EQUIANALGESIC DOSING GUIDELINE FOR CHRONIC PAIN
CHANGING ROUTES OFADMINISTRATION PO / PR IV / SC / IM Epidural Intrathecal 3 : 1 : 0.1 : 0.01 CHANGING ANALGESICS Oral / rectal Dose (mg) Analgesic Parenteral SC / IV / IM Dose(mg) 150 Meperidine 50 150 Tramadol - 150 Codeine 50 15 Hydrocodone - 15 Morphine 5 10 Oxycodone - 5 Oxymorphone - 3 Hydromorphone 1 2 Levorphanol 1 Fentanyl 0.050mg* *1000 mcg = 1 mg; must convert to mg to calculate equianalgesic dose TRANSDERMAL FENTANYL Morphine 50 mg PO in 24 hr ≈ Fentanyl 25 mcg transdermal patch q72H
METHADONE
Conversion Ratios
Daily Oral Morphine Equivalent (OME) Dose (mg/24 hr PO)
Morphine PO
Methadone PO
No more than 7.5 mg oral methadone daily (e.g., 2.5 mg three times daily)
<60 OME
60-199 OME and < 65 years of age ≥ 200 OME and/or > 65 years of age
10
:
1
20 1 Suggest no more than 30-40 mg per day, regardless of previous opioid does :
METHADONE SC / IV DOSING For Morphine PO to Methadone SC or IV 1. Calculate the Methadone PO Dose/24 hr using the table above 2. Then ÷ 2 to convert to Methadone SC or IV Dose/24 hr For Methadone SC or IV to Methadone PO 1. Use 1 : 1.3 (parenteral : oral) ADJUST FOR INCOMPLETE CROSS TOLERANCE Poor pain control 100 % equianalgesic dose Moderate pain control 75 % equianalgesic dose Excellent pain control 50 % equianalgesic dose
12 NB: These Reference Cards do not replace careful clinical judgment specific to each patient / family situation. PCIC: Palliative Care Interdisciplinary Curriculum is a collaborative effort of OhioHealth, The Ohio State University Wexner Medical Center, and Nationwide Children’s Hospital in Columbus, Ohio, USA, and other contributors. Permission to reproduce any or all of these PCIC Reference Cards is granted for non-commercial educational purposes only, provided that the attribution statement and copyright are displayed. To reproduce for all other purposes, contact Frank D. Ferris at info@pallmed.us. Copyright © Frank D Ferris 2013-2024. All rights reserved. V14.1, 2024
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