Today we did a special rounds on palliative care. The discussant touched upon many of the important issues of symptom control, managing drug side effects, and psychosocial management.
I wanted to provide you with some information on narcotic equivalence:
1) ORAL to IV conversion is approximately 2 to 1 (i.e. 10mg oral morphine is 5mg IV morphine)
2)
Tylenol #1 = 8mg codeine
Tylenol #2 = 16mg codeine
Tylenol #3 = 30mg codeine
Tylenol #4 = 60mg codeine
** Caveat -- some people (~1/7) won't metabolize codeine. Others will metabolize codeine much more than predicted. So I tend of avoid it **
3)
60mg codeine is equal to approximately 10mg of oral morphine.
10mg of oral morphine is approximately 2mg of oral hydromorphone
30mg of oral morphine is approximately 20mg of oral oxycodone
90mg of oral morphine (OVER 24hours) is equal to approximately a 25mcg/hr fentanyl patch (OVER 24 hours)
Principles of analgesia titration:
Give reasonable dose on a prn basis (i.e. morphine 10mg po q2h prn or q4h prn)
Find the 24 hour total usage and apply this (minus about 25%) as a standing dose with prns approximately 10% of the total 24h dose.
(i.e. if they used 120mg, you would give them 15mg po q4h standing and 10mg po q2h prn)
Titrate daily as required (usually not by more than 25-50%)
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