DRUG | INITIAL LOW DOSE | COMMENTS |
---|---|---|
Codeine, with or without acetaminophen | 15–30 mg orally every 4–6 h (dose-limiting ceiling effect at > 60 mg per dose) |
|
Codeine CR | 50 mg orally every 12 h (consider low doses of stronger opioid if > 200 mg/d) | |
Tramadol, with or without acetaminophen | 37.5 mg orally every 6 h (maximum 8 tablets daily) |
|
Tramadol CR (given every 24 h) | 100–150 mg/d orally | |
Buprenorphine patch12 | 5 μg/h every 7 d (maximum 20 μg/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 National Opioid Use Guidelines Group,2 Stone and Regier,5 The Oxford League Table of Analgesic Efficacy,6 Department of Veterans Affairs and Department of Defense,7 Smith,8 Regier,9 Michael G. DeGroote National Pain Centre,10 MacDonald and MacLeod,11 Regier,12 Flockhart.13