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Thread: [Palliative Care] Opioids with Pure Mu-agonist Activity That are Used for Pain in Palliative Care

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    PharmD Year 1 TomHsiung's Avatar
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    Default [Palliative Care] Opioids with Pure Mu-agonist Activity That are Used for Pain in Palliative Care

    TABLE 12-1 Opioids with Pure Mu-Agonist Activity That are Used for Pain in Palliative Care
    Opioid Analgesic Equianalgesic Dosing (mg)a,b Half-life (h) Peak Effect (h) Duration (h)
    Morphine 10 IM/IV/SQ 2-3 0.5-1 3-4
      20-30 po 2-3 1-2 3-6
    Controlled-release morphine 20-30 po 2-3 NA 8-12
    Sustained-release morphine 20-30 po 2-3 NA 12-24
    Hydromorphone 1.5 IM/IV/SQ 2-3 0.5-1 3-4
      7.5 po 2-3 1-2 3-6
    Oxycodone 20-30 po 2-3 1-2 3-6
    Controlled-release oxymorphone 20-30 po NA 3-4 8-12
    Oxymorphone 1 IM/IV/SQ NA 0.5-1 3-6
      10 pr NA 1.5-3 4-6
      15 po      
    Levorphanol 2 IM/IV/SQ 12-15 0.5-1 3-6
      4 po 12-15 1-2 3-6
    Methadone Variable 12-150 1-2 6-8
    Hydrocodone 30 po 2-4 1-2 3-6
    Fentanyl 50-100 μg 7-12 <10 min 1-2
      IV/SQ      
    Fentanyl transdermal NA NA 12-24 48-72 per patch
    Oral transmucosal fentanyl citrate NA 7-12 15-30 min 1-2

    IM = intramuscular; IV = intravenous; SQ = subcutaneous; po = by mouth; pr = per rectum.

    aDose provides analgesia equivalent to 10 mg of morphine given by IM route. These ratios are useful guides when switching drugs or routes of administration. In clinical practice, the potency of the IM route is considered to be identical to IV and SQ routes.

    bWhen switching from one opioid to another, incomplete cross-tolerance requires a reduction in the dose of the new drug by 25% to 50%, to prevent excessive opioid effects. Provision of "rescue" medication during the conversion period (a few days) prevents breakthrough pain.
    Last edited by admin; Tue 27th May '14 at 11:04pm.
    B.S. Pharm, West China School of Pharmacy, Class of 2007, Health System Pharmacist, RPh. Hematology, Infectious Disease.

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