EQUIANALGESIC DOSING FOR MANAGEMENT OF ACUTE* OR CHRONIC PAIN
(Equivalent to Morphine 10mg IM/SC/IV)
| Drug | IM/SC/IV (mg) | PO/PR/SL (mg) | Duration of Action (hrs) |
| AGONISTS | |||
| Morphine | 10 | 20-30 | 3-4 |
| Codeine | 120-130 | 200 | 3-4 |
| Hydromorphone | 2 | 4 | 3-4 |
| Oxycodone | - | 15-20 | 3-4 |
| Meperidine** | 75-100 | 300 | 3 |
| Fentanyl | 100mcg (0.1mg) | - | 2-3 |
| Fentanyl Transdermal | 25mcg/hr = 30- 66 mg
IM/IV morphine/24hrs |
25mcg/hr = 60-134mg
PO morphine/24hrs |
3 days |
| Methadone | - | Depends on morphine dose
(see below)** |
>6 |
* dose conversion is
based on chronic pain management. May require lower IV doses for acute pain,
especially with IV bolus dosing
** not recommended for chronic pain management
- 2 x Tylenol #3 is approximately equivalent to 10mg PO morphine
- 2 x 292 is approximately equivalent to 10mg PO morphine.
- In round the clock
administration of narcotics the IV/IM/SC routes are essentially equianalgesic.
- The oral, rectal, and sublingual routes are equianalgesic, if available
- Dosing frequency is usually based on the duration of action of the analgesic
used; however,
certain individuals may obtain control with longer dosing intervals, and
some patients may need
more frequent administration.
- Intravenous narcotics may have a shorter duration of action compared to other
routes of administration.
|
**Daily chronic oral morphine equivalent |
Conversion ratio morphine:methadone |
|
< 100 mg |
3:1 |
|
100-300mg |
5:1 |
|
300-600mg |
10:1 |
|
600-800mg |
12:1 |
|
800-1000mg |
15:1 |
|
> 1000 mg |
20:1 |
|
|
|