Opioid pain medications: Difference between revisions

Latest revision as of 13:14, 6 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

Conversions are mostly done to and from oral Morphine milligram equivalents (MME)

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%

@@ Line 1: / Line 1: @@
-== Opioid equivalence doses ==
+==Opioid equivalence doses==
 {| 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]]