Drug | Brand name (United States) | Sample initial dose in opioid-tolerant adults | Serum half-life (hours) | Duration of analgesic effect (hours) | Comments |
Oral, long-acting preparations | |||||
Hydrocodone | Hysingla ER | 20 mg orally every 24 hours | 7 to 9 | 24 |
|
Zohydro ER (brand not available; generic only) | 10 mg orally every 12 hours | 13 | ≤12 in patients with non-cancer back pain | ||
Hydromorphone | Exalgo | 8 mg orally every 24 hours | 11 | 24 |
|
Hydromorph Contin (available in Canada) | 3 mg orally every 12 hours | Not specified | ≥12 | ||
Morphine | MS Contin | 15 mg orally every 8 or 12 hours | Not specified | 8 to 12 |
|
Kadian (brand not available; generic only) | 30 mg orally daily in 1 or 2 divided doses | 11 to 13 | 12 to 24 | ||
Oxycodone | OxyContin | 10 mg orally every 12 hours | 4.5 | 8 to 12 |
|
Xtampza ER | 9 mg orally every 12 hours | 5.6 | ≤12 | ||
Oxymorphone | Generic only | 5 mg orally every 12 hours | 9 to 11 | 12 |
|
Tapentadol | Nucynta ER | 50 mg orally every 12 hours | 5 to 6 | 12 |
|
Transdermal | |||||
Fentanyl | Duragesic | 12 or 25 mcg per hour, patch applied every 72 hours | 20 to 27 following patch removal | 48 to 72 Some analgesic effect may persist following patch removal due to continued absorption from skin |
|
CrCl: creatinine clearance; CYP2D6: cytochrome P450 2D6; CYP3A4: cytochrome P450 3A4; ER: extended-release; IV: intravenous; MAOI: monoamine oxidase inhibitor; mcg: microgram; P-gp: P-glycoprotein; SNRI: serotonin-norepinephrine reuptake inhibitor; SSRI: selective serotonin reuptake inhibitor; TCA: tricyclic antidepressants.
* Lists of drugs that alter CYP3A4 metabolism or P-gp multidrug efflux transporter (ie, inhibitors and inducers) are available as separate tables in UpToDate. To determine drug interactions and management suggestions for specific combinations, use the drug interactions program included within UpToDate.
¶ Abuse-deterrent formulations have 1 or more properties that make intentional manipulation of the dose form more difficult (eg, resistant to crushing and dissolution) or less likely to produce an opioid effect (eg, altered to minimize absorption through nasal mucosa). No oral opioid formulation prevents ingestion of an excessive dose.Courtesy of Kathleen Broglio, DNP, MN, ANP-BC, ACHPN and Russell K Portenoy, MD.
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