Drug

Oral dose

Parenteral dose

Duration of relief

Comments

Morphine

30 mg

10 mg

3-4 hours

Extended release:15,30,60,90 and100mg. MS Contin is bid dosing. Kadian and Avinza are once daily dosing. Short acting forms are Roxanol and MS-IR. Oral solutions:4 and 20mg/ml. Tablet:15mg, suppository:10mg, injection:2,4,8,10,15mg/ml, PCA:1 or 5mg/ml 30ml. Use 1/10th of the long acting form as the rescue dose and if 5 rescue doses are required per day, then increase the long acting form.

Hydromorphone

8 mg

3 mg

3-4 hours

4-5 times as potent as morphine. Comes as inj:2,4,10mg. Tablet:2,4,8,16mg. Suppository:3mg. PCA: 1or 5mg/ml 30ml

Codeine

200 mg

120 mg

3-4 hours

T#2 has codeine 15mg, T3# has 30mg and T#4 has 60mg codeine

Fentanyl

No oral prep. Transdermal 15 mcg/hr

0.2 mg

72 hours

Comes as 50mcg/ml inj. No oral form available. The patch (TTS) comes as 25,50,75 and 100mcg/hr. Patch is changed q72 hours. Takes 8-12 hours for peak effect.

Oxycodone

20 mg

Long acting forms are Oxycodone ER and Oxycontin. Comes as 10,20,40,80 mg. It is dosed as bid. Short acting forms are Oxy-IR and Roxicodone. Comes as 5 mg and 15 mg tablets, 1mg/ml oral solution. Use 1/10th of the long acting form as the rescue dose. If more than 5 rescue doses are required then increase the long acting form. Slightly more potent than morphine.

Hydrocodone

30 mg

NA

Vicondin 5/500, vicodin ES 7.5/750, Lortab 2.5, 5, 7.5 with APAP 500, Norco 2.5, 5, 7.5, 10 with APAP 325 (lowest Apap dose), (Morphine: hydrocodone = 1:1)

Methadone

20 mg (acute pain), 2-4 mg (chronic pain)

10 mg

4-6 hours

Unpredictable and long half-life. Drug accumulates with frequent dosing. When switching to methadone from another opioid start with 10-25% of the equianalgesic dose and titrate slowly q 3-7 days. Comes as 10mg tablet.