Table 11. Common Opioids Used in Chronic Pain Management
Available Oral Strengths
Medication
Dosage
Clinical Considerations
Hydrocodone, extended- release tablets • Zohydro ER
Tablets: 10 mg 15 mg 20 mg 30 mg 40 mg 50 mg
Initiate: • 10 mg every 12 hours • Titrate by 10 mg every 12 hours as needed every 7 to 10 days
The conversion factor for daily oral opioids to Zohydro: • Hydrocodone: 1
• Oxycodone: 1 • Methadone: 1 • Oxymorphone: 2 • Hydromorphone: 2.67 • Morphine: 0.67 • Codeine: 0.1
Do not use it to convert Zohydro to other opioids, as it will result in overestimation and possible fatal overdose. During treatment with extended-release formulations, immediate- release formulations may be required for breakthrough pain.
Hydrocodone, extended- release tablets • Hysingia ER
Tablets: 20 mg 30 mg 40 mg 60 mg 80 mg 100 mg 120 mg
Initiate: 20 mg every 24 hours
Conversion factor for daily oral opioids to Hysingia: • Hydrocodone: 1 • Oxycodone: 1
Titrate dose by 10 to 20 mg every 3 to 4 days as needed
• Methadone: 1.5 • Oxymorphone: 2 • Hydromorphone: 4
• Morphine: 0.5 • Codeine: 0.15 • Tramadol: 0.1
Do not use it to convert Hysingia 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. In opioid-tolerant patients, the dose and duration of pain relief will vary depending on the patient’s tolerance. Commonly used for breakthrough pain in patients receiving around-the-clock hydromorphone.
Hydromorphone, immediate release
Tablets: 2 mg 4 mg 8 mg
As the first opioid or in patients not opioid tolerant: • Tablets: 2 to 4 mg PO every 4 to 6 hours • Oral solution: 2.5 to 10 mg PO every 3 to 6 hours
Oral solution: 5 mg/5 mL
Hydromorphone, extended-release tablets • Exalgo
Tablets: 8 mg 12 mg 16 mg 32 mg
Conversion from immediate release hydromorphone: • Calculate total daily
The conversion factor for daily oral opioids to Exalgo: • Hydromorphone: 1 • Codeine: 0.06 • Hydrocodone: 0.4
hydromorphone dose and give orally once daily
• Methadone: 0.6 • Oxycodone: 0.4 • Oxymorphone: 0.6
• Titrate dose by 4 to 8 mg every 3 to 4 days as needed
Do not use to convert Exalgo 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.
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