Opioid Equianalgesic Doses

OPIOID EQUIANALGESIC DOSES
All equivalencies should be considered approxi– mations only and can be affected by interpatient variability, type of pain (ie, acute vs. chronic), chronic administration, tolerance, etc. Patients should be monitored for efficacy and adverse reactions and the dose adjusted accordingly.
Generic	Dose Equal to 10mg IM of Morphine Sulfate
Generic	Oral	Injection (IM/IV/SC)¹
morphine²	30mg (60mg)	10mg
codeine	180–200mg	130mg
fentanyl³	N/A	0.1mg (100mcg)
hydrocodone⁴	30mg	N/A
hydromorphone	7.5mg	1.5mg
levorphanol	4mg	2mg
meperidine	300mg	100mg
methadone	10–20mg	5–10mg
oxycodone IR	20–30mg	N/A
oxycodone CR	40mg	N/A
oxymorphone	10mg	N/A
NOTES
Key: CR=controlled-release; IR=immediate-release ¹Although controlled studies are not available, in clinical practice it is customary to consider the doses of opioids given IM, IV, or SC to be equivalent. There may be some differences in pharmacokinetic parameters such as C_max and T_max. ²The conversion ratio of 10mg parenteral morphine = 30mg oral morphine is based on clinical experience in patients with chronic pain. The conversion ratio of 10mg parenteral morphine = 60mg oral morphine is based on a potency study in acute pain. ³See literature for conversion of fentanyl transdermal patch, buccal tablets, buccal soluble film, sublingual tablets, units for transmucosal administration, and nasal spray. ⁴Hydrocodone not available as a single entity product.
REFERENCE
Feldman MD, Christensen JF, Satterfield JM. Behavioral Medicine: A Guide For Clinical Practice, Fourth Edition. New York, NY: McGraw-Hill Education; 2014. (Rev. 6/2018)

Want to read more?