1 | 0.5 mg and 0.125 mg SL daily | 0.5 mg and 0.125 mg SL once daily | 0.25 mg and 0.0625 mg SL once daily | 0.1 mg of clonidine twice daily as needed for agitation 400-600 mg of ibuprofen 4 times daily as needed and 650-1000 mg acetaminophen every 6 h as needed for myalgia 50 mg of dimenhydrinate every 6 h as needed for nausea or vomiting 2 mg of loperamide after loose bowel movement as needed for diarrhea Can consider providing 2 doses of 2 mg and 0.5 mg of SL buprenorphine-naloxone every h as needed for withdrawal
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2 | 0.5 mg and 0.125 mg SL daily | 0.5 mg and 0.125 mg SL twice daily | 0.25 mg and 0.0625 mg SL twice daily |
3 | 1 mg and 0.25 mg SL daily | 1 mg and 0.25 mg SL twice daily | 0.5 mg and 0.125 mg SL twice daily |
4 | 1.5 mg and 0.375 mg SL daily | 2 mg and 0.5 mg SL twice daily (can stop short-acting or begin tapering long-acting opioids) | 1 mg and 0.25 mg SL twice daily |
5 | 2 mg and 0.5 mg SL daily | 3 mg and 0.75 mg SL twice daily | 2 mg and 0.5 mg SL twice daily (can stop short-acting or begin tapering long-acting opioids) |
6 | 3 mg and 0.75 mg SL daily | 4 mg and 1 mg SL twice daily | 4 mg and 1 mg SL twice daily |
7 | 4 mg and 1 mg SL daily (can stop short-acting or begin tapering long-acting opioids) | 12 mg and 4 mg SL once daily (stop all opioids) | 12 mg and 4 mg SL once daily (stop all opioids) |
8 | 5 mg and 1.25 mg SL daily | Adjust further dosing based on patient symptoms | Adjust further dosing based on patient symptoms |
9 | 6 mg and 1.5 mg SL daily | | |
10 | 7 mg and 1.75 mg SL daily | | |
11 | 8 mg and 2 mg SL daily | | |
12 | 10 mg and 3 mg SL daily | | |
13 | 12 mg and 4 mg SL daily (stop all opioids) | | |
14 | Adjust further dosing based on patient symptoms | | |