Table of Contents

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


**Caveat: Equivalence of methadone to morphine may vary considerably from one individual
     to another.  Note that this Table is uni-directional ie. morphine to methadone conversion only.