Table 11. Common Opioids Used in Chronic Pain Management (Continued)
Available Oral Strengths
Medication
Dosage
Clinical Considerations
Morphine, immediate release
Tablets: 15 mg 30 mg
Initiate: • 10 to 30 mg PO every 4 hours as needed
Commonly used for breakthrough pain in patients receiving around-the-clock morphine.
Oral solution: 10 mg/0.5 mL 10 mg/5 mL 20 mg/5 mL 20 mg/5 mL 100 mg/5mL
Morphine, extended- release tablets • Arymo ER • Morphaond • MS Contin
Tablets 15 mg 30 mg 60 mg 100 mg 200 mg
Conversion from immediate- release morphine: • Calculate total daily
Conversion ratios from other opioids to extended-release morphine formulations have not been defined.
morphine dose; give half every 12 hours or one- third every 8 hours
During treatment with extended-release formulations, immediate- release formulations may be required for breakthrough pain.
• Adjust dosage every 1 to 2 days based on
complete daily morphine requirements
Morphine, extended- release capsules
Capsules: 10 mg 20 mg 30 mg 40 mg 60 mg 80 mg 100 mg 200 mg
Conversion from immediate release morphine: • Calculate total daily morphine dose and give orally once daily • Adjust dosage every 1
Conversion ratios from other opioids to extended-release morphine formulations have not been defined.
• Avinza • Kadian
During treatment with extended-release formulations, immediate- release formulations may be required for breakthrough pain.
to 2 days (Kadian) or 3 to 4 days (Avinza) based on total daily morphine requirements
Oxycodone, immediate release • Oxaydo • Roxicodone, • Roxybond
Capsules: 5 mg
Initiate: • 5 to 15 mg PO every 4 to 5 hours.
Commonly used for breakthrough pain in patients receiving around-the-clock oxycodone.
Tablets: 5 mg 7.5 mg 10 mg 15 mg 20 mg 30 mg
Oral solution: 5 mg/5 mL 20 mg/5 mL 100 mg/5 mL
Oxycodone, extended- release tablets • OxyContin
Tablets: 10 mg 15 mg 20 mg 30 mg 40 mg 60 mg 80 mg
Conversion from immediate release oxycodone: • Calculate total daily oxycodone dose. • Divide into two equal amounts and give orally every 12 hours. • Titrate the total daily
Due to drug interactions, particular drugs may need to be avoided, or dosage adjustments may be necessary.
During treatment with extended-release formulations, immediate- release formulations may be required for breakthrough pain. To convert from fentanyl transdermal patch to oxycodone: 10 mg PO every 12 hours for each 25 mcg/hour fentanyl transdermal patch beginning 18 hours after removal of the fentanyl transdermal patch.
oxycodone dose by 25% to 50% every 1 to 2 days.
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