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Equianalgesic

December 15, 2023

An equianalgesic chart is a conversion chart that lists equivalent doses of analgesics (drugs used to relieve pain). Equianalgesic charts are used for calculation of an equivalent dose (a dose which would offer an equal amount of analgesia) between different analgesics.[1] Tables of this general type are also available for NSAIDs, benzodiazepines, depressants, stimulants, anticholinergics and others.

Format edit

Equianalgesic tables are available in different formats, such as pocket-sized cards for ease of reference.[1] A frequently-seen format has the drug names in the left column, the route of administration in the center columns and any notes in the right column.[2][3]

Purpose edit

There are several reasons for switching a patient to a different pain medication. These include practical considerations such as lower cost or unavailability of a drug at the patient's preferred pharmacy, or medical reasons such as lack of effectiveness of the current drug or to minimize adverse effects. Some patients request to be switched to a different narcotic due to stigma associated with a particular drug (e.g. a patient refusing methadone due to its association with opioid addiction treatment).[4] Equianalgesic charts are also used when calculating an equivalent dosage of the same drug, but with a different route of administration.[citation needed]

Precautions edit

An equianalgesic chart can be a useful tool, but the user must take care to correct for all relevant variables such as route of administration, cross tolerance, half-life and the bioavailability of a drug.[5] For example, the narcotic levorphanol is 4–8 times stronger than morphine, but also has a much longer half-life. Simply switching the patient from 40 mg of morphine to 10 mg of levorphanol would be dangerous due to dose accumulation, and hence frequency of administration should also be taken into account.

There are other concerns about equianalgesic charts. Many charts derive their data from studies conducted on opioid-naive patients. Patients with chronic (rather than acute) pain may respond to analgesia differently. Repeated administration of a medication is also different from single dosing, as many drugs have active metabolites that can build up in the body.[6] Patient variables such as sex, age, and organ function may also influence the effect of the drug on the system. These variables are rarely included in equianalgesic charts.[7][3][8]

Opioid equivalency table edit

Opioids are a class of compounds that elicit analgesic (pain killing) effects in humans and animals by binding to the µ-opioid receptor within the central nervous system. The following table lists opioid and non-opioid analgesic drugs and their relative potencies. Values for the potencies represent opioids taken orally unless another route of administration is provided. As such, their bioavailabilities differ, and they may be more potent when taken intravenously.[citation needed]

Nonlinearities edit

This chart measures pain relief versus mass of medication. Not all medications have a fixed relationship on this scale. Methadone is different from most opioids because its potency can vary depending on how long it is taken. Acute use (1–3 days) yields a potency about 1.5× stronger than that of morphine and chronic use (7 days+) yields a potency about 2.5 to 5× that of morphine. Similarly, the effect of tramadol increases after consecutive dosing due to the accumulation of its active metabolite and an increase of the oral bioavailability in chronic use.[citation needed]

