Commonly used opioid equianalgesic doses
Pain and Symptom Control Card
Commonly Used Opioid Equianalgesic Doses
Tylenol #1= 8mg Codeine + 300mg Acetaminophen
Tylenol #2= 15mg Codeine + 300mg Acetaminophen
Tylenol #3= 30mg Codeine + 300mg Acetaminophen
Tylenol #4= 60mg Codeine + 300mg Acetaminophen
Percocet = 5mg Oxycodone + 325mg Acetaminophen
NB: A Tylenol#3 is equivalent to ~3mg of oral morphine plus 300mg Acetaminophen
A Percocet is equivalent to ~10mg of oral morphine plus 325mg Acetaminophen
Key Points to Remember: 1. First-line drug is morphine. Use hydromorphone in elderly or renally-impaired. 2. Oral to parenteral conversion is roughly 2:1 for morphine and hydromorphone. 3. These conversions are estimates. When changing opioids, use ~75% of the newly
4. Routine doses of immediate release opiates should be given Q4H. 5. Breakthrough (PRN) doses of opiates should be ½ of the regular (Q4H) dose or 10% of the
total daily dose. Frequency depends on route: Q1H (PO), Q30min (SC) or q15min (IV).
6. Monitor and titrate frequently. Check the frequency of PRN use over 24h, and adjust the
regular (Q4H) doses accordingly. Watch for oversedation and respiratory depression.
7. Always give an antinauseant and a stimulant laxative (e.g. sennokot) with opiates. Sample Initial Order:
Morphine 5mg PO Q1H PRN
After 24h- if pt requested 12 doses (x 5mg) = 60mg total
Divide total dose by 6 to get Q4H dose (60/6 = 10mg)
Morphine 10mg PO Q4H + 5mg PO Q1H PRN
Reassess every 24h and adjust accordingly.
Fentanyl Patch and Breakthrough Dosing
Total Daily Morphine
Fentanyl Patch Dose
*Adapted from Health Canada Dosing Conversion Guidelines
(March 8, 2010)
Common Adjuvant Analgesic Medications**
**NB: These are examples of commonly used adjuvant medications and doses. Adjuvant
therapies are best prescribed and adjusted with the assistance of a pain-control specialist.
****Do NOT give laxatives until a bowel obstruction has been ruled out. The following is a
suggested stepwise approach to a constipated patient.
Fleet enema, Sennokot 8.6mg x2 tabs QHS +/- MOM 30cc PO BID
Add bisacodyl 5mg PO QHS/10mg PR QAM +/- Lactulose 30cc PO BID
(after 2 days) Third Attempt
Magnesium citrate +/- repeat enemas +/- manual disimpaction
Consider methylnaltrexone 0.15mg/kg SC for opioid-induced constipation
Common Antinauseant Regimens- 2 Step Guide
STEP 1: Find the appropriate antinauseant class for the etiology
Recommended Class of Medication
- Dopamine ant. and consider improved constipation
- Serotonin/Histamine ant.
Dopamine/Histamine ant. +/- steroids +/- hydration
Cholinergic ant. +/- Octreotide 100mcg q8-12h,
Enemas + Stimulant Laxatives (Senna or Bisacodyl) +
Metoclopramide 20mg IV q6h +/- Erythromycin 250-500mg IV/PO q6h
Proton pump inhibitors +/- Antacids +/- prostaglandins
Dopamine/Histamine ant., opioids, oxygen and anxiolytics
(<24 hours) - (Serotonin ant. + Dexamethasone 20mg IV +/-
metoclopramide 2-3 mg/kg IV) ONCE prior to chemotherapy
(>24 hours) - (Dexamethasone 8mg BID + dopamine ant.
Serotonin/Dopamine ant. before each fraction
- Steroids + Dopamine/Histamine ant. Liver
- Dopamine/Histamine ant.
STEP 2: Choose a medication from the appropriate class
Medications and Typical Dosages
Ondansetron (Zofran) 8mg IV or PO BID-TID
Granisetron (Kytril) 1mg IV or 2mg PO BID
Metoclopramide (Maxeran) 10mg PO/IV BID-QID or 2-3mg/kg IV
Prochlorperazine (Stemetil) 10-20mg PO or 5-10mg IV q6h Haloperidol (Haldol) 0.5-2mg IV/SC q6h
Diphenhydramine (Benadryl) 25-50mg IV/PO q4h
Scopolamine hydrobromide 1.5mg patch behind ear 4h before
needed, replace every 3 days if needed; or 0.1-0.4 mg SC/IV q4h
ASCO Antiemetics Guidelines. Gralla et al. J Clin Oncol
17(9):2971 Ian Anderson Program in End-of-Life Care
. University of Toronto 2000 Version 2.1 Aug 25th, 2010, by James Downar and Hershl Berman. Copyright James Downar. See J Gen Intern Med
2008 Aug;23(8):1222-7 for publication of a study of this card.
Research [email protected] Volume 13 Issue 4 - April 2, 2010 Body Mass Index Can Determine the Healing of Reflux Esophagitis with Los-Angles Grades C and D by Esomeprazole , Wei-Lun Chang1,3, Hsui-Chi Cheng1,3, Ai-Wen Kao1 and Cheng-Chan Lu21Department of Internal Medicine, Medical College, National Cheng Kung University, Tainan, Taiwan 2Department of Pathology, Medical College, National
Depo-Provera Perpetual Calendar 4 - T I M E S - A - Y E A R D O S I N G F L E X I B I L I T Y [based on 3-month (13-week) dosing intervals, with the flexibility of dosing between weeks 11 and 13] Mar 19 - Apr May 4 - May 18 Jun 19 - Jul Aug 4 - Aug 18 Mar 20 - Apr May 5 - May 19 Jun 20 - Jul Aug 5 - Aug 19 Mar 21 - Apr May 6 - May 20 Jun 21 - Jul Aug 6 - Aug