| Pure
Opioid agonists |
| Opioid |
Equi-analgesic Doses |
Peak (h) |
Duration (h) |
T1/2 (h) |
Usual
Starting Dosesa |
Comment |
| Morphine |
10mg IM/IV/SQ
30mg po |
0.25-1
1-2 |
4-5
4-7 |
2
2 |
5-10mg q 4h IM
2-4mg q 5min IV
15mg q 4h po
|
Gold standard for comparison
to other opioids |
| Morphine CR (MS Contin) |
30mg po |
N/A |
8-12 |
4-5 |
15mg q 12h po scheduled |
Generics available |
| Morphine SR (Kadian, Oramorph)
|
30mg po |
N/A |
Kadian : 12-24 Oramorph : 8-12 |
N/A N/A |
15mg q 12h po scheduled |
|
| Morphine ER (Avinza) |
30mg po |
N/A |
24 |
N/A |
15mg q 12h po scheduled |
|
| Oxycodone |
20mg po |
1-2 |
4-5 |
3 |
5-10mg q 3-4h po |
Available in combination with APAP
or ibuprofen |
| Oxycodone CR (Oxycontin) |
20mg po |
2-3 |
8-12 |
4-5 |
10mg q 12h po scheduled |
Formulation provides immediate as well
as
slow release of drug |
| Hydromorphone |
1.5mg IM/IV/SQ 7.5mg po |
0.25-1 1-2 |
4-5 4-6 |
2.5 2.5 |
1-4mg q 4h IM 0.2mg q 5min IV 2mg q
3h po |
SR no longer available |
| Hydrocodone |
30mg po |
2 |
3-5 |
2-4 |
5-10mg q 3-4 po |
Only available in combination with
APAP, ASA, or ibuprofen |
| Oxymorphone (Opana) |
1mg IM/IV/SQ 10mg po |
0.25-0.5 2 |
3-6 4-6 |
2-3 7-11 |
1mg q 3h IM 0.5mg q 10min IV 5-10mg
q 4h po |
Bioavailability po=10% |
| Oxymorphone ER (Opana ER) |
10mg po q12 dosing |
2 |
12 |
N/A |
5mg q 12h po scheduled |
Avoid alcohol with ER |
| Methadone |
Variableb |
1-2 |
4-6 |
12-15 |
2.5mg q 4-6h po for acute pain |
Required careful monitoring |
| Meperidine |
300mg IM/IV/SQ 75mg po |
0.25-0.5 1-2 |
2-4 4-6 |
3-4 3-4 |
50mg q 4h IM 5mg q 5min IV po not rec. |
Not rec. for chronic
pain ;
normeperidine half-life
=24-48h ;
associated with CNS
toxicities (seizures) |
| Fentanyl |
100mcg IV/IM |
<0.25 |
1-2 |
3 |
0.05mg q 1h IM 25mcg q 1h IV |
|
| Fentanyl, mucosal lozenge
(Actiq) |
|
0.25-0.5 |
7 |
1-2 |
Not rec.c |
Avoid in opioid naive |
| Fentanyl, buccal (Fentora) |
|
0.5-0.75 |
N/A |
3-12 |
Not rec.c |
Avoid in opioid naive ; lower dose
if switching from Actiq |
| Fentanyl, transdermal
(Duragesic) |
25mcg/h patch 50-100mg oral morphine/24h |
N/A |
48-72/patch |
17 |
Not rec.c |
Avoid in opioid naive ; variable absorption
; diffuses from adipose after removal |