Comparison to oral morphine[a]
Analgesic Strength
(relative) 		Equivalent dose
(10 mg oral morphine)[b]		 Bioavailability Half-life of active metabolites
(hours) 		Oral-to-parenteral ratio Speed of onset Duration
Paracetamol (non-opioid) 1⁄360 3600 mg 63–89% 1–4 37 min (PO); 8 min (IV) 5–6 hours
Aspirin (NSAID, non-opioid) 1⁄360 3600 mg 80–100% 3.1–9
Ibuprofen[10] (NSAID, non-opioid) 1⁄222 2220 mg 87–100% 1.3–3
Diflunisal (NSAID, non-opioid) 1⁄160 1600 mg 80–90% 8–12
Naproxen[10] (NSAID, non-opioid) 1⁄138 1380 mg 95% 12–24
Piroxicam (NSAID non-opioid) 1⁄120 (est.)
Indomethacin (NSAID non-opioid) 1⁄64 (est.)
Diclofenac[10][11] (NSAID, non-opioid) 1⁄10 (est.) (same as Codeine) 100 mg (est.) 50–60% 1–4
Ketorolac[12] (NSAID, non-opioid) 1⁄3 (est.) 30 mg IV (est.) 80–100% 5–7
Nefopam (Centrally-acting non-opioid) 5⁄8 (est.) 16 mg IM (est.) Nefopam: 3–8, Desmethylnefopam 10–15
Dextropropoxyphene[13] 1⁄13–1⁄20 130–200 mg
Codeine 1⁄10–3⁄20 100–120 mg (PO) ~90% 2.5–3 (C6G 1.94;[14] morphine 2–3) 15–30 min (PO) 4–6 hours
Tramadol 1⁄10 ~100 mg 75% (IR), 85–90% (ER) 6.0–8.8[15] (M1)
Opium (oral) 1⁄10 ~100 mg ~25% (morphine) 2.5–3.0 (morphine, codeine)
Tilidine 1⁄10 100 mg
Dihydrocodeine 1⁄5 50 mg 20% 4
Anileridine[16] 1⁄4 40 mg
Alphaprodine 1⁄4–1⁄6 40–60 mg
Tapentadol[17] 3⁄10 32 mg 32% (fasting)
Pethidine (meperidine) 1⁄3 30 mg SC/IM/IV, 300 mg (PO) 50–60% 3–5
Benzylfentanyl 1⁄2
AH-7921 4⁄5
Hydrocodone 1 10 mg 70%[18] 3.8–6 (Instant Release; PO) 10–30 min (Instant Release; PO) 4–6
Metopon 1 10 mg
Pentazocine lactate (IV)[19] 1 10 mg SC/IV/IM, 150 mg (PO)
Morphine (oral) 1 10 mg ~25% 2–4 3:1 30 min (PO) 3–6 hours
Oxycodone (oral)[20] 1.5 6.67 mg 60-87% 2–3 hours (Instant Release)(PO); 4.5 hours (Controlled Release)(PO) 10–30 min (Instant Release)(PO); 1 hour (Controlled Release)(PO) 3–6 hours (Instant Release)(PO); 10–12 hours (Controlled Release)(PO)[21]
Spiradoline 1.5
Nicomorphine 2–3 3.33–5 mg 20% 4
Oxycodone (IV)[22] 3 3.33 mg 96% 1.5–3 (IV) 5 min (IV)[22] 2-4 hours
Morphine (IV/IM) 3 3.33 mg 100% 2–3 3:1 Instantaneously (from 5 to 15 sec; IV); 5–15 min (IM) 3–7 hours
Clonitazene 3 3.33 mg
Methadone (acute)[23][24] 3–4 2.5–3.33 mg 40–90% 15–60 2:1
Methadone (chronic)[24] 2.5–5 2–4 mg 40–90% 15–60 2:1
Phenazocine 4 ~2.5 mg
Diamorphine (Heroin; IV/IM)[25] 4–5 (iv, im) 2–2.5 (insufflated)[26] 2–2.5 mg 100% <0.6 (morphine prodrug)[27] Instantaneously (from 5 to 15 sec; IV); 2 to 5 min (IM) 3 to 7 hours
Dezocine 4–6 1.6–2.5 mg 97% (IM) 2.2
Hydromorphone[28][29][17] 10–15 (SC, IV, IM)
3.75–5 (PO) 		0.75 mg (SC, IV, IM)
2 mg (PO) 		62% 2–3 5:1
Oxymorphone[20] 8 3.33 mg (PO), 1 mg (IV,IM & Interlaminar) 10%–PO, ≈ 25% Sublabial, ≈ 28% Buccal, (35–40%) Sublingual & Intranasal 43% BA. 7.25–9.43 35 min (PO), Instantaneously (from 5 to 15 sec)(IV) 6–8 hours
U-47700 7.5 1.5 mg 1.5–3
Levorphanol[30] 8 1.25 mg 70% 11–16 1:1
Desomorphine (Krokodil) 8–10 1–1.25 mg ~100% (IV) 2–3 Instantaneously (from 5 to 15 sec)(IV); 2–5 min (IM) 3–4 hours
N-Phenethylnormorphine 8–14
Alfentanyl 10–25 1.5 (90–111 minutes) Instantaneously (from 5 to 15 sec); 4× more rapid than fentanyl 0.25 hr (15 min); up to 54 minutes until offset of effects
Trefentanil (10–25)+
Brifentanil (10–25)+
Acetylfentanyl 15
7-Hydroxymitragynine 17 ~0.6 mg
Furanylfentanyl 20
Butyrfentanyl 25
Enadoline 25 15 µg (threshold) and 0.160 mg/kg (dissociative effects)
Buprenorphine (SL)[13] 40 0.25 mg 30% (SL);[31] ~100% (TD); 65% (buccal);[32][33] 48% (INS)[34] 20–70, mean 37 3:1 45 min 12–24 hours
N-Phenethyl-14-ethoxymetopon 60 160 µg
Etonitazene 60 160 µg
Phenomorphan 60–80 0.13–0.16 mg
N-Phenethylnordesomorphine 85
Phenaridine (50–100)−
Fentanyl 50–100 0.1 mg (100 µg) IM/IV 33% (SL); 92% (TD); 89% (INS); 50% (buc) 0.04 (IV); 7 (TD) 5 min (TD/IV) 30–60 minutes (IV)
Acrylfentanyl (50–100+)
Buprenorphine (Transdermal)[35][36] 100–115 0.1 mg (100 µg) 30% (SL);[31] ~100% (TD); 65% (buccal);[32][33] 48% (INS)[34] 3:1 45–60 minutes 12–24 hours
14-Cinnamoyloxycodeinone 177 77 µg
Remifentanil 100–200 50–100 µg 0.05 (3–6 min context-sensitive half-life; 7–18min elimination half-life) Instantaneously (from 5 to 15 sec) 15 minutes; rapid offset of effects necessitates continuous infusion for maintenance of anesthesia
Ocfentanil 125–250 40–80 µg
Ro4-1539 240–480 20-40 µg
Sufentanil 500–1,000 10–20 µg 4.4
BDPC 504 ~20 µg
C-8813 591
4-Phenylfentanyl 800
3-Methylfentanyl 1000–1500
Etorphine 1,000–3,000 3.3–10 µg
Ohmefentanyl 6300
Acetorphine 8700 1.33 µg
Dihydroetorphine[37] 1,000–12,000 0.83–10 µg (20–40 µg SL)
Carfentanil[38] 10,000 1.0 µg 7.7
2-Fluorohmefentanil 18,000
4-Carboethoxyohmefentanil 30,000
Ohmecarfentanil (30,000)
R-30490 (10,000–100,000)−
Lofentanil (10,000–100,000)+
14-Methoxymetopon (intraspinally) (1,000,000)
PO: oral • IV: intravenous injection • IM: intramuscular injection • SC: subcutaneous injection • SL: sublingual • TD: transdermal
"Strength" is defined as analgesic potency relative to oral morphine.
Tolerance, sensitization, cross-tolerance, metabolism, and hyperalgesia may be complex factors in some individuals.
Interactions with other drugs, food and drink, and other factors may increase or decrease the effect of certain analgesics and alter their half-life.
Because some listed analgesics are prodrugs or have active metabolites, individual variation in liver enzymes (e.g., CYP2D6 enzyme) may result in significantly altered effects.

