Opioid Equianalgesic Chart

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