Table 3: OPIOID EQUIANALGESIC CONVERSION TABLE 1
Medication {How supplied}
Equianalgesic Dose IM2/IV1 PO1 mg mg
Peak Effect (min)
Duration of Action (hr)
IV Push: 10 - 20 PO: 45 - 60 IM2/SubQ: 30 PO: 1.5 – 2 h
IV Push: 1 PO/IM2/SubQ: 3 – 6
IV Push: 10 - 20 PO: 45 - 60 IM2/SubQ: 30 IV over 20 min: 30 - 60 PO: 2 – 4 hr
IV Push: 1 PO/IM2/SubQ: 3 - 4 IV over 20 min/PO/IM2: 4-6
20 – 30
IV Push: 1 - 3
RECOMMENDED STARTING DOSE PEDIATRICS
ADULTS
IV: See Footnote IV: 0.05-0.1mg/kg q 1-3h PO: 30mg q 3-4h PO: 0.3-0.6mg/kg q3-4h IM2/SubQ: 10mg q 3-4h Used around the clock for recurrent, continuing pain after pain is controlled on short-acting analgesic. Perform equianalgesic conversion from short-acting to long acting analgesic. Do not crush/cut/chew. May be given PR, use oral equivalent. IV: See Footnote3 IV: 0.01-0.04mg/kg q 1-3h PO: 6mg q 3-4h PO: 0.05-0.2mg/kg q 3-4h IM2/SubQ: 1.5mg q 3-4h IV over 20 min: 10mg q 6-12h IV over 20 min: 0.1mg/kg q 6-8h Prolonged elimination half-life (15-36 hr), PO: 20mg q 6-12h PO: 0.2 mg/kg q 6-8h drug may accumulate. Analgesic duration 6-8 hours IV: 25-50mcg q 30min-1h IV: 0.5-1mcg/kg q 30 min-1h Highly potent; may produce respiratory depression, apnea, or stiff chest. When used IVP, administer in the ICU or use careful observation and pulse oximetry. IV: See Footnote3 IV: Not recommended Max dose is 1Gm/24h and 2-3Gm/7 days or PO: Not recommended PO: 0.75mg/kg q 6-8h less. IM1/SubQ: 100mg q 3h Toxic metabolite normeperidine may cause seizures and agitation Liquid solution available - comes as 5mg/ml; PO: 10mg q 3-4h PO: 0.15-0.2ml/kg q 3-4h alcohol free. 3
Morphine
10
30
Morphine sustained release (MS Contin)
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30
Hydromorphone (Dilaudid)
1.5
7.5
Methadone (Dolophine)
10
20
Fentanyl4 (Sublimaze)
100 (mcg)
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Meperidine (Demerol)
100
300 NR
NR = Not recommende d
IV Push: 10 - 20 PO: 45 - 60 IM1/SubQ: 30
IV Push: 1 PO/IM1/SubQ: 2 - 4
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20
45 - 60
3-4
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15
60
12
PO: 10mg q 12 h
Not recommended in children < 10 years old
30
45 - 60
3-4
PO: 1-2 tabs q 4h
PO: 0.15-0.2ml/kg q 3-4h
200 NR
45 - 60
3-6
PO: 60mg q 3-4h
PO: 0.5-1mg/kg q 3-4h
Oxycodone {Roxicodone (5mg/tab), Solution (5mg/5ml)} Oxycodone sustained release (OxyContin) Oxycodone/ Acetaminophen {Percocet 1 tab or Roxicet 5ml (5mg/325mg)}
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Codeine
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Codeine/ Acetaminophen {Tylenol #3 1 tab (30mg/325mg)} Propoxyphene HCl/ Acetaminophen {Wygesic 1 tab (65mg/650mg)}
8 – 12
Comments
Used around the clock for recurrent, continuing pain after pain is controlled on short-acting analgesic. Do not crush/cut/chew. Liquid solution available - comes as oxycodone 5mg/acetaminophen 325mg per 5ml; alcohol free. Consider acetaminophen upper dose limits5 Suggested maximum single dose = 65mg. Expect increased side effects with doses >65mg.
Liquid elixir available - comes as 12mg codeine/120mg acetaminophen per 5ml; contains alcohol. Consider acetaminophen upper dose limits5 Toxic metabolite accumulates but generally --200 NR 45 - 60 3-6 PO: 1 tab q 4h PO: Not recommended clinically significant only in the elderly. Weak opioid: Propoxyphene HCl 65mg = Acetaminophen 650mg Consider acetaminophen upper dose limits5 1 All conversions are considered equianalgesic to 10 mg parenteral morphine. When performing an equianalgesic conversion, consider reducing dose by 25% due to incomplete cross-tolerance. 2 Least desired route 3 For IV push dose, divide IM/SubQ dose by 3 and administer IV push over 2-3 min q 1 hour, or administer via continuous infusion 4 Fentanyl Patch (Duragesic): Used around the clock for recurrent, continuing pain after pain is controlled on short-acting analgesic. Perform equianalgesic conversion from short-acting to long acting analgesic. Fentanyl patch 25 mcg/hr is approximately equivalent to 45-134 mg. PO morphine/day. Peak effect 18-24 hours after initial application, duration of action 3 days. Do not cut patch. Not recommended for pediatric patients <20kg. 5 Acetaminophen upper dose limits: Peds 90 mg/kg/day, Adult 3-4 Gm/day. /var/www/apps/pdfcoke/pdfcoke/tmp/scratch2/10058086.doc 6/11/02 ---
135 NR
45 - 60
3-6
PO: 1 -2 tabs q4h
PO: 0.4ml/kg q 4h