potent as oral morphine. Transdermal fentanyl is ~80 times as potent as oral morphine. (See Table 7 to convert morphine to fentanyl transdermal patches.)
30 mg
10 mg
Oxycodone
20 mg
Hydrocodone
20 to 30 mg
Hydromorphone
7 mg
1.5 mg
Fentanyl
100 mcg (0.1 mg) 15 mcg/hour
Methadone
Variable
Variable
Tramadol Codeine
300 mg
0.1
200 mg
0.15
Meperidine
300 mg of oral meperidine
75 mg of parenteral meperidine
Oral morphine is about 10 times more potent than oral meperidine and about twice as potent as parenteral meperidine (mg for mg).
*Note: To convert to ER/LA opioids, see conversion factors listed in Table 7.
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Book Code: RPUS3024
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