What should be considered when prescribing opioid equivalents?

Updated: Jan 29, 2018
  • Author: Stephen Kishner, MD, MHA; Chief Editor: Erik D Schraga, MD  more...
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See the list below:

  • A thorough pain assessment is vital to the initial evaluation of a patient and must be performed to guide treatment decisions. [1, 2, 3, 4, 5]

  • Dosing may be done incrementally and titrated to analgesic effect. Particularly in those without prior analgesic use, effects are variable and overdosing in these patients can result in adverse events.

  • Individualize doses based on risk for adverse outcomes, prior effective doses, comorbidities, concomitant medications, and response to therapy.

  • Immediate-release opioids are recommended for breakthrough pain.

  • When possible, use the same class of opioid analgesic for long-acting (ie, 24-hour scheduled doses) and short-acting (ie, PRN doses for breakthrough pain) pain relief.

  • Dosing charts are guidelines only.

  • Most data are reported for opioid-tolerant patients so must be used with caution.

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