Starting Doses of Opioids
Titrate dose and frequency to maintain adequate symptom control.
Dose and frequency increases may need to be very aggressive during the active dying process.
There is no absolute maximum dose for opioid medications.
Frequency may be increased up to q30 min PRN for enteral dosing and up to q10 min PRN for IV dosing.
Intermittent Starting Doses |
| PO | IV/SQ | |
| Oxycodone | 0.1 - 0.2 mg/kg, q4h* |
--- |
| Morphine | 0.2 - 0.3 mg/kg, q4h* |
0.1 mg/kg, q4h |
| HydroMORPHone | 0.04 - 0.07 mg/kg, q4h |
15 mcg/kg, q4h |
| Fentanyl | --- | 1 mcg/kg, q2h |
| If using for dyspnea alone - start at half of the above dosing |
*oxycodone, morphine, and hydromorphone are available in oral liquids, which can also be given sublingual at the same dose
IV Continuous Infusion/PCA Starting Doses |
| Morphine | 50 mcg/kg/hr | 27 mcg/kg PCA/NCA | 10 min lockout |
| HydroMORPHone | 8 mcg/kg/hr | 4 mcg/kg PCA/NCA | 10 min lockout |
| Fentanyl | 0.5 mcg/kg/hr | 0.27 mcg/kg PCA/NCA | 10 min lockout |
Equianalgesic Doses |
| PO | IV/SQ | |
| Oxycodone | 20 mg | -- |
| Morphine | 30 mg | 10 mg |
| HydroMORPHone | 7.5 mg | 1.5 mg |
| Fentanyl | -- | 100 mcg |
| Reduce dosing by 20% - 30% for incomplete cross-tolerance |
These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.