See also edit

  • Oripavine – for more on the comparative strength of oripavine derivatives

Explanatory notes edit

  1. ^ Approximate. There is a wide range of values in controlled trials.[9]
  2. ^ 10 mg oral morphine is equivalent to n mg analgesic drug x, e.g. 10 mg morphine is equivalent to 3600 mg paracetamol or 1.5 mg hydromorphone

Citations edit

  1. ^ a b Joishy 1999.
  2. ^ McPherson 2009, p. 5.
  3. ^ a b Natusch 2012.
  4. ^ McPherson 2009, p. 3.
  5. ^ McPherson 2009, p. 4.
  6. ^ McPherson 2009, p. 8.
  7. ^ McPherson 2009, p. 9.
  8. ^ Anderson et al 2001.
  9. ^ Pereira et al 2001.
  10. ^ a b c "Dosing Guidelines for Acetaminophen and Selected NSAIDs" (PDF). Elsevier Health. Mosby. 1999. Retrieved 2022-11-22.
  11. ^ "Diclofenac (Voltaren®) vs Naproxen (Aleve®, Naprosyn®) - eMedExpert.com". www.emedexpert.com. Retrieved 2022-11-22.
  12. ^ Pharma Guide Pre-Work 3rd Edition
  13. ^ a b . Drugs of Abuse. Drug Enforcement Administration, U.S. Department of Justice. 2005. Archived from the original on 2006-11-02.
  14. ^ KuKanich B (February 2010). "Pharmacokinetics of acetaminophen, codeine, and the codeine metabolites morphine and codeine-6-glucuronide in healthy Greyhound dogs". J. Vet. Pharmacol. Ther. 33 (1): 15–21. doi:10.1111/j.1365-2885.2009.01098.x. PMC 2867071. PMID 20444020.
  15. ^ "ULTRAM® (tramadol hydrochloride) Tablets Full Prescribing Information" (PDF). US Food and Drug Administration. Ortho-McNeil Pharmaceutical, Inc. March 2008. p. 4. Retrieved December 28, 2016. The mean terminal plasma elimination half-lives of racemic tramadol and racemic M1 are 6.3 ± 1.4 and 7.4 ± 1.4 hours, respectively. The plasma elimination half-life of racemic tramadol increased from approximately six hours to seven hours upon multiple dosing.
  16. ^ "Anileridine". DrugBank Version: 3.0. DrugBank.
  17. ^ a b Cupp 2012.
  18. ^ Zacny JP, Gutierrez S (April 2009). "Within-subject comparison of the psychopharmacological profiles of oral hydrocodone and oxycodone combination products in non-drug-abusing volunteers". Drug Alcohol Depend. 101 (1–2): 107–14. doi:10.1016/j.drugalcdep.2008.11.013. PMID 19118954.
  19. ^ "TALWIN (pentazocine lactate) injection, solution". DailyMed. National Institute of Health. Retrieved 2011-12-10.
  20. ^ a b "Equianalgesic Conversion". GlobalRPH.
  21. ^ Sunshine, A.; Olson, N.; Colon, A.; Rivera, J.; Kaiko, R.F.; Fitzmartin, R.D.; Reder, R.F.; Goldenheim, P.D. (July 1996). "Analgesic Efficacy of Controlled‐Release Oxycodone in Postoperative Pain". Journal of Clinical Pharmacology. 36 (7): 595–603. doi:10.1002/j.1552-4604.1996.tb04223.x. PMID 8844441. S2CID 35076787.
  22. ^ a b Silvasti, M; Rosenberg, P; Seppälä, T; Svartling, N; Pitkänen, M (May 1998). "Comparison of analgesic efficacy of oxycodone and morphine in postoperative intravenous patient-controlled analgesia". Acta Anaesthesiologica Scandinavica. 42 (5): 576–580. doi:10.1111/j.1399-6576.1998.tb05169.x. PMID 9605375. S2CID 25763059. Retrieved 10 August 2022.
  23. ^ Tabla de equivalencia opiáceos
  24. ^ a b Manfredonia JF (March 2005). "Prescribing methadone for pain management in end-of-life care". J Am Osteopath Assoc. 105 (3 Suppl 1): S18–21. PMID 18154194. Table 2: Conversion Ratio of Oral Morphine to Methadone.
  25. ^ Reichle CW, Smith GM, Gravenstein JS, Macris SG, Beecher HK (April 1962). "Comparative analgesic potency of heroin and morphine in postoperative patients". J. Pharmacol. Exp. Ther. 136 (1): 43–6. PMID 14491157.
  26. ^ Cone, E. J.; Holicky, B. A.; Grant, T. M.; Darwin, W. D.; Goldberger, B. A. (October 1993). "Pharmacokinetics and pharmacodynamics of intranasal 'snorted' heroin". Journal of Analytical Toxicology. 17 (6): 327–337. doi:10.1093/jat/17.6.327. ISSN 0146-4760. PMID 8271778.
  27. ^ Sawynok J (January 1986). "The therapeutic use of heroin: a review of the pharmacological literature". Canadian Journal of Physiology and Pharmacology. 64 (1): 1–6. doi:10.1139/y86-001. PMID 2420426.
  28. ^ Toronto Surgery 2014.
  29. ^ Walker 2001.
  30. ^ "Levorphanol". DrugBank Version: 3.0. DrugBank.
  31. ^ a b Mendelson J, Upton RA, Everhart ET, Jacob P 3rd, Jones RT (1997). "Bioavailability of sublingual buprenorphine". Journal of Clinical Pharmacology. 37 (1): 31–7. doi:10.1177/009127009703700106. PMID 9048270
  32. ^ a b "Buprenorphine / Naloxone Buccal Film (BUNAVAIL) C-III" (PDF). Pharmacy Benefits Management (PBM) Services. September 2014.
  33. ^ a b BUNAVAIL (buprenorphine and naloxone) buccal film, CIII [prescribing information online]. BioDelivery BioDelivery Sciences International, Inc. (BDSI), Raleigh, NC. Jun 2014.
  34. ^ a b Eriksen J, Jensen NH, Kamp-Jensen M, Bjarnø H, Friis P, Brewster D (1989). "The systemic availability of buprenorphine administered by nasal spray". J. Pharm. Pharmacol. 41 (11): 803–5. doi:10.1111/j.2042-7158.1989.tb06374.x
  35. ^ Khanna, IK; Pillarisetti, S (2015). "Buprenorphine - an attractive opioid with underutilized potential in treatment of chronic pain". Journal of pain research. 8: 859–70. doi:10.2147/JPR.S85951. PMID 26672499
  36. ^ Cote, J; Montgomery, L (July 2014). "Sublingual buprenorphine as an analgesic in chronic pain: a systematic review". Pain medicine (Malden, Mass.). 15 (7): 1171–8. doi:10.1111/pme.12386. PMID 24995716
  37. ^ Ohmori, Satoshi; Morimoto, Yasunori (2002). "Dihydroetorphine: a potent analgesic: pharmacology, toxicology, pharmacokinetics, and clinical effects". CNS Drug Reviews. 8 (4): 391–404. doi:10.1111/j.1527-3458.2002.tb00236.x. ISSN 1080-563X. PMC 6741694. PMID 12481194. Dihydroetorphine (DHE) is one of the strongest analgesic opioid alkaloids known; it is 1000 to 12,000 times more potent than morphine. ...
         MOR is the most commonly used opioid analgesic for pain relief, and its oral daily dose (20 to 1000 mg) is relatively high (44). On the other hand, DHE produces rapid analgesic effects at an extremely low dose, 20 ìg sublingually in humans (60, 78). ...
  38. ^ "Carfentanil". DrugBank Version: 3.0. DrugBank.

General and cited references edit

Books edit

  • Cupp, Melanie (August 2012). "Equianalgesic Dosing of Opioids for Pain Management. PL Detail-Document #280801" (PDF). Pharmacist's Letter.
  • Joishy, S. K. (1999). Palliative medicine secrets. Philadelphia PA: Hanley & Belfus. p. 97. ISBN 978-1-56053-304-7.
  • McCaffery, Margo; Pasero, Chris (1999). Pain: Clinical Manual (2nd ed.). Mosby. ISBN 978-0-8151-5609-3., Extra information, including printable charts
  • McPherson, Mary Lynn M. (2009). Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing. Bethesda MD: American Society of Health-System Pharmacists. p. 5. ISBN 978-1-58528-297-5.

