EQUIANALGESIC DOSING FOR MANAGEMENT OF ACUTE OR CHRONIC PAIN

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- 67 mg IM/IV morphine/24hrs	25mcg/hr = 60-134mg PO morphine/24hrs	3 days
Methadone	-	Depends on morphine dose (see below)**	>6
Propoxyphene	-	260-390	4-6
AGONIST-ANTAGONISTS
Pentazocine*	60	180	3

* 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. Use conversion table with caution. (From BC College of Physicians and Surgeons)