IM dose
IM duration
(hours)
Starting oral dose Comments Drug
Agonists related to morphine
Morphine 10 mg 3-6
Hydromorphone ( Dilaudid, others) 1 mg
NA
3-5
NA
15-30 mg Available as 8-12 hour sustained-release tablets ( MS-Contin,
Oramorph SR ), 12-24 hour sustained-release capsules
( Kadian, Non-formulary), and as suppository.
Oral: Prompt release:15-30 mg every 4 hours as needed;
controlled release: 15-30 mg every 8-12 hours
IV PCA: Usual 1-3 mg, range 0.1-5 mg; lockout interval;
4-8 mg
--
usual 5-20 minutes; 4-hour lockout: usual range 10-
30 mg, maximum 30 mg
IV,S.C. continuous infusion: 0.8-10 mg/hr; may increase
depending on pain relief/ adverse effects
Available as high potency injectable ( Dilaudid-HP ) and as suppository
Check with attending prior to use Oxymorphone
Agonists related to codeine
Codeine 15 mg 3-5
Hydrocodone ( Lortab , Vicodin, others)
Oxycodone ( Roxicodone, others)
--
--
--
--
30-60 mg 60 mg PO equivalent to 650 mg of aspirin or acetaminophen; usually used orally in combinations with these drugs; some patients resistant to analgesic effect
5-10 mg 10 mg PO equivalent to codeine 80 mg PO; available in combinations with acetaminophen
5 mg 10 mg PO equivalent to codeine 90 mg PO; available in combinations and as 12 hour sustained-release tablets
( OxyContin )
Synthetic opioid agonists
Meperidine ( Demerol, others) 50-100 mg 2-4
Fentanyl ( Sublimaze )
Methadone ( Dolophine, others)
Levorphanol
( Levo-Dromoran, others)
Tramadol ( Ultram )
0.1 mg
--
1-2
5,10 mg 4-6
2 mg 4-6
--
50 mg
--
Irritating to tissues IM; toxic metabolite with long half-life causes CNS excitation and convulsions
Transdermal patch ( Duragesic ) for chronic pain releases fentanyl over 72 hours, possibly with less constipation than morphine; Actiq “transmucosal system” FDA approved for breakthrough pain
10-20 mg Long half-life; risk of CNS depression with repeated use
2-4 mg Long half-life; risk of CNS depression with repeated us
50-100 mg q 6 hr
50 mg equivalent to codeine 60 mg; 100 mg comparable to aspirin 650 mg plus codeine 60 mg
Partial agonists and mixed agonist/antagonists
Buprenorphine ( Buprenex,BuTrans patch, suboxone formulations,
0.3 mg others)
Butorphanol ( Stadol ) Nonformulary
1-2 mg
Nalbuphine ( Nubain , others) 10 mg
4-6
3-6
3-6
--
--
--
Partial agonist; virtually no psychotomimetic effects; sublingual preparation effective
Mixed agonist/antagonist; nasal spray ( Stadol NS
1mg/spray) comparable to IM injection
Mixed agonist/ antagonist; less psychotomimetic effects than pentazocine
1.
Morphine: MS Contin: 15, 30, 60, 100 mg (q 12 h)
Oramorph SR: 30, 60, 100 mg
Injection:
Suppository:
2, 4, 8, 10, 15, 25 mg/mL
5, 10, 20, 30 mg (q 4 h)
Immediate release: oral solution 2 mg/mL (q 4 h) oral concentrate 20 mg/mL (q 4 h) oral tablets 15, 30 mg (q 4 h)
Preservative free: Duramorph, Astramorph:
0.5, 1 mg/mL (IV, I.T., epidural)
Infumorph - 10, 25 mg/mL- for continuous infusion

2.
Hydromorphone : Dilaudid: injection: 2, 4, mg/mL tablets: 1, 2, 3, 4 mg suppository: 3 mg
3.
Codeine: Phosphate:
Sulfate: injection: 15, 30, 60 mg/mL tablets: 15, 30, 60 mg oral solution: 3 mg/mL tablets: 15, 30, 60 mg
4.
Oxycodone: Oxycontin
Percocet
Tylox
Roxicet
Percodan
10, 20, 40, 80 mg
5 mg oxycodone + acetaminophen 325 mg
5 mg oxycodone + acetaminophen 500 mg
5 mg oxycodone + acetaminophen 325 mg (tablet or solution 5-325/5 mL)
Roxicodone
5 mg oxycodone + aspirin 325 mg
5 mg oxycodone tablet or solution 5 mg/5 mL
Roxilox 5 mg oxycodone + acetaminophen 500 mg
5.
Hydrocodone Vicodin 5 mg hydrocodone + acetaminophen 500 mg
( Vicodin ES 7.5 mg/750 mg)
6.
Butorphanol
(Non-formulary)
Stadol : 1, 2 mg/mL injection
10 mg/mL nasal spray (1mg/spray)
7.
Fentanyl: Patch
(Dose 0.5-2 mg IV q 4 h)
25, 50, 75, 100 mcg/hr
(Dose achieved in 18 hrs)
Actiq Transmucosal System 200, 400, 600, 800, 1200, 1600 mcg
(Initial dose should be 200 mcg)
8.
Methadone: Tablets 5,10 mg
9.
Propoxyphene: Darvon 65 mg
-propoxyphene 65 mg
Darvocet N-100 propoxyphene 100 mg/ acetaminophen 650 mg
A.
Oral: Parenteral
Morphine Sulfate O4
Codeine
Meperidine
Methadone
Hydromorphone
( Dilaudid)
B.
Morphine Equivalents (IV)
1 mg morphine IV=
1 mg morphine IV=
1 mg morphine IV=
1 mg morphine IV=
1 mg morphine IV=
3:1
2:1
4:1
2:1
5:1
10 mg meperidine IV ( Demerol )
0.5- 0.8 mg methadone IV ( Dolophine )
0.20 mg hydromorphone IV ( Dilaudid )
10-15 mcg fentanyl IV
0.15 mg levorphanol IV ( Levo-Dromoran )

C.
Epidural morphine 1mg = IV morphine 10 mg
D.
Intrathecal morphine 1 mg = IV morphine 100 mg