Opioid pain medications
From IDWiki
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%
