Opioid pain medications: Difference between revisions
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== Starting doses == |
== Starting doses == |
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* Codeine: 15mg po q4h + 15mg po q1-2h prn |
* [[Codeine]]: 15mg po q4h + 15mg po q1-2h prn |
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* Morphine: 5mg po q4h + 5mg po q1-2h prn |
* [[Morphine]]: 5mg po q4h + 5mg po q1-2h prn |
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* Hydromorphone: 1mg po q4h + 1mg po q1-2h prn |
* [[Hydromorphone]]: 1mg po q4h + 1mg po q1-2h prn |
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* Start lower with severe frailty, COPD, and CHF |
* Start lower with severe [[frailty]], [[COPD]], and [[CHF]] |
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* Start with short-acting and stabilize pain before transitioning to long-acting |
* Start with short-acting and stabilize pain before transitioning to long-acting |
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* Also consider: |
* Also consider: |
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** Senna |
** [[Senna]], [[lactulose]], and [[PEG]] (but not [[docusate]]) for constipation |
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** Metoclopramide |
** [[Metoclopramide]] or [[domperidone]] for nausea |
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== Breakthrough dosing == |
== Breakthrough dosing == |
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Revision as of 14:04, 5 July 2020
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, 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
- Start as 10% of total daily dose, then titrate 5-20%
