Table 10. Dose equivalents for opioid analgesics in opioid-naive adults and children >=50 kg body weight[1]

Pain & HIV/AIDS

Dose equivalents for opioid analgesics in opioid-naive adults and children >=50 kg body weight[1]

Drug Approximate
equianalgesic dose Usual starting dose
for moderate to
severe pain

Oral Parenteral Oral Parenteral

Opioid agonist[2]

Morphine[3] 30 mg q 3-4 h
(repeat around-
the-clock
dosing)
60 mg q 3-4 h
(single dose or
intermittent
dosing)
10 mg q 3-4 h 30 mg q 3-4 h 10 mg q 3-4 h

Morphine,
controlled-release[3,4]
(MS Contin,Oramorph) 90-120 mg q 12 h N/A 90-120 mg q 12 h N/A

Hydromorphone[3]
(Dilaudid) 7.5 mg q 3-4 h 1.5 mg q 3-4 h 6 mg q 3-4 h 1.5 mg q 3-4 h

Levorphanol
(Levo-Dromoran) 4 mg q 6-8 h 2 mg q 6-8 h 4 mg q 6-8 h 2 mg q 6-8 h

Meperidine
(Demerol) 300 mg q 2-
3 h 100 mg q 3 h N/R 100 mg q 3 h

Methadone
(Dolophine, other) 20 mg q 6-8 h 10 mg q 6-8 h 20 mg q 6-8 h 10 mg q 6-8 h

Oxymorphone[3]
(Numorphan) N/A 1 mg q 3-4 h N/A 1 mg q 3-4 h

Combination opioid/NSAID preparations[5]

Codeine[6](with
aspirin or acetaminophen) 180-200 mg q
3-4 h 130 mg q 3-4 h 60 mg q 3-4 h 60 mg q 2 h
(IM/SC)

Hydrocodone(in
Lorcet, Lortab,
Vicodin, others) 30 mg q 3-4 h N/A 10 mg q 3-4 h N/A

Oxycodone
(Roxicodone, also in
Percocet, Percodan,
Tylox, others) 30 mg q 3-4 h N/A 10 mg q 3-4 h N/A

Drug	Approximate equianalgesic dose	Usual starting dose for moderate to severe pain
	Oral	Parenteral	Oral	Parenteral
Opioid agonist[2]
Morphine[3]	30 mg q 3-4 h (repeat around- the-clock dosing) 60 mg q 3-4 h (single dose or intermittent dosing)	10 mg q 3-4 h	30 mg q 3-4 h	10 mg q 3-4 h
Morphine, controlled-release[3,4] (MS Contin,Oramorph)	90-120 mg q 12 h	N/A	90-120 mg q 12 h	N/A
Hydromorphone[3] (Dilaudid)	7.5 mg q 3-4 h	1.5 mg q 3-4 h	6 mg q 3-4 h	1.5 mg q 3-4 h
Levorphanol (Levo-Dromoran)	4 mg q 6-8 h	2 mg q 6-8 h	4 mg q 6-8 h	2 mg q 6-8 h
Meperidine (Demerol)	300 mg q 2- 3 h	100 mg q 3 h	N/R	100 mg q 3 h
Methadone (Dolophine, other)	20 mg q 6-8 h	10 mg q 6-8 h	20 mg q 6-8 h	10 mg q 6-8 h
Oxymorphone[3] (Numorphan)	N/A	1 mg q 3-4 h	N/A	1 mg q 3-4 h
Combination opioid/NSAID preparations[5]
Codeine[6](with aspirin or acetaminophen)	180-200 mg q 3-4 h	130 mg q 3-4 h	60 mg q 3-4 h	60 mg q 2 h (IM/SC)
Hydrocodone(in Lorcet, Lortab, Vicodin, others)	30 mg q 3-4 h	N/A	10 mg q 3-4 h	N/A
Oxycodone (Roxicodone, also in Percocet, Percodan, Tylox, others)	30 mg q 3-4 h	N/A	10 mg q 3-4 h	N/A

Attention:
1. Caution: Recommended doses do not apply for adult patients with body weight less than 50 kg. For recommended starting doses for children and adults <50 KG BODY WEIGHT, SEE TABLE 11.
2. Caution: Recommended doses do not apply to patients with renal or hepatic insufficiency or other conditions affecting drug metabolism and kinetics.
3. Caution: For morphine, hydromorphone, and oxymorphone, rectal administration is an alternate route for patients unable to take oral medications. Equianalgesic doses may differ from oral and parenteral doses because of pharmacokinetic differences.
4. Transdermal fentanyl (Duragesic) is an alternative option. Transdermal fentanyl dosage is not calculated as equianalgesic to a single morphine dosage. See the package insert for dosing calculations. Doses above 25 micro- g/h should not be used in opioid-naive patients.
5. Caution: Doses of aspirin and acetaminophen in combination opioid/NSAID preparations must also be adjusted to the patient's body weight. Aspirin is contraindicated in children in the presence of fever or other viral disease because of its association with Reye's syndrome.
6. Caution: Codeine doses above 65 mg often are not appropriate because of diminishing incremental analgesia with increasing doses but continually increasing nausea, constipation, and other side effects.

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 responses 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.

Codes:q=every. N/A=not available. N/R, not recommended. IM=intramuscular. SC=subcutaneous.

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