Table 2.
Most commonly used opioid analgesics in United States
| Drug name | Formulation | Duration of action (hours) | Recommended analgesic dose |
|---|---|---|---|
| Morphine sulfate | Tablets (IR): 15 and 30 mg | 2–4 | 10–30 mg q3–4h |
| Rectal suppositories: 5, 10, 20, and 30 mg | 10–20 mg q4h | ||
| Parenteral (SC, IM, IV): 2, 4 and 20 mg/ml | 2.5–10 mg q2–6h1 | ||
| Epidural | 3–5 mg once, then 0.1–0.7 mg/hr | ||
| Intrathecal | Start 100:1 IT-to-IV, then titrate to pain | ||
| MS Contin® | Tablets (CR): 15, 30, 60, 100, 200 mg | 8–12 | 15–30 mg q8–12h |
| Oramorph®SR | Tablets (SR): 15, 30, 60, 100 mg | 8–12 | 15–30 mg q8–12h |
| Kadian® | Capsules (ER): 20, 30, 50, 60, 100 mg | 24 | 20 mg q24h, may increase by 20 mg increments every other day |
| Avinza® | Capsules (ER): 30, 60, 90, 120 mg | 24 | 30 mg q24h, may increase by 30 mg increments q4days (max 1600 mg/d) |
| Codeine | Tablets: 15, 30, 60 mg Oral solution: 15 mg/5 ml, 30 mg/5 ml |
2–4 | 15–60 mg q4–6h (max 60 mg/d) |
| Dilaudid® (hydromorphone) | Tablets (IR): 2, 4, 8 mg; Oral solution: 5 mg/5 mL; Suppositories: 3 mg | 2–4 | 2–8 mg q3-4h for PO and PR |
| Parenteral (SC, IM, IV): 1, 2, 4, 8 mg/ml; | 1–4 mg q4–6h2 | ||
| Intrathecal | Start 100:1 IT-to-IV, then titrate to pain | ||
| Palladone® | Capsules (ER): 12, 16, 24, 32 mg | 24 | Withdrawn from the market in 2005 |
| Roxycodone® (oxycodone) | Tablets (IR3): 5, 15, 30 mg, capsules: 5 mg; Oral solution: 5 mg/5 ml, 20 mg/ml | 2–4 | 5–30 mg q4h |
| OxyContin® | Tablets (SR): 10, 20, 40, 80, 160 mg | 12 | 10–160 mg q12h4 |
| Opana® (oxymorphone) | Tablets (IR) 5, 10 mg | 4-8 | 5–10 mg q4–6h |
| Opana®ER | Tablets (ER) 5, 10, 20, 40 mg | 12 | 5–40 mg q12h |
| Propoxyphene HCl | Capsules: 65 mg5 | 2–4 | 65 mg q4h (max 390 mg/24h) |
| Methadone | Oral solution: 5 mg/5 ml, 10 mg/5 ml, 10 mg/ml; Tablets: 5, 10, 40 mg |
4–8 | 2.5–10 mg q3-6h Has very long half-life (8–60 hours) |
| Meperidine (Demerol®) | Oral solution: 50 mg/5 ml Tablets: 50, 100 mg |
2–4 | 50–150 mg q3–4h (decrease dose if given IV, administer slow or via PCA). |
| Parenteral (SC, IM, IV): 10 mg/ml | Not recommended for chronic use. | ||
| Fentanyl | Parenteral (IM, IV) | 1–3 | 25–100 mcg q1–2h 0.5–1.5 mcg/kg/hr IV infusion via PCA |
| Actiq® | Oral transmucosal lozenge: 200, 400, 600, 800, 1200, 1600 mcg | 2–4 | Start with 200 mcg for breakthrough pain episodes6, then titrate to pain |
| Duragesic® | Transdermal patch: 25, 50, 75, 100 mcg/hr | 72 | 25 mcg/h q72hr, may increase q3–6days |
Abbreviations: IR, immediate release; CR, controlled release; SR, sustained release; ER, extended release.
Notes: Alternative dose for IV morphine: 0.1 mg/kg IV once, then 1-10mg/hr via IV PCA.
Start 0.2-0.6 mg q2-3h (IV), 0.8-1 mg q4-6h (SC/IM) in opiate-naive patients
Oxycodone is also available as OxyIR (5 mg immediate release tablets); doses are similar to Roxycodone
80 mg and 160 mg formulations of Oxycontin should be used in opiate-tolerant patients only
65 mg propoxyphene hydrochloride (Darvon®) = 100 mg propoxyphene napsylate (Darvon-N)
Can be also used IM or SC at 2.5-10 mg q8-12h, but generally PO is recommended for chronic pain
For use only in opiate tolerant patients, recommended maximum dose is 4 units per day