Commonly Used Step 3 Opioids
| Drug | Dosage Form (Brand Name) | Usual Adult Dosage | Cost* |
|---|---|---|---|
| Immediate-Release Product | |||
| Morphine | IV: 1, 2, 4, 5, 8, 10, 15, 25, 50 mg/mL | IV: 2–10 mg | $18–30/100s tab; $9–13/100 mL liquid; $15–30/12s supp |
| Tablets: 15, 30 mg (MSIR, generic) | SC/IM: 10 mg q4 hours | ||
| Liquid: 10 mg/5 mL, 20 mg/5 mL, 20 mg/mL, 100 mg/5 mL (Roxanol, others) | PO: 10–30 mg q4 hours | ||
| Suppositories: 5, 10, 20, 30 mg (various) | Rectal: 10–20 mg q4 hours | ||
| Hydromorphone | IV: 1, 2, 4, 10 mg/mL (Dilaudid, others) | IV/IM/SC: 1–4 q4–6 hours | $37–70/100s tab; $22/6s supp |
| Tablets: 1, 2, 3, 4, 8 mg (Dilaudid, others) | PO: 2–6 mg q3–4 hours | ||
| Liquid: 5 mg/5 mL (Dilaudid, others) | Rectal: 3 mg q6–8 hours | ||
| Suppositories: 3 mg (Dilaudid, others) | |||
| Oxycodone | Tablets: 5 mg (Percolone, Roxicodone) | PO: 10–30 mg q 4 hours | $30–36/100s tab |
| Capsules: 5 mg (OxyIR) | |||
| Liquid: 5 mg/5 mL (Roxicodone), 20 mg/mL (Roxicodone Intensol, OxyFAST) | |||
| Meperidine† | IV: 10, 25, 50, 75, 100 mg/mL (various) | IV/IM/SC: 50–100 mg q3–4 hours | $68/100s tab |
| Tablets: 50, 100 mg (Demerol, various) | PO: 50–100 mg q3–4 hours | ||
| Liquid: 50 mg/5 mL (Demerol, various) | |||
| Sustained-Release Products‡ | |||
| Morphine Sustained-Release§ | SR Tablets: 15, 30, 60, 100, 200 mg (MS Contin, Oramorph SR) | Not recommended for initial therapy | $90, $171, $334, $511/100s tabs |
| Oxycodone Controlled-Release§ | CR Tablets: 10, 20, 40, 80 mg | Opioid-naive patients: 10 mg q 12 hours, and titrate | $124, $238, $422, $793/100s |
| Fentanyl Transdermal Patch | Transdermal Patch: 25, 50, 75, 100 μg/hr (Duragesic) | Opioid-naïve patients: 25 μg/hr every 3 days | $62, $102, $163, $203/5s |
| Opioids with Long Duration of Action‡ | |||
| Levorphanol | Tablets: 2 mg (Levo-Dromoran) | PO: 2–4 mg q 6–8 hours | $87/100s |
| Methadone | Tablets: 5, 10, 40 mg (Dolophine, others, generic) | PO: 5–20 mg Q 6–8 hours | $9, $15, $37/100s |
* Cost based on generic pricing listed in 2001 Drug Topics Redbook.
† Not recommended for cancer pain.
‡ Not recommended for initial therapy.
§ Tablets are not to be chewed or crushed.