Palliative Care and Pain Management at the End of Life ___________________________________________
DOSE CONVERSION RATIOS FOR METHADONE
Oral Morphine
Conversion Ratio (Morphine:Oral Methadone)
30–90 mg 91–300 mg
4:1 8:1
>300 mg
12:1
100 mcg/hour 800 mg The oral conversion ratio of methadone varies. Practitioners are advised to consult with a pain or palliative care specialist if they are unfamiliar with methadone prescribing. Source: [187] Table 10
EQUIANALGESIC ORAL OPIOID DOSES FOR FENTANYL TRANSDERMAL PATCH
Transdermal Fentanyl
Morphine
Hydromorphone
Oxycodone
Codeine 200 mg 400 mg 600 mg 800 mg
25 mcg/hour 50 mcg/hour 75 mcg/hour 100 mcg/hour Source: [187; 223]
60 mg
7.5 mg 15 mg 22.5 mg
30 mg 60 mg 90 mg
120 mg 180 mg 240 mg
30 mg
120 mg
Table 11
ORAL ADJUVANT ANALGESICS
Drug Class
Drug
Typical Starting Dose 100–300 mg once daily 25–75 mg twice daily 50–100 mg twice daily
Usual Effective Dose
Anticonvulsants
Gabapentin Pregabalin
300–1,200 mg (2 or 3 divided doses)
75–200 mg (3 divided doses)
Carbamazepine
300–600 mg twice daily 50–200 mg twice daily 150–600 mg twice daily 4–12 mg twice daily 50–150 mg at bedtime
Topiramate
25–50 mg daily
Oxcarbazepine
150–300 mg twice daily
Tiagabine
4 mg at bedtime
Tricyclic antidepressants
Amitriptyline Nortriptyline Desipramine Venlafaxine
10–25 mg at bedtime
Serotonin-norepinephrine reuptake inhibitors Skeletal muscle relaxants
37.5 mg daily
150–350 mg daily
Baclofen
5 mg twice daily 5 mg 3 times daily 400 mg 3 times daily
10–20 mg 2 or 3 times daily 10–20 mg 3 times daily
Cyclobenzaprine
Metaxalone
Not defined Not defined
Corticosteroids
Dexamethasone
1–2 mg
Source: [187; 223; 252]
Table 12
32
MDCA1525
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