|
| Drug |
Dose |
Duration
(hrs) |
Half-Life |
Price
NYH |
Price
Outpatient |
| Morphine |
10 mg SC
30 mg PO |
3-4 hrs
4-6 hrs |
2-3 hrs |
$0.49
$0.10 |
|
| MS Contin |
1 |
12 hrs |
2-3 hrs |
|
$1.73 |
Hydromorphone
(Dilaudid®) |
1.5 mg SC
3.0 mg PO |
3-4 hrs
4-6 hrs |
2-3 hrs |
$0.59
$0.56 |
$1.88 |
Levorphanol
(Levodromeran®) |
2 mg SC
4 mg PO |
4-5 hrs
4-6 hrs |
12-16 hrs |
$2.26
$0.84 |
|
| Methadone |
10 mg IM
20 mg PO |
4-5 hrs
4-6 hrs |
15-40 hrs |
$0.53
$0.45 |
|
Meperidine 2
(Demerol®) |
75 mg SC
300 mg PO |
2-3 hrs
3-4 hrs |
3-4 hrs |
$0.38
$1.36 |
|
| Fentanyl |
0.1 mg IM
3 Patch |
1-2 hrs |
2-4 hrs |
$0.24
$17.39 |
|
Oxycodone
(5 mg in Percocet) |
30 mg PO |
4-5 hrs |
2-3 hrs |
$0.02 |
$1.35 |
Codeine 4
Tylenol with Codeine |
120 mg SC
200 mg PO |
4-6 hrs
4-6 hrs |
2-4 hrs |
$1.08
$0.82
$0.28 |
|
Notes
Ten
milligrams of Morphine SC is an appropriate starting dose
for acute severe pain in metabolically-normal ,narcotic-naive,
middle-aged, 70kg patients. People who are old, small metabolically
deranged or with liver disease need smaller initial doses.
Younger people, patients with substantially larger lean body
mass or patients already tolerant to narcotics wilI often
require larger doses. Individualization of dosage is required
for every patient. Small infrequent doses are better than
large infrequent doses. There is not a complete cross tolerance
to opiates. When switching from one to another, start with
one-half to two-thirds the analgesic equivalent.
1.
Initially 60 mg morphine P0 is equivalent to 10 mg SC. After
several doses PO, a metabolite builds up so that 30-40 mg
PO is equivalent to 10 mg SC. To switch to MS Contin take
last 24 hours cumulative dose of morphine and give one-half
of that as MS Contin Q12 H or one-third of it Q8H.
2.
Meperidine (Demerol®) is metabolized to a compound, normeperidine,
which is known to cause seizure disorders and accumulates
during chronic use. We urge using a different opiate for pain
relief.
3.
The fentanyl patch (Duragesic®) has an onset of action several
hours after placement. After removal the drug in the skin
in slowly absorbed with a half-life of 18 hours. To calculate
initial dose, calculate the amount of morphine or "morphine
equivalents" given in the last 24 hours. If less than
134 mg, use 25 mcg/hr. If 135-224 mg, use 50 mcg/hr; 225-314
use 75 mcg/hr, etc.
4.
Codeine at these doses produce very much excitation and constipation.
Use 15-30 mg with an NSAID or acetaminophen for additive effect.
OPIATE
ANTAGONISTS
Naloxone
(Narcan®), half-life 30-80 minutes, is a competitive antagonist
to opiates. Give 0.4 - 2.0 mg IV. Repeat at 2-3 minute intervals
until desired degree of reversal is reached. Repeat as necessary
to maintain reversal since naloxone has shorter half-life
than any opiate. Naloxone can precipitate withdrawl in opiate
dependent person.
Note:
PIease give Dr. Reidenberg at extension 66227 or Dr. Owen
0'Connor any suggestions for improvement, additional information
desired, or correction that you think will improve the usefulness
of this handout.
Revised
2/22/95
Page
created with permission 10/15/98
|
Revised: October 7, 2000.