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Table 3: OPIOID EQUIANALGESIC CONVERSION TABLE 1

Equianalgesic
Dose Peak Duration RECOMMENDED STARTING DOSE Comments
Medication IM2/IV1 PO1 Effect of Action
{How supplied} mg mg (min) (hr) PEDIATRICS
ADULTS
IV Push: 10 - 20 IV Push: 1 IV: See Footnote
3
IV: 0.05-0.1mg/kg q 1-3h
Morphine 10 30 PO: 45 - 60 PO/IM2/SubQ: 3 – 6 PO: 30mg q 3-4h PO: 0.3-0.6mg/kg q3-4h
IM2/SubQ: 30 IM2/SubQ: 10mg q 3-4h
Morphine sustained release --- 30 PO: 1.5 – 2 h 8 – 12 Used around the clock for recurrent, continuing pain after pain is controlled on short-acting analgesic. Perform
(MS Contin) equianalgesic conversion from short-acting to long acting analgesic. Do not crush/cut/chew. May be given PR, use oral
equivalent.
Hydromorphone IV Push: 10 - 20 IV Push: 1 IV: See Footnote3 IV: 0.01-0.04mg/kg q 1-3h
(Dilaudid) 1.5 7.5 PO: 45 - 60 PO/IM2/SubQ: 3 - 4 PO: 6mg q 3-4h PO: 0.05-0.2mg/kg q 3-4h
IM2/SubQ: 30 IM2/SubQ: 1.5mg q 3-4h
Methadone IV over 20 min: 30 - 60 IV over 20 min/PO/IM2: IV over 20 min: 10mg q 6-12h IV over 20 min: 0.1mg/kg q 6-8h Prolonged elimination half-life (15-36 hr),
(Dolophine) 10 20 PO: 2 – 4 hr 4-6 PO: 20mg q 6-12h PO: 0.2 mg/kg q 6-8h drug may accumulate.
Analgesic duration 6-8 hours
Fentanyl4 100 20 – 30 IV Push: 1 - 3 IV: 25-50mcg q 30min-1h IV: 0.5-1mcg/kg q 30 min-1h Highly potent; may produce respiratory
(Sublimaze) (mcg) --- depression, apnea, or stiff chest. When used
IVP, administer in the ICU or use careful
observation and pulse oximetry.
Meperidine 100 300 NR IV Push: 10 - 20 IV Push: 1 IV: See Footnote3 IV: Not recommended Max dose is 1Gm/24h and 2-3Gm/7 days or
(Demerol) NR = Not PO: 45 - 60 PO/IM1/SubQ: 2 - 4 PO: Not recommended PO: 0.75mg/kg q 6-8h less.
recommende
d IM1/SubQ: 30 IM1/SubQ: 100mg q 3h Toxic metabolite normeperidine may cause
seizures and agitation
Oxycodone Liquid solution available - comes as 5mg/ml;
{Roxicodone (5mg/tab), --- 20 45 - 60 3-4 PO: 10mg q 3-4h PO: 0.15-0.2ml/kg q 3-4h alcohol free.
Solution (5mg/5ml)}
Oxycodone sustained --- 15 60 12 PO: 10mg q 12 h Not recommended in children Used around the clock for recurrent,
release (OxyContin) < 10 years old continuing pain after pain is controlled on
short-acting analgesic.
Do not crush/cut/chew.
Oxycodone/ Acetaminophen Liquid solution available - comes as
{Percocet 1 tab or Roxicet 30 45 - 60 3-4 PO: 1-2 tabs q 4h PO: 0.15-0.2ml/kg q 3-4h oxycodone 5mg/acetaminophen 325mg per
 5ml (5mg/325mg)} --- 5ml; alcohol free.
Consider acetaminophen upper dose limits5
Suggested maximum single dose = 65mg.
Codeine --- 200 NR 45 - 60 3-6 PO: 60mg q 3-4h PO: 0.5-1mg/kg q 3-4h Expect increased side effects with doses
>65mg.

Codeine/ Liquid elixir available - comes as 12mg


Acetaminophen --- 135 NR 45 - 60 3-6 PO: 1 -2 tabs q4h PO: 0.4ml/kg q 4h codeine/120mg acetaminophen per 5ml;
{Tylenol #3 1 tab contains alcohol.
(30mg/325mg)} Consider acetaminophen upper dose limits5
Propoxyphene HCl/ Toxic metabolite accumulates but generally
Acetaminophen --- 200 NR 45 - 60 3-6 PO: 1 tab q 4h PO: Not recommended clinically significant only in the elderly.
{Wygesic 1 tab Weak opioid: Propoxyphene HCl 65mg =
(65mg/650mg)} Acetaminophen 650mg
Consider acetaminophen upper dose limits5
1
All conversions are considered equianalgesic to 10 mg parenteral morphine. When performing an equianalgesic conversion, consider reducing dose by 25% due to incomplete cross-tolerance.
2
Least desired route
3
For IV push dose, divide IM/SubQ dose by 3 and administer IV push over 2-3 min q 1 hour, or administer via continuous infusion
4
Fentanyl Patch (Duragesic): Used around the clock for recurrent, continuing pain after pain is controlled on short-acting analgesic. Perform equianalgesic conversion from short-acting to long acting analgesic. Fentanyl patch 25 mcg/hr is
approximately equivalent to 45-134 mg. PO morphine/day. Peak effect 18-24 hours after initial application, duration of action 3 days. Do not cut patch. Not recommended for pediatric patients <20kg.
5
Acetaminophen upper dose limits: Peds 90 mg/kg/day, Adult 3-4 Gm/day. /var/www/apps/scribd/scribd/tmp/scratch2/10058086.doc 6/11/02