Opioid pain medications - Revision history

Aidan at 13:14, 6 July 2020

2020-07-06T13:14:09Z

← Older revision		Revision as of 13:14, 6 July 2020
Line 1:		Line 1:
	== Opioid equivalence doses ==		==Opioid equivalence doses==

	{\| class="wikitable"		{\| class="wikitable"
	! Opioid		!Opioid
	! PO		!PO
	! SC/IV		!SC/IV
	\|-		\|-
	\| [[Morphine]]		\|[[Morphine]]
	\| 10mg		\|10mg
	\| 5mg		\|5mg
	\|-		\|-
	\| [[Codeine]]		\|[[Codeine]]
	\| 100mg		\|100mg
	\| —		\|—
	\|-		\|-
	\| [[Hydromorphone]]		\|[[Hydromorphone]]
	\| 2mg		\|2mg
	\| 1mg		\|1mg
	\|-		\|-
	\| [[Oxycodone]]		\|[[Oxycodone]]
	\| 5-7.5mg		\|5-7.5mg
	\| —		\|—
	\|-		\|-
	\| [[Methadone]]		\|[[Methadone]]
	\| 1mg		\|1mg
	\| —		\|—
	\|-		\|-
	\| [[Fentanyl]]		\|[[Fentanyl]]
	\| —		\|—
	\| 50mcg		\|50mcg
	\|}		\|}

			* Conversions are mostly done to and from oral [[Morphine]] milligram equivalents (MME)
⚫	== Starting doses ==

		⚫	==Starting doses==
⚫	* [[Codeine]]: 15mg po q4h + 15mg po q1-2h prn
⚫	* [[Morphine]]: 5mg po q4h + 5mg po q1-2h prn
⚫	* [[Hydromorphone]]: 1mg po q4h + 1mg po q1-2h prn
⚫	* Start lower with severe [[frailty]], [[COPD]], and [[CHF]]
⚫	* Start with short-acting and stabilize pain before transitioning to long-acting
⚫	* Also consider:
⚫	** [[Senna]], [[lactulose]], and [[PEG]] (but not [[docusate]]) for constipation
⚫	** [[Metoclopramide]] or [[domperidone]] for nausea

		⚫	*[[Codeine]]: 15mg po q4h + 15mg po q1-2h prn
⚫	== Breakthrough dosing ==
		⚫	*[[Morphine]]: 5mg po q4h + 5mg po q1-2h prn
		⚫	*[[Hydromorphone]]: 1mg po q4h + 1mg po q1-2h prn
		⚫	*Start lower with severe [[frailty]], [[COPD]], and [[CHF]]
		⚫	*Start with short-acting and stabilize pain before transitioning to long-acting
		⚫	*Also consider:
		⚫	**[[Senna]], [[lactulose]], and [[PEG]] (but not [[docusate]]) for constipation
		⚫	**[[Metoclopramide]] or [[domperidone]] for nausea

		⚫	==Breakthrough dosing==
⚫	* Rule out end-of-dose failure

⚫	* Use short-acting formulation of background opioid
		⚫	*Rule out end-of-dose failure
⚫	* Start as 10% of total daily dose, then titrate 5-20%
		⚫	*Use short-acting formulation of background opioid
		⚫	*Start as 10% of total daily dose, then titrate 5-20%

	[[Category:Palliative care]]		[[Category:Palliative care]]

Aidan: /* Starting doses */

2020-07-05T14:04:54Z

Starting doses

← Older revision		Revision as of 14:04, 5 July 2020
Line 33:		Line 33:
	== Starting doses ==		== Starting doses ==

	* Codeine: 15mg po q4h + 15mg po q1-2h prn		* [[Codeine]]: 15mg po q4h + 15mg po q1-2h prn
	* Morphine: 5mg po q4h + 5mg po q1-2h prn		* [[Morphine]]: 5mg po q4h + 5mg po q1-2h prn
	* Hydromorphone: 1mg po q4h + 1mg po q1-2h prn		* [[Hydromorphone]]: 1mg po q4h + 1mg po q1-2h prn
	* Start lower with severe frailty, COPD, and CHF		* Start lower with severe [[frailty]], [[COPD]], and [[CHF]]
	* Start with short-acting and stabilize pain before transitioning to long-acting		* Start with short-acting and stabilize pain before transitioning to long-acting
	* Also consider:		* Also consider:
	** Senna/lactulose/PEG (not ~~colace~~) for constipation		** [[Senna]], [[lactulose]], and [[PEG]] (but not [[docusate]]) for constipation
	** Metoclopramide/domperidone for nausea		** [[Metoclopramide]] or [[domperidone]] for nausea

	== Breakthrough dosing ==		== Breakthrough dosing ==

Aidan: /* Opioid equivalence doses */ linkified

2020-07-05T14:04:04Z

Opioid equivalence doses: linkified

← Older revision		Revision as of 14:04, 5 July 2020
Line 6:		Line 6:
	! SC/IV		! SC/IV
	\|-		\|-
	\| Morphine		\| [[Morphine]]
	\| 10mg		\| 10mg
	\| 5mg		\| 5mg
	\|-		\|-
	\| Codeine		\| [[Codeine]]
	\| 100mg		\| 100mg
	\| —		\| —
	\|-		\|-
	\| Hydromorphone		\| [[Hydromorphone]]
	\| 2mg		\| 2mg
	\| 1mg		\| 1mg
	\|-		\|-
	\| Oxycodone		\| [[Oxycodone]]
	\| 5-7.5mg		\| 5-7.5mg
	\| —		\| —
	\|-		\|-
	\| Methadone		\| [[Methadone]]
	\| 1mg		\| 1mg
	\| —		\| —
	\|-		\|-
	\| Fentanyl		\| [[Fentanyl]]
	\| —		\| —
	\| 50mcg		\| 50mcg

Aidan: /* Opioid equivalence doses */

2020-07-05T14:03:40Z

Opioid equivalence doses

← Older revision		Revision as of 14:03, 5 July 2020
Line 1:		Line 1:
	== Opioid equivalence doses ==		== Opioid equivalence doses ==

			{\| class="wikitable"
	{\|
	! Opioid		! Opioid
	! PO		! PO

Maintenance script: Imported from text file

2020-07-04T01:17:48Z

Imported from text file

New page

== Opioid equivalence doses ==

{|
! Opioid
! PO
! SC/IV
|-
| Morphine
| 10mg
| 5mg
|-
| Codeine
| 100mg
| —
|-
| Hydromorphone
| 2mg
| 1mg
|-
| Oxycodone
| 5-7.5mg
| —
|-
| Methadone
| 1mg
| —
|-
| Fentanyl
| —
| 50mcg
|}

== Starting doses ==

* Codeine: 15mg po q4h + 15mg po q1-2h prn
* Morphine: 5mg po q4h + 5mg po q1-2h prn
* Hydromorphone: 1mg po q4h + 1mg po q1-2h prn
* Start lower with severe frailty, COPD, and CHF
* Start with short-acting and stabilize pain before transitioning to long-acting
* Also consider:
** Senna/lactulose/PEG (not colace) for constipation
** Metoclopramide/domperidone for nausea

== Breakthrough dosing ==

* Rule out end-of-dose failure
* Use short-acting formulation of background opioid
* Start as 10% of total daily dose, then titrate 5-20%

[[Category:Palliative care]]