Opioids
Types of Opioids
- Natural derivatives: Heroin, Morphine, Codeine, Hydrocodone, Oxycodone (+ UDS)
- Synthetic: Fentanyl, Hydromorphone, Buprenorphine, Methadone, Meperidine, Dextromethorphan (- UDS)
General Opioid Analgesics Chart
DRUG |
TYPICAL ADULT DOSE |
PHARMACOKINETICS |
COMMENTS |
0.1 mg/kg IV 10mg IM 0.3 mg/kg PO |
Onset: 1-2 min (IV), 10-15 min (IM/SC) Peak effect: 3-5 min (IV), 15-30 min (IM) Duration: 1-2 h (IV), 3-4 h (IM/SC) |
| |
(Dilaudid) |
0.015 mg/kg IV 1-2 mg IM |
Onset: 3-5 min (IV) Peak effect: 7-10 min (IV) Duration: 2-4 h (IV) |
|
1.0 mcg/kg IV |
Onset: <1 min (IV) Peak effect: 2-5 min (IV) Duration: 30-60 min (IV) |
| |
(Demerol) |
1.0-1.5 mg/kg IV/IM |
Onset: 5 min (IV) Peak effect: 5-10 min (IV) Duraction 2-3 h (IV) |
|
5-10 mg PO 30 mg PR |
Onset: 10-15 min (PO) Duration 3-6 h (PO) |
| |
5-10 mg PO |
Onset: 30-60 min (PO) Duraction 4-6 h (PO) |
| |
30-60 mg PO 30-100 mg IM |
Onset: 30-60 min (PO) Duraction: 4-6 h (PO) |
| |
(Ultram) |
50-100 mg PO |
Onset: 10-15 min (PO) Duration: 4-6 h (PO) |
|
Parenteral Opioid Dosing Chart
DRUG | ROUTE | DOSAGE | COMMENTS |
Morphine | IV or IM |
Titrate 2-5 mg increments q5-10 min Peak analgesia in 10-20 min Average: 10 mg q3-4h |
Preferred first-line agent in most situations |
Fentanyl | IV or IM |
Titrate 25-50 mcg increments q2-3 min Peak analgesia in 3-5 min Duration 30-60 min |
Ideal for short procedures No histamine release Typically not suitable for the ED |
(Demerol) |
IV |
Titrate 12.5-50 mg increments Peak analgesia in 5-10 min Average: 100 mg q2-3h |
Risk of unique CNS toxicity with repeated dosing IM injection is very irritating to tissue |
(Dilaudid) |
IV |
Titrate 0.5-1.0 mg increments Peak analgesia in 5-15 min Average: 1.5 mg q3-4h |
|
(Stadol) |
IV |
Titrate 0.5-2.0 mg increments Peak analgesia in 4-5 min Average: 2 mg q3-4h |
Mixed agonist-antagonist May be preferred in biliary colic |
Oral Opioid Dosing Chart
DRUG | ANALGESIC EQUIVALENCE | USUAL STARTING DOSE | USUAL INTERVAL |
Morphine (MSIR, Roxanol, others) | 30 mg | 15-30 mg | 3-4 h |
Morphine: sustained release (MS Contin, Oramorph-SR) | 30 mg | 30 mg | 8-12 h |
Meperidine (Demerol) | 300 mg | 50-100 mg | 2-3 h |
Codeine (in Tylenol #3, others) | 200 mg | 30-60 mg | 3-4 h |
Oxycodone (Roxicodone, also in Percocet, Percodan, Tylox, others) | 20-30 mg | 5-10 mg | 3-6 h |
Hydrocodone (in Lorcet, Lortab, Vicodin, others) | 30 mg | 5-10 mg | 3-6 h |
Hydromorphone (Dilaudid) | 7.5 mg | 4-8 mg | 2-3 h |
Tramadol (Ultram) | N/A | 25-50 mg | 4-6 h |