|Opiates: updated list|
Pain: Oral, M, IV, SC: 30 mg (15-60mg) q4-6h prn. (Max 360mg/day).
Cough (non-productive): 10-20mg q4-6h prn (Max: 120 mg/day).
Comments: Oral dose = 2/3 effectiveness of IV route when converting. Adult doses > 60mg fail to give commensurate relief of pain but merely prolong analgesia and are associated with an appreciably increased incidence of side effects.
[Supplied: codeine phosphate (inj): 30 mg (1,2 ml); 60 mg (1,2 ml); Solution: 15 mg/5 ml. Tablet: 30, 60 mg.
Codeine sulfate: 15, 30, 60mg tablet.]
PHOSPHATE/ ACETAMINOPHEN: Tylenol #2: 15mg/300mg. Tylenol #3: 30mg (codeine)/300mg (APAP). Tylenol #4: 60mg (codeine)/300mg (APAP).
Pain: acetaminophen 300-1000 mg (Max 4000 mg/day); codeine 15-60 mg (Max: 360 mg/day) orally every 4 hours as needed. Pain: 15 ml (1 tbsp) orally every 4 hours as needed.
[Supplied: Suspension: 120 mg-12 mg/5 ml. Tablets: 300/15 mg, 300/30mg, 300/60mg, 650/30 mg]
|Fentanyl patch Duragesic ®|| Apply
1 patch every 3 days.
IM/IV: 0.5 - 1 mcg/kg. Higher doses for major
|Hydrocodone||Limit APAP to 4 grams/day or less.
Dosing (tablets with 5 mg hydrocodone): 1-2 tablets q4-6h prn or
5-10 ml q4-6h prn. (Tablets with 7.5 or 10 mg hydrocodone): 1 tab
Maximum: 60 mg hydrocodone/day.
[Supplied: Capsule: Bancap HC®, Ceta-Plus®, Hydrocet®, Hydrogesic®, Lorcet-HD® (5/500mg).
Elixir Lortab®: 2.5 mg - 167mg/ 5 ml (480 ml)
Tabets: 2.5/500mg, 5/500mg, 7.5/500mg, 7.5/650 mg, 7.5/750 mg, 10mg/325mg, 10/500mg, 10/650mg.
Anexsia ®(tablets): 5/325mg, 5/500mg, 7.5/325mg, 7.5/650mg, 10/660mg. Co-Gesic®: 5/500mg. Lorcet ®: 10/650mg. Lorcet® Plus: 7.5/650mg. Maxidone®: 10/750mg. Norco®: 5/325mg, 7.5/325mg,10/325mg. Vicodin®: 5/500mg. Vicodin ES ®: 7.5/750mg. Vicoden® HP: 10/660mg. Zydone®: 5/400mg, 7.5/400mg, 10/400mg. ]
|Hydromorphone Dilaudid ®|| Give
2 to 4 mg orally every 4 to 6 hours as needed.
1-4 mg IM/SC/IV every 4 to 6 hours as needed.
3 mg rectally every 6 to 8 hours as needed.
frequent administration may be required in opiate tolerant
|Levorphanol Levo-Dromoran ®||2 mg orally or SC every 6 to 8 hours as needed.|
| 25-150 mg
IM/SC/IV/orally every 3 to 4 hours as needed.
Analgesic: Oral, IM, IV, SC: 50-150 mg q3-4h prn. Oral therapy is discouraged. Oral dose: 50% effectiveness of IV route. 25-150 mg IM/SC/IV/orally every 3 to 4 hours as needed.
infusion: 10mg/ml (30ml).
|Methadone Dolophine ®|| Severe pain: 2.5 to 10mg
IM/SC/orally every 3 to 4 hours as needed. Detox: 15-40mg orally once daily to start.
Important Note: Methadone
accumulates with repeated doses and dosage may need to be adjusted
downward after 3-5 days to prevent toxic effects. Some patients may
benefit from q8-12h dosing intervals.
Injection: 10 mg/ml (20 ml).
| (Regular release): 10-30mg
orally every 4 hours.
(MS Contin): 15-60mg orally every 8 to 12 hours.
(Oral soln-Roxanol): 10-30 mg orally every 4 hours. (Injection): usual range: 2-15 mg IM/SC/IV every 4 hours as needed.