Articles edit

  • Anderson, Robert; Saiers, Joseph H; Abram, Stephen; Schlicht, Christian (May 2001). "Accuracy in Equianalgesic Dosing". Journal of Pain and Symptom Management. 21 (5): 397–406. doi:10.1016/S0885-3924(01)00271-8. PMID 11369161.
  • Natusch, Douglas (February 2012). "Equianalgesic doses of opioids – their use in clinical practice". British Journal of Pain. 6 (1): 43–46. doi:10.1177/2049463712437628. PMC 4590088. PMID 26516465.
  • Pereira, Jose; Lawlor, Peter; Vigano, Antonio; Dorgan, Marlene; Bruera, Eduardo (August 2001). "Equianalgesic Dose Ratios for Opioids". Journal of Pain and Symptom Management. 22 (2): 672–687. doi:10.1016/s0885-3924(01)00294-9. PMID 11495714.
  • Shaheen, Philip E.; Walsh, Declan; Lasheen, Wael; Davis, Mellar P.; Lagman, Ruth L. (September 2009). "Opioid equianalgesic tables: are they all equally dangerous?". Journal of Pain and Symptom Management. 38 (3): 409–417. doi:10.1016/j.jpainsymman.2009.06.004. ISSN 1873-6513. PMID 19735901.

Websites edit

  • "Opioid Equianalgesic Table". Lecture Notes. Department of Surgery, University of Toronto. November 2014. Retrieved 26 February 2020.
  • Walker, Paul (2001). . Palliative Care Tips: Info for Health Professionals. Palliative & End of Life Care (PEOLC), Alberta Health Services. Archived from the original on December 24, 2001.
  • "Management of Opioid Therapy (OT) for Chronic Pain (2017)" (PDF). VA/DoD Clinical Practice Guidelines. Department of Veterans Affairs. p. 99. Retrieved 26 February 2020.
  • Online opioid equianalgesia calculator Electronic calculator that includes logic for bidirectional and dose-dependent conversions

