EQUIANALGESIC DOSING GUIDELINE FOR CHRONIC PAIN
COMBINATION PRODUCTS Acetaminophen 325 mg + Codeine 30 mg PO ( aka Tylenol#3 )
Acetaminophen 500 mg + Hydrocodone 5 mg PO ( akaVicodin )
Acetaminophen 325 mg + Oxycodone 5 mg PO ( akaPercocet )
Morphine 4‒5 mg PO ≈
Morphine 6‒7 mgPO ≈
Morphine 8‒9 mg PO ≈
13 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 CALCULATION FORMULA To convert from one analgesic/route of administration to another analgesic/route of administration: X mg analgesic 1 by route 1 value for analgesic 1 by route 1 from table Y mg analgesic 2 by route 2 value for analgesic 2 by route 2 from table EXAMPLE To calculate the dose of morphine PO q4H equivalent to hydromorphone 2 mg/hr IV (without adjusting for incomplete cross-tolerance): 1. Calculate the total dose of hydromorphone q24H = 2 x 24 = 48 mg q24H 2. Convert to an equianalgesic dose of morphine PO q24H: X mg morphine PO 15 for morphine PO Y mg hydromorphone IV 1 for hydromorphone IV X mg morphine PO 15 48 mg hydromorphone IV 1 X mg morphine PO = 48 x 15 = 720 mg morphine PO q24H 3. Calculate the dose q4H = 720/6 = 120 mg morphine PO q4H = = =
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