Suggested initial opioid dose and titration based on oral dosing for CNCP
| OPIOID | INITIAL DOSE | RECOMMENDED TIME INTERVAL FOR INCREASE | SUGGESTED DOSE INCREASE | MINIMUM DAILY DOSE BEFORE CONVERTING IR TO CR |
|---|---|---|---|---|
| Codeine | 15–30 mg every 6 h | 7 d | 15–30 mg/d up to 600 mg/d | 100 mg |
| CR codeine | 50 mg every 12 h | 2 d | 50 mg/d up to maximum of 300 mg every 12 h | NA |
| Tramadol-acetaminophen | • 37.5/325 mg • 1 tablet every 4–6 h up to 4/d | 7 d | 1 tablet every 4–6 h up to 8 tablets/d | 3 tablets |
| CR tramadol | ||||
| • Zytram | 150 mg every 24 h | 7 d | 400 mg/d maximum | NA |
| • Tridural | 100 mg every 24 h | 2 d | 300 mg/d maximum | NA |
| • Ralivia | 100 mg every 24 h | 5 d | 300 mg/d maximum | NA |
| IR morphine | • 5–10 mg every 4–6 h • maximum 40 mg/d | 7 d | 5–10 mg/d | 20–30 mg |
| CR morphine | • 10–20 mg: once, twice, or 3 times daily • maximum 40 mg/d | 14 d | 5–10 mg/d | NA |
| IR oxycodone | • 5 mg every 4–6 h • maximum 30 mg/d | 7 d | 5 mg/d | 20 mg |
| CR oxycodone | • 10 mg 2–3 times daily • maximum 30 mg/d | 14 d | 10 mg/d | NA |
| IR hydromorphone | • 1–2 mg every 4–6 h • maximum 8 mg/d | 7 d | 1–2 mg/d | 6 mg |
| CR hydromorphone (Hydromorph Contin) | • 3 mg 2–3 times daily • maximum 9 mg/d | 14 d | 2–4 mg/d | NA |
CNCP—chronic noncancer pain, CR—controlled release, IR—immediate release, NA—not applicable.
Adapted from the National Opioid Use Guideline Group.5