December 15, 2023
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An equianalgesic chart is a conversion chart that lists equivalent doses of analgesics drugs used to relieve pain Equianalgesic charts are used for calculation of an equivalent dose a dose which would offer an equal amount of analgesia between different analgesics 1 Tables of this general type are also available for NSAIDs benzodiazepines depressants stimulants anticholinergics and others Contents 1 Format 2 Purpose 3 Precautions 4 Opioid equivalency table 4 1 Nonlinearities 5 See also 6 Explanatory notes 7 Citations 8 General and cited references 8 1 Books 8 2 Articles 8 3 WebsitesFormat editEquianalgesic tables are available in different formats such as pocket sized cards for ease of reference 1 A frequently seen format has the drug names in the left column the route of administration in the center columns and any notes in the right column 2 3 Purpose editThere are several reasons for switching a patient to a different pain medication These include practical considerations such as lower cost or unavailability of a drug at the patient s preferred pharmacy or medical reasons such as lack of effectiveness of the current drug or to minimize adverse effects Some patients request to be switched to a different narcotic due to stigma associated with a particular drug e g a patient refusing methadone due to its association with opioid addiction treatment 4 Equianalgesic charts are also used when calculating an equivalent dosage of the same drug but with a different route of administration citation needed Precautions editAn equianalgesic chart can be a useful tool but the user must take care to correct for all relevant variables such as route of administration cross tolerance half life and the bioavailability of a drug 5 For example the narcotic levorphanol is 4 8 times stronger than morphine but also has a much longer half life Simply switching the patient from 40 mg of morphine to 10 mg of levorphanol would be dangerous due to dose accumulation and hence frequency of administration should also be taken into account There are other concerns about equianalgesic charts Many charts derive their data from studies conducted on opioid naive patients Patients with chronic rather than acute pain may respond to analgesia differently Repeated administration of a medication is also different from single dosing as many drugs have active metabolites that can build up in the body 6 Patient variables such as sex age and organ function may also influence the effect of the drug on the system These variables are rarely included in equianalgesic charts 7 3 8 Opioid equivalency table editThis section appears to contradict the equianalgesic table in the article on oxycodone Please discuss at the talk page and do not remove this message until the contradictions are resolved September 2023 Opioids are a class of compounds that elicit analgesic pain killing effects in humans and animals by binding to the µ opioid receptor within the central nervous system The following table lists opioid and non opioid analgesic drugs and their relative potencies Values for the potencies represent opioids taken orally unless another route of administration is provided As such their bioavailabilities differ and they may be more potent when taken intravenously citation needed Nonlinearities edit This chart measures pain relief versus mass of medication Not all medications have a fixed relationship on this scale Methadone is different from most opioids because its potency can vary depending on how long it is taken Acute use 1 3 days yields a potency about 1 5 stronger than that of morphine and chronic use 7 days yields a potency about 2 5 to 5 that of morphine Similarly the effect of tramadol increases after consecutive dosing due to the accumulation of its active metabolite and an increase of the oral bioavailability in chronic use citation needed Comparison to oral morphine a Analgesic Strength relative Equivalent dose 10 mg oral morphine b Bioavailability Half life of active metabolites hours Oral to parenteral ratio