DRUG | INITIAL LOW DOSE | COMMENTS |
---|---|---|
Morphine IR | 2.5–5 mg orally every 4–8 h |
|
Morphine CR (most given every 12 h, eg, MS Contin, MOS SR, M-Eslon; Kadian given every 24 h) | 10 mg orally every 12 h (this dose is for M-Eslon only) 15 mg orally every 12 h 10–20 mg orally every 24 h | |
Hydromorphone IR | 0.5–1mg orally every 4–8 h |
|
Hydromorphone CR (Contin given every 12 h; Jurnista given every 24 h) | 3 mg orally every 12 h 4 mg orally every 24 h | |
Oxycodone, with or without acetaminophen | 2.5–5 mg orally every 4–8 h (most tablets scored; allows for lower dose or titration by half tablets) |
|
Oxycodone CR | 5–10 mg orally every 12 h | |
Fentanyl patch | 12–25 μg/h every 72 h |
|
CR—controlled release, CYP—cytochrome P450, IR—immediate release, M3G—morphine-3-glucuronide, M6G—morphine-6-glucuronide.
↵* Cytochrome P450 2D6 inhibitors include amiodarone, bupropion, duloxetine, fluoxetine, paroxetine, ritonavir, and ropinirole.
↵† Cytochrome P450 3A4 inhibitors include clarithromycin, diltiazem, erythromycin, grapefruit juice, itraconazole, and verapamil.
Data from Stone and Regier,5 Department of Veterans Affairs and Department of Defense,7 Smith,8 Regier,9 Michael G. DeGroote National Pain Centre,10 Flockhart,13 RPHWorld.com,14 Peterson et al,15 Regier and Jensen.16