PCMS_Philadelphia_Medicine_Summer2017 - 12

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FEATURE

P h ila d e lp h ia Ta sk Fo rce Rep o r t o n Op io id Ep id emic

EQUIANALGESIC
Opioid
Equivalency
Table
(morphine, oral)

Analgesic	

Equivalent	dose	
Strength	
(10	mg	oral	
(relative)	
morphine)	

Bioavailability	

Half-life	of	active	
metabolites	
(hours)	

Acetaminophen	(nonopioid)	

 1⁄360	

3600	mg	

63-89%	

	

Aspirin	(NSAID,	nonopioid)	

 1⁄360	

3600	mg	

80-100%	

3.1-9	

Ibuprofen[7]	(NSAID,	
non-opioid)	

 1⁄222	

2220	mg	

87-100%	

1.3-3	

Diflunisal	(NSAID,	nonopioid)	(Dolobid)	

 1⁄160	

1600	mg	

80-90%	

8-12	

Naproxen[7]	(NSAID,	
non-opioid)	

 1⁄138	

1380	mg	

95%	

12-24	

Diclofenac[7]	[8](NSAID,	
non-opioid)	

 1⁄14	(est.)	 160	mg	(est.)	

50-60%	

1-4	

Dextropropoxyphene[9]	
		(Darvocet)	

 1⁄13- 1⁄20	

130-200	mg	

	

	

Codeine

 1⁄10	

180	mg	(PO)	

≈90%	

2.5-3	
(C6G	1.94;[10]	morphine	
2-3)	

 1⁄10	

>200	mg	

75%	(IR),	85-90%	
6.0-8.8[11]	(M1)	
(ER)	

Opium	(oral)	

 1⁄10	

≈100	mg	

≈35%	

2.5-3.0	
(morphine,	codeine)	

	

	

	

	

	

Dihydrocodeine

1

  ⁄ 5	

50	mg	

20%	

4	

1	

10	mg	

≥80%	

3.8-6	

1	

10	mg	

≈25%	

	

1.5	

6.67	mg	

≤87%	

3-4.5	

3	

3.33	mg	

100%	

2-3	

	

Tramadol

	

Hydrocodone

	

	

Morphine	(oral)	
Oxycodone

[15]
	

Morphine	(IV/IM)	
Methadone	(acute)

[16][17]

2.5-3.33	mg	

40-90%	

15-60	

Methadone	(chronic)[17]	 2.5-5	

3.33		mg	

40-90%	

15-60	

Diamorphne	(heroin	
IV/IM)18	

4-5	

2-2.5	mg	

100%	

<0.6	

Fentanyl	

50-100	

0.1	mg	(100	μg)	
IM/IV	

33%	(SL);	92%	
(TD)	

0.04	(IV);	7	(TD)	

Carfentanil[20]	

10,000-
100,000	

0.1-1.0	μg	

	

7.7	

References[edit]
1. a b Joishy, S. K. (1999). Palliative medicine secrets. Philadelphia PA:
Hanley & Belfus. p. 97. ISBN 1-56053-304-8.
2. McPherson, Mary Lynn M. (2000). Demystifying Opioid Conversion
Calculations: A Guide for Effective Dosing. Bethesda MD: American Society
of Health-System Pharmacists. p. 5. ISBN 1-58528-198-0.
3. McPherson 2000, p. 3
4. McPherson 2000, p. 4
5. McPherson 2000, p. 8
6. McPherson 2000, p. 9
7. a b c "Dosing Guidelines for Acetaminophen and Selected NSAIDs"
(PDF). www3.us.elsevierhealth.com.
8. ttp://www.emedexpert.com/compare-meds/diclofenac-vs-naproxen.shtml
9. a b "Ch. 4 Narcotics: Synthetic Narcotics: Dextropropoxyphene". Drugs of
Abuse. Drug Enforcement Administration, U.S. Department of Justice. 2005.
10. KuKanich B (February 2010). "Pharmacokinetics of acetaminophen,
codeine, and the codeine metabolites morphine and codeine-6-glucuronide

12 Philadelphia Medicine : Summer 2017

Opioid equivalency table summarized from
https://en.wikipedia.org/wiki/Equianalgesic

	 3-4	

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.
11. "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.
12. Anileridine". DrugBank Version: 3.0. DrugBank.
13. Equianalgesic Dosing of Opioids for Pain Management" (PDF).
August 2012.
14. "TALWIN (pentazocine lactate) injection, solution". DailyMed. National
Institute of Health. Retrieved 2011-12-10.
15. a b "Equianalgesic Conversion". GlobalRPH.
16. J Tabla de equivalencia opiáceos

17. 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 18 154194. Table 2: Conversion Ratio of Oral Morphine
to Methadone.
18. 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.
19. Paul Walker. "MORPHINE vs HYDROMORPHINE vs OXYCODONE
vs THE PATCH". Archived from the original on December 24, 2001.
20. a b "Levorphanol". DrugBank Version: 3.0. DrugBank.
21. Ohmori, Satoshi; Morimoto, Yasunori (2002). "Dihydroetorphine: a
potent analgesic: pharmacology, toxicology, pharmacokinetics, and clinical
effects". CNS drug reviews. 8 (4): 391-404. ISSN 1080-563X. 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).
https://philamedsoc.org/ https://en.wikipedia.org/wiki/Equianalgesic
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