Еквіанальгетичні дози опіоїдних анальгетиків*,†,‡

Еквіанальгетичні дози опіоїдних анальгетиків*,†,‡
Medication	Parenteral (mg)	Oral (mg)
Butorphanol	2	—
Codeine	130	200
Hydromorphone	1.5	7.5
Levorphanol	2	4
Meperidine	75	300
Methadone	10	20
Morphine	10	30
Nalbuphine	10	—
Oxycodone	15§	20
Oxymorphone	1	15
Pentazocine	60	180
* Equivalences are based on single-dose studies influenced by clinical experience. Cross-tolerance between medications is incomplete, so when one medication is substituted for another, the equianalgesic dose should be reduced by 50%; methadone should be reduced by 75–90%. Some experts have suggested that morphine:methadone equivalence is nonlinear and that it changes when morphine dosage is higher, as in the following morphine-to-methadone conversion ratios: < 30 OMME/day: 2:1 31–99 OMME/day: 4:1 100–299 OMME/day: 8:1 300–499 OMME/day: 12:1 500–999 OMME/day: 15:1 ≥ 1000 OMME/day: 20:1 Methadone dosage should still be reduced by 75–90% even when this more conservative equivalence calculation is used.
† See also Kreutzwiser D, Tawfic QA and Pain Guidelines (based on Quill TE: Primer of Palliative Care, ed. 7. Chicago, Academy of Hospice and Palliative Medicine, 2019). ‡ Additional recommendations for even more conservative dosing regimens are available in the following resources: Chou R, Cruciani RA, Fiellin DA, et al. Methadone safety: a clinical practice guideline from the American Pain Society and College on Problems of Drug Dependence, in collaboration with the Heart Rhythm Society. J Pain. 2014;15(4):321-337. doi:10.1016/j.jpain.2014.01.494 McPherson ML, Walker KA, Davis MP, et al. Safe and Appropriate Use of Methadone in Hospice and Palliative Care: Expert Consensus White Paper. J Pain Symptom Manage. 2019;57(3):635-645.e4. doi:10.1016/j.jpainsymman.2018.12.001
§ Parenteral oxycodone is available in Europe but not in the United States.
OMME = oral morphine milligram equivalents.

* Equivalences are based on single-dose studies influenced by clinical experience. Cross-tolerance between medications is incomplete, so when one medication is substituted for another, the equianalgesic dose should be reduced by 50%; methadone should be reduced by 75–90%. Some experts have suggested that morphine:methadone equivalence is nonlinear and that it changes when morphine dosage is higher, as in the following morphine-to-methadone conversion ratios:

< 30 OMME/day: 2:1
31–99 OMME/day: 4:1
100–299 OMME/day: 8:1
300–499 OMME/day: 12:1
500–999 OMME/day: 15:1
≥ 1000 OMME/day: 20:1

Methadone dosage should still be reduced by 75–90% even when this more conservative equivalence calculation is used.

† See also Kreutzwiser D, Tawfic QA and Pain Guidelines (based on Quill TE: Primer of Palliative Care, ed. 7. Chicago, Academy of Hospice and Palliative Medicine, 2019).

‡ Additional recommendations for even more conservative dosing regimens are available in the following resources:

Chou R, Cruciani RA, Fiellin DA, et al. Methadone safety: a clinical practice guideline from the American Pain Society and College on Problems of Drug Dependence, in collaboration with the Heart Rhythm Society. J Pain. 2014;15(4):321-337. doi:10.1016/j.jpain.2014.01.494

McPherson ML, Walker KA, Davis MP, et al. Safe and Appropriate Use of Methadone in Hospice and Palliative Care: Expert Consensus White Paper. J Pain Symptom Manage. 2019;57(3):635-645.e4. doi:10.1016/j.jpainsymman.2018.12.001

§ Parenteral oxycodone is available in Europe but not in the United States.

OMME = oral morphine milligram equivalents.

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