Table 3: OPIOID EQUIANALGESIC CONVERSION TABLE 1

Equianalgesic Dose IM2/IV1 PO1 mg mg
10 --30 30

Medication {How supplied}
Morphine Morphine sustained release (MS Contin®) Hydromorphone (Dilaudid®) Methadone (Dolophine®) Fentanyl4 (Sublimaze®) Meperidine (Demerol®) Oxycodone {Roxicodone® (5mg/tab), Solution (5mg/5ml)} Oxycodone sustained release (OxyContin®) Oxycodone/ Acetaminophen {Percocet® 1 tab or Roxicet ® 5ml (5mg/325mg)} Codeine Codeine/ Acetaminophen {Tylenol #3 1 tab (30mg/325mg)} Propoxyphene HCl/ Acetaminophen {Wygesic® 1 tab (65mg/650mg)}

Peak Effect (min)
IV Push: 10 - 20 PO: 45 - 60 IM2/SubQ: 30 PO: 1.5 – 2 h IV Push: 10 - 20 PO: 45 - 60 IM2/SubQ: 30 IV over 20 min: 30 - 60 PO: 2 – 4 hr 20 – 30

Duration of Action (hr)
IV Push: 1 PO/IM2/SubQ: 3 – 6 8 – 12 IV Push: 1 PO/IM2/SubQ: 3 - 4 IV over 20 min/PO/IM2: 4-6 IV Push: 1 - 3

RECOMMENDED STARTING DOSE
ADULTS
3

Comments

PEDIATRICS

1.5 10 100 (mcg) 100

7.5 20 --300 NR

NR = Not recommende d

IV Push: 10 - 20 PO: 45 - 60 IM1/SubQ: 30 45 - 60 60

IV Push: 1 PO/IM1/SubQ: 2 - 4

-----

20 15

3-4 12

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. PO: 10mg q 12 h Not recommended in children < 10 years old 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.

-----

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

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/scribd/scribd/tmp/scratch2/10058086.doc 6/11/02 --135 NR 45 - 60 3-6 PO: 1 -2 tabs q4h PO: 0.4ml/kg q 4h

Sign up to vote on this title
UsefulNot useful