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Opioids - Equianalgesic Dosages Career Center MORE

Equianalgesic dosage table

Buprenorphine (IM/IV): 0.4 Morphine (IV/IM/SC): 10
Butorphanol (IM/IV): 2.0 Morphine (acute PO): 60
Codeine (IM/IV): 120 Morphine (chronic PO): 30
Codeine (PO): 200 Nalbuphine (IV/IM/SC): 10
Fentanyl (IM/IV): 0.1 Oxycodone (PO): 20
Fentanyl (Transdermal): 0.2 Oxymorphone (IV/IM/SC): 1.0
Hydrocodone (PO): 30 Oxymorphone (PO): 10
Hydromorphone (IV/IM/SC): 1.5 Tapentadol (PO): 75
Hydromorphone (PO): 7.5
Levorphanol (acute PO): 4.0 Methadone Chronic dosing:
Levorphanol (chronic PO): 1.0 0-99 mg: 4:1
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Meperidine (IV/IM/SC): 75 100-299 mg: 8:1
Meperidine (PO): 300 300-499 mg: 12:1 Medical Calculators - A thru Z
Methadone (acute IV): 5.0 500-999 mg: 15:1
Methadone (acute PO): 10 >1000 mg: 20:1 A B C D E F G H I J
K L M N O P Q R S T
Fentanyl Patch Conversions - Package Insert Recommendations
U V W X Y Z
RECOMMENDED INITIAL DURAGESIC® DOSE BASED UPON DAILY ORAL
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MORPHINE DOSE4

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 Oral 24-hour DURAGESIC®
Morphine Dose
(mg/day) (mcg/h)

60–134 25
135–224 50
225–314 75
315–404 100
405–494 125
495–584 150
585–674 175
675–764 200
765–854 225
855–944 250
945–1034 275
1035–1124 300
Discontinuation of DURAGESIC®:
To convert patients to another opioid, remove DURAGESIC® and titrate the dose of the
new analgesic based upon the patient's report of pain until adequate analgesia has been
attained. Upon system removal, 17 hours or more are required for a 50% decrease in
serum fentanyl concentrations. Opioid withdrawal symptoms (such as nausea, vomiting,
diarrhea, anxiety, and shivering) are possible in some patients after conversion or dose
adjustment. For patients requiring discontinuation of opioids, a gradual downward titration
is recommended since it is not known at what dose level the opioid may be discontinued
without producing the signs and symptoms of abrupt withdrawal.

NOTE: In clinical trials, these ranges of daily oral morphine doses were used as a basis
for conversion to DURAGESIC® . Advertisement

Lab Values - A thru Z

This table should not be used to convert from DURAGESIC® to other
therapies because this conversion to DURAGESIC® is conservative. Use
A B C D E F G H I J
of this table for conversion to other analgesic therapies can overestimate
the dose of the new agent. K L M N O P Q R S T
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 U V W X Y Z
References
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1] American Pain Society (APS). Principles of Analgesic Use in the Treatment of
Acute Pain and Cancer Pain, 6th edition. 2008. Glenview, IL 60025.

2] Ayonrinde OT, Bridge DT. The rediscovery of methadone for cancer pain
management. Med J Aust 2000; 173(10): 536-540.

3] Breitbart W, Chandler S, Eagel B, et al. An alternative algorithm for dosing

transdermal fentanyl for cancer-related pain. Oncology. 2000;14:695-705.

4] Duragesic® Package Insert: http://www.duragesic.com/prescribing-

information.html
Accessed: October 2010.

5] Donner B, et al. Direct conversion from oral morphine to transdermal fentanyl. Pain.
1996; 64:527-534.

6] Fisch MJ, Cleeland CS: Managing cancer pain. In: Skeel RT, ed.: Handbook of
Cancer Chemotherapy. 6th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2003,
pp 663.

7] Methadone PI (package insert). Dolophine hydrochloride, 5 mg, 10mg tablets. Oct

.2006.

8] Ripamonti C, Groff L, Brunelli C, Polastri D, Stavrakis A, De Conno F. Switching

from morphine to oral methadone in treating cancer pain: what is the equianalgesic
dose ratio? J Clin Oncol. 1998;16(10):3216-3221.

Equianalgesic
Drug Duration Half-life Route
Dosage
Codeine 4–6 h 3h IM 120 mg
PO 200 mg

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 Fentanyl 1–2 h 1.5–6 h IM 0.1 mg
Hydrocodone 4–8 h 3.3–4.5 h PO 30 mg
Hydromorphone 4–5 h 2–3 h IM 1.3–1.5 mg
PO 7.5 mg
Levorphanol 6–8 h 12–16 h IM 2 mg
PO 4 mg
Meperidine 2–4 h 3–4 h IM 75 mg
PO 300 mg
Methadone 4–6 h 15–30 h IM 10 mg
PO 10–20 mg
Morphine 3–7 h 1.5–2 h IM 10 mg
PO 30–60 mg
Oxycodone 4–6 h NA PO 15-30 mg (20 mg)
Oxymorphone 3–6 h NA IM 1 mg
PR 10 mg
130-200 mg *
Propoxyphene 4–6 h 6–12 h PO
(Inconclusive data)
*Propoxyphene HCL: 130mg; Napsylate: 200mg. Not recommended for chronic pain.

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