| Drug | Approximate Equianalgesic Dose | Recommended Starting Dose (adults >50 kg body weight) | Recommended Starting Dose (children and adults >50 kg body weight)* | |||
|---|---|---|---|---|---|---|
| Oral | Parenteral | Oral | Parenteral | Oral | Parenteral | |
| Opioid Agonist | ||||||
| Morphine† | 30 mg q3–4h (around-the-clock dosing) 60 mg q3–4h (single dose or intermittent dosing) | 10 mg q3–4h | 30 mg q3–4h | 10 mg q3–4h | 0.3 mg/kg q3–4h | 0.1 mg/kg q3–4h |
| Codeine‡ | 180–200 mg q3–4h | 130 mg q3–4h | 60 mg q3–4h | 60 mg q2h (intramuscular/subcutaneous) | 1 mg/kg q3–4h§ | Not recommended |
| Hydrocodone (in Lorcet, Lortab, Vicodin, others) | 30 mg q3–4h | Not available | 10 mg q3–4h | Not available | 0.2 mg/kg q3–4h§ | Not available |
| Opioid Agonist | ||||||
| Hydromorphone† (Dilaudid) | 7.5 mg q3–4h | 1.5 mg q3–4h | 6 mg q3–4h | 1.5 mg q3–4h | 0.06 mg/kg q3–4h | 0.015 mg/kg q3–4h |
| Levorphanol (Levo-Dromoran) | 4 mg q6–8h | 2 mg q6–8h | 4 mg q6–8h | 2 mg q6–8h | 0.04 mg/kg q6–8h | 0.02 mg/kg q6–8h |
| Meperidine (Demerol) | 300 mg q2–3h | 100 mg q3h | Not recommended | 100 mg q3h | Not recommended | 0.75 mg/kg q2–3h |
| Methadone (Dolophine, others) | 20 mg q6–8h | 10 mg q6–8h | 20 mg q6–8h | 10 mg q6–8h | 0.2 mg/kg q6–8h | 0.1 mg/kg q6–8h |
| Oxycodone (Roxicodone, also in Percocet, Percodan, Tylox, others) | 30 mg q3–4h | Not available | 10 mg q3–4h | Not available | 0.2 mg/kg q3–4h§ | Not available |
| Oxymorphone† (Numorphan) | Not available | 1 mg q3–4h | Not available | 1 mg q3–4h | Not recommended | Not recommended |
| Opioid Agonist-Antagonist and Partial Agonist | ||||||
| Buprenorphine (Buprenex) | Not available | 0.3–0.4 mg q6–8h | Not available | 0.4 mg q6–8h | Not available | 0.004 mg/kg q6–8h |
| Butorphanol (Stadol) | Not available | 2 mg q3–4h | Not available | 2 mg q3–4h | Not available | Not recommended |
| Dezocine (Dalgan) | Not available | 10 mg q3–4h | Not available | 10 mg q3–4h | Not available | Not recommended |
| Nalbuphine (Nubain) | Not available | 10 mg q3–4h | Not available | 10 mg q3–4h | Not available | 0.1 mg/kg q3–4h |
| Pentazocine (Talwin, others) | 150 mg q3–4h | 60 mg q3–4h | 50 mg q4–6h | Not recommended | Not recommended | Not recommended |
Note: Published tables vary in the suggested doses that are equianalgesic to morphine. Clinical response is the criterion that must be applied for each client; titration to clinical response is necessary. Because there is not complete cross-tolerance among these drugs, it is usually necessary to use a lower-than-equianalgesic dose when changing drugs and to retitrate to response.
Caution: Recommended doses do not apply to clients with renal or hepatic insufficiency or other conditions affecting drug metabolism and kinetics.
* Caution: Doses listed for clients with body weight less than 50 kg cannot be used as initial starting doses in babies less than 6 mo of age.
† For morphine, hydromorphone, and oxymorphone, rectal administration is an alternate route for clients unable to take oral medications, but equianalgesic doses may differ from oral and parenteral doses because of pharmacokinetic differences.
‡ Caution: Codeine doses above 65 mg often are not appropriate because of diminishing incremental analgesia with increasing doses but continually increasing constipation and other side effects. Oral doses refer to combination with aspirin or acetaminophen.
§ Caution: Doses of aspirin and acetaminophen in combination opioid/NSAID preparations must also be adjusted to the client's body weight.
Adapted from Acute Pain Management Guideline Panel: Acute Pain Management in Adults: Operative Procedures. Quick Reference Guide for Clinicians. Agency for Health Care Policy and Research, Department of Health and Human Services, Rockville, MD. AHCPR Publication No. 92–0019.