Speed of onset DurationParacetamol non opioid 1 360 3600 mg 63 89 1 4 37 min PO 8 min IV 5 6 hoursAspirin NSAID non opioid 1 360 3600 mg 80 100 3 1 9Ibuprofen 10 NSAID non opioid 1 222 2220 mg 87 100 1 3 3Diflunisal NSAID non opioid 1 160 1600 mg 80 90 8 12Naproxen 10 NSAID non opioid 1 138 1380 mg 95 12 24Piroxicam NSAID non opioid 1 120 est Indomethacin NSAID non opioid 1 64 est Diclofenac 10 11 NSAID non opioid 1 10 est same as Codeine 100 mg est 50 60 1 4Ketorolac 12 NSAID non opioid 1 3 est 30 mg IV est 80 100 5 7Nefopam Centrally acting non opioid 5 8 est 16 mg IM est Nefopam 3 8 Desmethylnefopam 10 15Dextropropoxyphene 13 1 13 1 20 130 200 mgCodeine 1 10 3 20 100 120 mg PO 90 2 5 3 C6G 1 94 14 morphine 2 3 15 30 min PO 4 6 hoursTramadol 1 10 100 mg 75 IR 85 90 ER 6 0 8 8 15 M1 Opium oral 1 10 100 mg 25 morphine 2 5 3 0 morphine codeine Tilidine 1 10 100 mgDihydrocodeine 1 5 50 mg 20 4Anileridine 16 1 4 40 mgAlphaprodine 1 4 1 6 40 60 mgTapentadol 17 3 10 32 mg 32 fasting Pethidine meperidine 1 3 30 mg SC IM IV 300 mg PO 50 60 3 5Benzylfentanyl 1 2AH 7921 4 5Hydrocodone 1 10 mg 70 18 3 8 6 Instant Release PO 10 30 min Instant Release PO 4 6Metopon 1 10 mgPentazocine lactate IV 19 1 10 mg SC IV IM 150 mg PO Morphine oral 1 10 mg 25 2 4 3 1 30 min PO 3 6 hoursOxycodone oral 20 1 5 6 67 mg 60 87 2 3 hours Instant Release PO 4 5 hours Controlled Release PO 10 30 min Instant Release PO 1 hour Controlled Release PO 3 6 hours Instant Release PO 10 12 hours Controlled Release PO 21 Spiradoline 1 5Nicomorphine 2 3 3 33 5 mg 20 4Oxycodone IV 22 3 3 33 mg 96 1 5 3 IV 5 min IV 22 2 4 hoursMorphine IV IM 3 3 33 mg 100 2 3 3 1 Instantaneously from 5 to 15 sec IV 5 15 min IM 3 7 hoursClonitazene 3 3 33 mgMethadone acute 23 24 3 4 2 5 3 33 mg 40 90 15 60 2 1Methadone chronic 24 2 5 5 2 4 mg 40 90 15 60 2 1Phenazocine 4 2 5 mgDiamorphine Heroin IV IM 25 4 5 iv im 2 2 5 insufflated 26 2 2 5 mg 100 lt 0 6 morphine prodrug 27 Instantaneously from 5 to 15 sec IV 2 to 5 min IM 3 to 7 hoursDezocine 4 6 1 6 2 5 mg 97 IM 2 2Hydromorphone 28 29 17 10 15 SC IV IM 3 75 5 PO 0 75 mg SC IV IM 2 mg PO 62 2 3 5 1Oxymorphone 20 8 3 33 mg PO 1 mg IV IM amp Interlaminar 10 PO 25 Sublabial 28 Buccal 35 40 Sublingual amp Intranasal 43 BA 7 25 9 43 35 min PO Instantaneously from 5 to 15 sec IV 6 8 hoursU 47700 7 5 1 5 mg 1 5 3Levorphanol 30 8 1 25 mg 70 11 16 1 1Desomorphine Krokodil 8 10 1 1 25 mg 100 IV 2 3 Instantaneously from 5 to 15 sec IV 2 5 min IM 3 4 hoursN Phenethylnormorphine 8 14Alfentanyl 10 25 1 5 90 111 minutes Instantaneously from 5 to 15 sec 4 more rapid than fentanyl 0 25 hr 15 min up to 54 minutes until offset of effectsTrefentanil 10 25 Brifentanil 10 25 Acetylfentanyl 157 Hydroxymitragynine 17 0 6 mgFuranylfentanyl 20Butyrfentanyl 25Enadoline 25 15 µg threshold and 0 160 mg kg dissociative effects Buprenorphine SL 13 40 0 25 mg 30 SL 31 100 TD 65 buccal 32 33 48 INS 34 20 70 mean 37 3 1 45 min 12 24 hoursN Phenethyl 14 ethoxymetopon 60 160 µgEtonitazene 60 160 µgPhenomorphan 60 80 0 13 0 16 mgN Phenethylnordesomorphine 85Phenaridine 50 100 Fentanyl 50 100 0 1 mg 100 µg IM IV 33 SL 92 TD 89 INS 50 buc 0 04 IV 7 TD 5 min TD IV 30 60 minutes IV Acrylfentanyl 50 100 Buprenorphine Transdermal 35 36 100 115 0 1 mg 100 µg 30 SL 31 100 TD 65 buccal 32 33 48 INS 34 3 1 45 60 minutes 12 24 hours14 Cinnamoyloxycodeinone 177 77 µgRemifentanil 100 200 50 100 µg 0 05 3 6 min context sensitive half life 7 18min elimination half life Instantaneously from 5 to 15 sec 15 minutes rapid offset of effects necessitates continuous infusion for maintenance of anesthesiaOcfentanil 125 250 40 80 µgRo4 1539 240 480 20 40 µgSufentanil 500 1 000 10 20 µg 4 4BDPC 504 20 µgC 8813 5914 Phenylfentanyl 8003 Methylfentanyl 1000 1500Etorphine 1 000 3 000 3 3 10 µgOhmefentanyl 6300Acetorphine 8700 1 33 µgDihydroetorphine 37 1 000 12 000 0 83 10 µg 20 40 µg SL Carfentanil 38 10 000 1 0 µg 7 72 Fluorohmefentanil 18 0004 Carboethoxyohmefentanil 30 000Ohmecarfentanil 30 000 R 30490 10 000 100 000 Lofentanil 10 000 100 000 14 Methoxymetopon intraspinally 1 000 000 PO oral IV intravenous injection