Opioid Analgesics Starting Oral - Dose Commonly Used for Severe Pain.

Starting Oral Dose

Name

 Equianalgesic Dose (mg)

Adults

Children

Morphine-like agonists

Oral

 (mg)

     Morphine

30

 15-30

     Hydromorphone (Dilaudid)

7.5

 4-8

     Oxycodone

20

 15-30

     Methadone (Dolopine)

20 acute
2-4 chronic

 5-10

Comments: Standard of comparison for opioid analgesics. Sustained-release preparations (MS Contin, OramorphSR) release drug over 8-12 hours. Recent addition of once-a-day sustained release formulation (Kadian). Slightly shorter duration than morphine. Good oral potency, long plasma half-life (24-36 hours). Transdermal fentanyl (Duragesic) 25 mcg/hour, roughly equivalent to sustained-release morphine, 45mg/day. Oral transmucosal fentanyl citrate now available for treatment of breakthrough pain in chronic cancer pain patients already taking around-the-clock opioids.

Precautions: For all opioids, caution in patients with impaired ventilation, bronchial asthma, increased intracranial pressure, liver failure. Accumulates with repeated dosing requiring decreases in dose size and frequency, especially on days 2-5. Because of skin reservoir of drug, 12-hour delay in onset and offset of transdermal patch; fever increases dose rate.