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 release 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 oxymorphone, 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 formulations, immediate- release formulations may be required for breakthrough pain. Only for severe pain requiring an opioid analgesic when alternative therapy has been inadequate. Maximum dose of tapentadol immediate release is 700 mg/day on day one and 600 mg/day thereafter. There are no established dosage ratios for direct conversion from other opioids to tapentadol. 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 daily 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 patches to other opioids, as this will result in overestimation and possible fatal overdose. During treatment with extended- release formulations, 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 release 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 opiate 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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