Oral (Regular release):
5-30mg q4h prn.
|Oxycodone (Roxicodone):|| 5 mg
orally every 6 hours as needed. [5 mg tab]
(OxyContin- Extended release): 10-40 mg orally every 12 hours. [10, 20, 40, 80, 160mg ]
Pain: (Regular release)- 2.5 - 5 mg po q6h prn. (Controlled release): 10 - 40 mg po q12h (Much higher doses possible in opiate tolerant patients).
|Propoxyphene Darvon ®|| 65 mg
orally every 4 hours as needed. [65mg]
Pain: Propoxyphene HCL: 65 mg po q3-4h prn.
|Fioricet (apap 325mg + butalbital 50mg + caffeine 40mg):||1-2 tabs orally every 4 hours (Maximum of 6 tablets/day)|
|Fiorinal (ASA 325mg + butalbital 50mg + caffeine 40mg):||1-2 tabs orally every 4 hours. (Maximum of 6 tablets/day)|
|Soma compound (carisprodol 200mg + ASA 325mg):||1-2 tabs orally four times daily.|
|Tramadol (Ultram):||50-100 mg orally every 4 to 6 hours as needed. Max 400 mg/day.|
|Anexsia (hydrocodone/APAP 5/500, 7.5/650, 10/660):||1 tab orally every 4 to 6 hours as needed.|
|Darvocet N-100 (propoxyphene 100mg/APAP 650mg):||1 tab orally every 4 to 6 hours as needed (Maximum of 6 tabs/day).|
|Darvon Compound (propoxyphene 65mg + ASA 389mg + caffeine 32.4mg)||1 tab orally every 4 hours as needed.|
|Lorcet (hydrocodone/APAP 5/500):||1-2 tabs orally every 4 to 6 hours as needed. // (7.5/650 & 10/650 ): 1 tab orally every 4 to 6 hours as needed.|
|Lortab (hydrocodone/APAP 2.5/500, 5/500):||1-2 tabs orally every 4 to 6 hours as needed. // (7.5/500, 10/500): 1 tab orally every 4 to 6 hours as needed.|
|Percocet (oxycodone 5 mg/APAP 325 mg):||1 tab orally every 6 hours as needed.|
|Percodan (Oxycodone 5 mg/ ASA 325mg):||1 tab orally every 6 hours as needed.|
|Roxicet (oxycodone/APAP 5/325, 5/500):||1 tablet orally every 6 hours as needed.|
Tylenol with Codeine |
#4: 300/60 mg:
|1-2 tabs orally every 4 to 6 hours as needed.|
|Tylox (oxycodone 5mg /APAP 500mg):||1 tab orally every 6 hours as needed.|
|Vicodin (hydrocodone/APAP 5/500 or Vicodin ES (7.5/750):||1-2 tabs orally every 4 to 6 hours as needed. Max 8 tablets/day (Vicodin) or max 5 tablets/day (Vicodin ES).|
|Wygesic (propoxyphene/APAP 65/650mg):||1 tablet orally every 4 hours as needed.|
|Buprenorphene (Buprenex):||0.3 to 0.6 mg IV/IM every 6 to 8 hours as needed.|
|Butorphanol (Stadol):||0.5 to 2 mg IV or 1-4 mg IM every 3 to 4 hours as needed. Nasal spray (Stadol NS): 1 spray every 3 to 4 hours as needed [1 mg/spray]|
|Dezocine (Dalgan):||2.5 to 10 mg IV every 2 to 4 hours or 5-20mg IM every 3 to 6 hours as needed.|
|Nalbuphine (Nubain):||10-20mg IV/IM/SC every 3 to 6 hours as needed.|
|Pentazocine (Talwin):||30mg IV/IM every 3 to 4 hours as needed.|
|Nalmefene (Revex):||opioid overdose: 0.5 mg/70kg IV with 1mg/70 kg 2 to 5 minutes later if needed. Post-op opoid reversal: 0.25 mcg/kg every 2 to 5 minutes as needed.|
|Naloxone (Narcan):||0.4 to 2 mg every 2 to 3 minutes as needed IV/IM/SC/ET.|
(Buprenorphine and naloxone)
opioid dependence. Not recommended
for use during the induction period. Initial treatment should begin using
buprenorphine oral tablets. Patients should be switched to the combination
product for maintenance and unsupervised therapy. Maintenance: Target dose (based on
buprenorphine content): 16 mg/day - range: 4-24 mg/day.
Non-opioid analgesic for the treatment of severe chronic pain.CLINICAL PHARMACOLOGY
Mechanism of Action
Ziconotide binds to N-type calcium channels located on the primary nociceptive (A- and C) afferent nerves in the superficial layers (Rexed laminae I and II) of the dorsal horn in the spinal cord. Although the mechanism of action of ziconotide has not been established in humans, results in animals suggest that its binding blocks N-type calcium channels, which leads to a blockade of excitatory neurotransmitter release from the primary afferent nerve terminals and antinociception.
Dosage (adults): Initial dose: 2.4 mcg/day (0.1 mcg/hour) intrathecally. Dose may be titrated by less than 2.4 mcg/day (0.1 mcg/hour) at intervals no greater than 2-3 times/week to a maximum dose of 19.2 mcg/day (0.8 mcg/hour) by day 21. Average dose at day 21: 6.9 mcg/day (0.29 mcg/hour). A faster titration should be used only if the urgent need for analgesia outweighs the possible risk to patient safety. Effects are generally reversible within 2 weeks of discontinuation.
Supplied: Injection (soln): 100 mcg/ml (1 ml, 2 ml, 5 ml).
25 mcg/ml (20 ml).