Comparative properties of selected opioid analgesics

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Adapted from Foley, K.M. & Inturrisi, C.E., "Analgesic drug therapy in cancer
pain: principles and practice," Med Clin North Am, 71:2, 1987, pp. 207-232 and
Cherny, N.I.& Portenoy, R.K., The Management of Cancer Pain, as well as the
Physician's Desk Reference.

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                            lynx-friendly version

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                    Dose (mg)
                equianalgesic to
              10 mg I.M. morphine                Half
              -------------------    I.M./P.O.   Life
Drug         I.M.       Oral(P.O.)   Potency     [hr]   Comments
-----------  ---------------------   ---------  ------  ------------------

Codeine         130         200          2        2-3   Usually combined with
                                                        a nonopioid.
                                                        Biotransformed in part
                                                        to morphine (10%)

Propoxyphene    N/A          50         N/A       2-3   Usually combined with
                                                        nonopioid.
                                                        Norpropoxyphene
                                                        (metabolite)
                                                        accumulation with
                                                        renal impairment may
                                                        cause seizures
                                                        (Brand names: Darvon,
                                                        Darvocet, etc.)

Hydrocodone      20          40           2       3-4   Usually combined with
                                                        a nonopioid.
                                                        (Brand names: Vicodin,
                                                        Lorcet, Anexsia, etc.)
                                                        
Oxycodone        15          30           2       2-3   Usually combined with
                                                        a nonopioid
                                                        (Brand names:
                                                        Percocet, Tylox,
                                                        Roxicet, etc.
                                                        [Oxycodone only:
                                                        Roxicodone])
                                                            
                                                            
  ------------------------------------------------------------------------

                    Dose (mg)
                equianalgesic to
              10 mg I.M. morphine                Half
              -------------------    I.M./P.O.   Life
Drug         I.M.       Oral(P.O.)   Potency     [hr]   Comments
-----------  ---------------------   ---------  ------  ------------------

Morphine         10          60           6       2-3   Morphine-6-glucuronide
                                                        in renal failure may
                                                        predispose
                                                        to additional
                                                        toxicity. Wide range
                                                        of formulations.
                                                        On World Health
                                                        Organization essential
                                                        drug list

Diamorphine       5         N/A          6-10    0.05   Biotransformed
 (Heroin)                                               completely to morphine
                                                        and 6-
                                                        monoacetylmorphine,
                                                        which are responsible
                                                        for analgesic
                                                        activity.

Hydromorphone     1.5         7.5         5       2-3   (Brand name: Dilaudid)

Methadone        10          20           2     15-190  Plasma accumulation
                                                        may lead to delayed
                                                        toxicity
                                                        (oversedation).
                                                        (Brand names: 
                                                        Dolophine, Physeptone)

Meperidine       75         300           5       2-3   Normeperidine
(Pethidine)                                             (metabolite) toxicity
                                                        limits utility.
                                                        Contraindicated in
                                                        patients
                                                        with renal failure and
                                                        those receiving
                                                        monoamine
                                                        oxidase (MAO)
                                                        inhibitors
                                                        (Brand name: Demerol)
                                                            
                                                            
  ------------------------------------------------------------------------

                    Dose (mg)
                equianalgesic to
              10 mg I.M. morphine                Half
              -------------------    I.M./P.O.   Life
Drug         I.M.       Oral(P.O.)   Potency     [hr]   Comments
-----------  ---------------------   ---------  ------  ------------------
                                                            
                                                             
Oxymorphone       1          10 (rectal)  N/A     2-3   No oral formulation
                                                        available. Less
                                                        histamine
                                                        release than other
                                                        opioids.
                                                        (Brand name: Numorphan)

Levorphanol       2           4           2      12-15  Plasma accumulation
                                                        may lead to
                                                        oversedation.
                                                        (Brand name:
                                                        Levo-Dromoran)

Fentanyl       0.1 (100      N/A         N/A       2-3  Transdermal patches
              micrograms)                               deliver 25, 50, 75,
                                                        and 100
                                                        micrograms/hr
                                                        Administered
                                                        intravenously for
                                                        general anaesthesia
                                                        (usually as an adjunct
                                                        to other drugs) in
                                                        doses as high as
                                                        3 mg or more.
                                                        (Brand names:
                                                        Sublimaze, Duragesic.)
                                                           
   ------------------------------------------------------------------------

                    Dose (mg)
                equianalgesic to
              10 mg I.M. morphine                Half
              -------------------    I.M./P.O.   Life
Drug         I.M.       Oral(P.O.)   Potency     [hr]   Comments
-----------  ---------------------   ---------  ------  ------------------

Pentazocine      60          180          3        2-3  Mixed
                                                        agonist-antagonist.
                                                        May cause
                                                        psychotomimetic
                                                        effects. May
                                                        precipitate withdrawal
                                                        in narcotic-dependent
                                                        individuals.
                                                        (Brand name: Talwin)

Butorphanol       2          N/A         N/A       3-4  Available as nasal
                                                        spray for migraine
                                                        headache.
                                                        Mixed
                                                        agonist-antagonist
                                                        similar to
                                                        pentazocine.
                                                        (Brand name: Stadol)

Buprenorphine     0.4        0.6         N/A       ?    No oral formulation
                         (sublingual)                   available in U.S.
                                                        Partial opioid
                                                        agonist. May
                                                        precipitate withdrawal
                                                        in narcotic-dependent
                                                        individuals. Does not
                                                        produce
                                                        psychotomimetic
                                                        effects.
                                                        (Brand names:
                                                        Temgesic, Buprenex,
                                                        Subutex)

 
   ------------------------------------------------------------------------

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