IM intramuscular injection SC subcutaneous injection SL sublingual TD transdermal Strength is defined as analgesic potency relative to oral morphine Tolerance sensitization cross tolerance metabolism and hyperalgesia may be complex factors in some individuals Interactions with other drugs food and drink and other factors may increase or decrease the effect of certain analgesics and alter their half life Because some listed analgesics are prodrugs or have active metabolites individual variation in liver enzymes e g CYP2D6 enzyme may result in significantly altered effects See also editOripavine for more on the comparative strength of oripavine derivativesExplanatory notes edit Approximate There is a wide range of values in controlled trials 9 10 mg oral morphine is equivalent to n mg analgesic drug x e g 10 mg morphine is equivalent to 3600 mg paracetamol or 1 5 mg hydromorphoneCitations edit a b Joishy 1999 McPherson 2009 p 5 a b Natusch 2012 McPherson 2009 p 3 McPherson 2009 p 4 McPherson 2009 p 8 McPherson 2009 p 9 Anderson et al 2001 Pereira et al 2001 a b c Dosing Guidelines for Acetaminophen and Selected NSAIDs PDF Elsevier Health Mosby 1999 Retrieved 2022 11 22 Diclofenac Voltaren vs Naproxen Aleve Naprosyn eMedExpert com www emedexpert com Retrieved 2022 11 22 Pharma Guide Pre Work 3rd Edition a b Ch 4 Narcotics Synthetic Narcotics Dextropropoxyphene Drugs of Abuse Drug Enforcement Administration U S Department of Justice 2005 Archived from the original on 2006 11 02 KuKanich B February 2010 Pharmacokinetics of acetaminophen codeine and the codeine metabolites morphine and codeine 6 glucuronide in healthy Greyhound dogs J Vet Pharmacol Ther 33 1 15 21 doi 10 1111 j 1365 2885 2009 01098 x PMC 2867071 PMID 20444020 ULTRAM tramadol hydrochloride Tablets Full Prescribing Information PDF US Food and Drug Administration Ortho McNeil Pharmaceutical Inc March 2008 p 4 Retrieved December 28 2016 The mean terminal plasma elimination half lives of racemic tramadol and racemic M1 are 6 3 1 4 and 7 4 1 4 hours respectively The plasma elimination half life of racemic tramadol increased from approximately six hours to seven hours upon multiple dosing Anileridine DrugBank Version 3 0 DrugBank a b Cupp 2012 Zacny JP Gutierrez S April 2009 Within subject comparison of the psychopharmacological profiles of oral hydrocodone and oxycodone combination products in non drug abusing volunteers Drug Alcohol Depend 101 1 2 107 14 doi 10 1016 j drugalcdep 2008 11 013 PMID 19118954 TALWIN pentazocine lactate injection solution DailyMed National Institute of Health Retrieved 2011 12 10 a b Equianalgesic Conversion GlobalRPH Sunshine A Olson N Colon A Rivera J Kaiko R F Fitzmartin R D Reder R F Goldenheim P D July 1996 Analgesic Efficacy of Controlled Release Oxycodone in Postoperative Pain Journal of Clinical Pharmacology 36 7 595 603 doi 10 1002 j 1552 4604 1996 tb04223 x PMID 8844441 S2CID 35076787 a b Silvasti M Rosenberg P Seppala T Svartling N Pitkanen M May 1998 Comparison of analgesic efficacy of oxycodone and morphine in postoperative intravenous patient controlled analgesia Acta Anaesthesiologica Scandinavica 42 5 576 580 doi 10 1111 j 1399 6576 1998 tb05169 x PMID 9605375 S2CID 25763059 Retrieved 10 August 2022 Tabla de equivalencia opiaceos a b Manfredonia JF March 2005 Prescribing methadone for pain management in end of life care J Am Osteopath Assoc 105 3 Suppl 1 S18 21 PMID 18154194 Table 2 Conversion Ratio of Oral Morphine to Methadone Reichle CW Smith GM Gravenstein JS Macris SG Beecher HK April 1962 Comparative analgesic potency of heroin and morphine in postoperative patients J Pharmacol Exp Ther 136 1 43 6 PMID 14491157 Cone E J Holicky B A Grant T M Darwin W D Goldberger B A October 1993 Pharmacokinetics and pharmacodynamics of intranasal snorted heroin Journal of Analytical Toxicology 17 6 327 337 doi 10 1093 jat 17 6 327 ISSN 0146 4760 PMID 8271778 Sawynok J January 1986 The therapeutic use of heroin a review of the pharmacological literature Canadian Journal of Physiology and Pharmacology 64 1 1 6 doi 10 1139 y86 001 PMID 2420426 Toronto