Table 5. Dosing Data for Opioid Analgesics
Opioid Agonist
Drug Approximate Approximate Recommended starting dose Recommended starting dose
equianalgesic equianalgesic (adults more than 50kg (children and adults less
oral dose parenteral dose body weight) than 50kg body weight)[1]
oral parenteral oral parenteral
___________________________________________________________________________________________________________________________
Morphine[2] | 30 mg q 3-4 hr | 10 mg q 3-4 hr | 30 mg q 3-4 hr | 10 mg q 3-4 hr | 0.3 mg/kg | 0.1 mg/kg
| (around-the-clock| | | | q 3-4 hr | q 3-4 hr
| dosing) | | | | |
|__________________|________________|________________|_________________|________________|________________
| 60 mg q 3-4 hr | | | | |
| (single dose or | | | | |
| intermittent | | | | |
| dosing | | | | |
__________________|__________________|________________|________________|_________________|________________|________________
Codeine[3] | 130 mg q 3-4 hr | 75 mg q 3-4 hr | 60 mg q 3-4 hr | 60 mg q 2 hr | 1 mg/kg | Not recommended
| | | |(intramulcular/ | 3-4 hr [4] |
| | | |subcutaneous) | |
__________________|__________________|________________|________________|_________________|________________|________________
Hydromophone[2] | 7.5 mg q 3-4 hr | 1.5 mg q 3-4 hr| 6 mg q 3-4 hr | 1.5 mg q 3-4 hr | 0.06 mg/kg | 0.015 mg/kg
(Dilaudid) | | | | | q 3-4 hr | q 3-4 hr
__________________|__________________|________________|________________|_________________|________________|________________
Hydrocodone (in | 30 mg q 3-4 hr | Not available | 10 mg q 3-4 hr | Not available | 0.06 mg/kg | Not available
Lorcet, Lortab, | | | | | q 3-4 hr [4] |
Vicodin, others) | | | | | |
__________________|__________________|________________|________________|_________________|________________|________________
Levorphanol | 4 mg q 6-8 hr | 2 mg q 6-8 hr | 4 mg q 6-8 hr | 2 mg q 6-8 hr | 0.04 mg/kg | 0.02 mg/kg
(Levo-Dromoran) | | | | | q 6-8 hr | q 6-8 hr
__________________|__________________|________________|________________|_________________|________________|________________
Meperidine | 300 mg q 2-3 hr | 100 mg q 3 hr | Not recommended| 100 mg q 3 hr | Not recommended| 0.75 mg/kg
(Demerol) | | | | | | q 2-3 hr
__________________|__________________|________________|________________|_________________|________________|________________
Methadone | 20 mg q 6-8 hr | 10 mg q 6-8 hr | 20 mg q 6-8 hr | 10 mg q 6-8 hr | 0.2 mg/kq | 0.1mk/kg
(Dolophine,others)| | | | | q 3-4 hr [4] | q 6-8 hr
__________________|__________________|________________|________________|_________________|________________|________________
Oxycodone | 30 mg q 3-4 hr | Not available | 10 mg q 3-4 hr | Not available | 0.2 mg/kg | Not available
(Roxicodone, also | | | | | q 3-4 hr [4] |
in Percocet, | | | | | |
Percodan, Tylox, | | | | | |
others) | | | | | |
__________________|__________________|________________|________________|_________________|________________|________________
Oxymorphone2 | Not available | 1 mg q 3-4 hr | Not available | 1 mg q 2-3 hr | Not recommended| Not recommended
(Numorphan) | | | | | |
__________________|__________________|________________|________________|_________________|________________|________________
Opioid Agonist-Antagonist and Partial Agonist
___________________________________________________________________________________________________________________________
Buprenorphine | Not available | 0.3-0.4 mg | Not available | 0.4 mg q 6-8 hr | Not available | 0.0004 mg/kg
(Buprenex) | | q 6-8 hr | | | | q 6-8 hr
__________________|__________________|________________|________________|_________________|________________|________________
Butorphanol | Not available | 2 mg q 3-4 hr | Not available | 2 mg q 3-4 hr | Not available | Not recommended
(Stadol) | | | | | |
__________________|__________________|________________|________________|_________________|________________|________________
Nalbuphine | Not available | 10 mg q 3-4 hr | Not available | 10 mg q 3-4 hr | Not available | 0.1 mg/kg
(Nubain) | | | | | | q 3-4 hr
__________________|__________________|________________|________________|_________________|________________|________________
Pentazocine | 150 mg q 3-4 hr | 60 mg q 3-4 hr | 50 mg q 4-6 hr | Not recommended | Not recommended| Not recommended
(Talwin, others) | | | | | |
__________________|__________________|________________|________________|_________________|________________|________________
________________
Note: Published tables vary in the suggested doses that are
equianalgesic to morphine. Clinical response is the criterion
that must be applied for each patient; titration to clinical
response is necessary. Because there is not complete cross
tolerance among these drugs, it is usually necessary to use a
lower than equianalgesic dose when changing drugs and to
retitrate to response.
________________
Caution: recommended doses do not apply to patients with renal or
hepatic insufficiency or other conditions affecting drug
metabolism and kinetics.
________________
[1] Caution: Doses listed for patients with body weight less than 50
kg cannot be used as initial starting doses in babies less than 6
months of age. consult the Clinical Practice Guideline for Acute
Pain Management: Operative or Medical Procedures and Trauma section
on management of pain in neonates for recommendations.
________________
[2] For morphine, hydromorphone, and oxymorphone, rectal administration
is an alternate route for patients unable to take oral medications,
but equianalgesic doses may differ from oral and parenteral doses
because of pharacokinetic differences.
________________
[3] Caution: Codeine doses above 65 mg often are not appropriate due
to diminishing incremental analgesia with increasing doses but
continually increasing constipation and other side effects.
________________
[4] Caution: Doses of aspirin and acetaminophen in combination
opioid/NSAID preparations must also be adjusted to the patient's
body weight.