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Table 78-6

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   Opioid Analgesics Commonly Used for Moderate to Severe Pain

Narcotic AgonistsParenteral (mg)Oral (mg)Conversion Factor (IV to PO)Comment
Morphine10303Standard of comparison for opioid analgesics; lower dose for aged and patients with impaired ventilation, bronchial asthma, increased intracranial pressure, liver failure, or renal failure
Hydromorphone (Dilaudid )1.57.55Slightly shorter acting
Methadone (Dolophine)10202Good oral potency, long plasma half-life; like morphine, may accumulate with repetitive dosing causing excessive sedation
Fentanyl (Duragesic)100 μg = 4 mg morphine IVShort half-life; transdermal and transmucosal preparations available
Meperidine (Demerol)753004Not recommended in chronic cancer pain due to toxic metabolite, impaired renal function, or if receiving monoamine oxidase inhibitors
Levorphanol (Levo-Dromoran)242Like methadone to opioid analgesics
Codeine1302001.5Often used in combination with nonopioid analgesics; biotransformed, in part to morphine
Oxycodone (Roxicodone, Tylox)30Also in combination with nonopioid analgesics, which limits dose escalation
Oxymorphone (Numorphan)16 (rectal)Like methadone; not available orally