Table 1.

Hospital-initiated Injectable Hydromorphone: Titration Schedule

	Scheduled Intravenous (IV) Hydromorphone	IV Hydromorphone PRN (Total Used in 24/h)	Scheduled Oral Opioid Agonist Therapy*
Case 1
Day 1	5mg q3h	1–2mg q1h prn (3mg)	—
Day 2	10mg q3h	1–2mg q1h prn (1mg)	—
Day 3	15 mg q3h	1–2 mg q1h prn (10 mg)	—
Day 4	20 mg q3h	1–2 mg q1h prn	—
Day 5	50mg q6h	5mg IV q2h prn	—
Discharge prescription Hydromorphone IV 110 mg BID
Case 2
Day 1	—	10–20–20 mg q2h PRN (80 mg)	SROM 200 mg
Day 2	40 mg q4h	10–20 mg q2h PRN (20 mg)	SROM 200 mg
Day 4	60 mg q4h	10–20 mg q2h PRN (20 mg)	SROM 200 mg
Day 5	110mg BID	—	SROM 200 mg
Discharge prescription Hydromorphone IV 110 mg BID, SROM 200 mg
Case 3
Day 1	25mg q3h	10 mg q3h PRN (30 mg)	Methadone 10 mg TID
Day 2	25mg q3h	10 mg q1h PRN (60 mg)	Methadone 10 mg TID
Day 4	25mg q3h	10 mg q2h PRN (70 mg)	Methadone 10 mg TID
Day 9	65mg TID	10 mg q2h PRN (90 mg)	Methadone 10 mg TID
Day 10	100mg TID	10 mg q2h PRN (10 mg)	Methadone 10 mg TID
Discharge prescription Hydromorphone IV 150 mg BID
Case 4
Day 1	4mg Q3H	2–4mg Q1H PRN (2mg)	—
Day 2	10mg Q3H	2–4mg Q1H PRN (8mg)	—
Day 3	12mg Q3H	2–4mg Q1H PRN (12mg)	—
Day 4	50mg twice daily	—	—
Discharge prescription Hydromorphone IV 50 mg BID

^*Oral OAT is often provided in combination with iOAT to alleviate withdrawal symptoms over night.

h, hours; mg, milligrams; PRN, as needed; q, every; QID, 4 times per day; SROM, slow release oral morphine; TID, 3 times per day.