MEDICATION | STARTING DOSE* | FREQUENCY |
---|---|---|
Pain or dyspnea | ||
• Immediate-release hydromorphone | 0.5 mg orally or 0.25 mg subcutaneously | Every 8–12 h standing dose, and every 2 h as needed |
• Morphine | 2.5 mg orally or 1.5 mg subcutaneously | Every 8–12 h standing dose, and every 2 h as needed |
• Oxycodone | 2.5 mg orally | Every 12 h standing dose, and every 2 h as needed |
• Fentanyl | Should never be started in an opioid-naïve patient | |
Neuropathic pain | ||
• Gabapentin | 100 mg orally | Daily (up to a total daily dose of 300 mg) |
• Pregabalin | 25 mg orally | Daily (up to a total daily dose of 100 mg) |
Delirium or nausea | ||
• Haloperidol | 0.5–1 mg orally or subcutaneously | Every 3 h as needed. If standing dose needed, every 12 h |
• Methotrimeprazine | 2.5–6.25 mg orally or subcutaneously | Every 3 h as needed. If standing dose needed, every 12 h |
• Olanzapine | 2.5–5 mg orally, sublingually, or subcutaneously | Every 8 h as needed. If standing dose needed, then daily |
Pruritus | ||
• Paroxetine | 5 mg | Daily at bedtime |
• Mirtazapine | 7.5 mg | Daily at bedtime |
↵* These suggested starting doses are based on the authors’ (D.S. and J.D.) experience.