Surgery 2014 Walker 2001 Levorphanol DrugBank Version 3 0 DrugBank a b Mendelson J Upton RA Everhart ET Jacob P 3rd Jones RT 1997 Bioavailability of sublingual buprenorphine Journal of Clinical Pharmacology 37 1 31 7 doi 10 1177 009127009703700106 PMID 9048270 a b Buprenorphine Naloxone Buccal Film BUNAVAIL C III PDF Pharmacy Benefits Management PBM Services September 2014 a b BUNAVAIL buprenorphine and naloxone buccal film CIII prescribing information online BioDelivery BioDelivery Sciences International Inc BDSI Raleigh NC Jun 2014 a b Eriksen J Jensen NH Kamp Jensen M Bjarno H Friis P Brewster D 1989 The systemic availability of buprenorphine administered by nasal spray J Pharm Pharmacol 41 11 803 5 doi 10 1111 j 2042 7158 1989 tb06374 x Khanna IK Pillarisetti S 2015 Buprenorphine an attractive opioid with underutilized potential in treatment of chronic pain Journal of pain research 8 859 70 doi 10 2147 JPR S85951 PMID 26672499 Cote J Montgomery L July 2014 Sublingual buprenorphine as an analgesic in chronic pain a systematic review Pain medicine Malden Mass 15 7 1171 8 doi 10 1111 pme 12386 PMID 24995716 Ohmori Satoshi Morimoto Yasunori 2002 Dihydroetorphine a potent analgesic pharmacology toxicology pharmacokinetics and clinical effects CNS Drug Reviews 8 4 391 404 doi 10 1111 j 1527 3458 2002 tb00236 x ISSN 1080 563X PMC 6741694 PMID 12481194 Dihydroetorphine DHE is one of the strongest analgesic opioid alkaloids known it is 1000 to 12 000 times more potent than morphine MOR is the most commonly used opioid analgesic for pain relief and its oral daily dose 20 to 1000 mg is relatively high 44 On the other hand DHE produces rapid analgesic effects at an extremely low dose 20 ig sublingually in humans 60 78 Carfentanil DrugBank Version 3 0 DrugBank General and cited references editBooks edit Cupp Melanie August 2012 Equianalgesic Dosing of Opioids for Pain Management PL Detail Document 280801 PDF Pharmacist s Letter Joishy S K 1999 Palliative medicine secrets Philadelphia PA Hanley amp Belfus p 97 ISBN 978 1 56053 304 7 McCaffery Margo Pasero Chris 1999 Pain Clinical Manual 2nd ed Mosby ISBN 978 0 8151 5609 3 Extra information including printable charts McPherson Mary Lynn M 2009 Demystifying Opioid Conversion Calculations A Guide for Effective Dosing Bethesda MD American Society of Health System Pharmacists p 5 ISBN 978 1 58528 297 5 Articles edit Anderson Robert Saiers Joseph H Abram Stephen Schlicht Christian May 2001 Accuracy in Equianalgesic Dosing Journal of Pain and Symptom Management 21 5 397 406 doi 10 1016 S0885 3924 01 00271 8 PMID 11369161 Natusch Douglas February 2012 Equianalgesic doses of opioids their use in clinical practice British Journal of Pain 6 1 43 46 doi 10 1177 2049463712437628 PMC 4590088 PMID 26516465 Pereira Jose Lawlor Peter Vigano Antonio Dorgan Marlene Bruera Eduardo August 2001 Equianalgesic Dose Ratios for Opioids Journal of Pain and Symptom Management 22 2 672 687 doi 10 1016 s0885 3924 01 00294 9 PMID 11495714 Shaheen Philip E Walsh Declan Lasheen Wael Davis Mellar P Lagman Ruth L September 2009 Opioid equianalgesic tables are they all equally dangerous Journal of Pain and Symptom Management 38 3 409 417 doi 10 1016 j jpainsymman 2009 06 004 ISSN 1873 6513 PMID 19735901 Websites edit Opioid Equianalgesic Table Lecture Notes Department of Surgery University of Toronto November 2014 Retrieved 26 February 2020 Walker Paul 2001 Issue 17 Morphine vs Hydromorphone vs Oxycodone vs The Patch Palliative Care Tips Info for Health Professionals Palliative amp End of Life Care PEOLC Alberta Health Services Archived from the original on December 24 2001 Management of Opioid Therapy OT for Chronic Pain 2017 PDF VA DoD Clinical Practice Guidelines Department of Veterans Affairs p 99 Retrieved 26 February 2020 Online opioid equianalgesia calculator Electronic calculator that includes logic for bidirectional and dose dependent conversions Retrieved from https en wikipedia org w index php title Equianalgesic amp oldid 1182440429, wikipedia, wiki, book, books, library,

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