Jump to content

Equianalgesic: Difference between revisions

Add links
From Wikipedia, the free encyclopedia
Browse history interactively
← Previous edit
Content deleted Content added
VisualWikitext
Raiders88 (talk | contribs)
109 edits
→Nonlinearities: No, I did not.
Tags: Mobile edit Mobile web edit
 
(323 intermediate revisions by more than 100 users not shown)
Line 1: Line 1:
{{Short description|Comparison of equivalent doses of pain medications}}{{cs1 config|name-list-style=vanc}}An '''equianalgesic''' chart is a [[Conversion of units|conversion chart]] that lists equivalent doses of [[analgesic]]s (drugs used to relieve pain). Equianalgesic charts are used for calculation of an equivalent dose (a dose which would offer an equal amount of [[Pain management|analgesia]]) between different analgesics.{{sfn|Joishy|1999}} Tables of this general type are also available for [[NSAID]]s, [[benzodiazepine]]s, [[depressant]]s, [[stimulant]]s, [[anticholinergic]]s and others.
An '''equianalgesic''' (or [[opioid|narcotic]]) chart is a conversion chart that lists equivalent doses of
[[analgesic]]s (drugs used to relieve pain). Equianalgesic charts are used for calculation of an equivalent dose (a dose which would offer an equal amount of [[analgesia]]) between different analgesics.<ref name=Joishy99>{{Cite book | ref=harv | title=Palliative medicine secrets | last=Joishy | first=S. K. | year=1999 | publisher=Hanley & Belfus | location=Philadelphia PA | page=97 | isbn=1-56053-304-8}}</ref>


==Format==
==Format==
Equianalgesic tables are available in different formats, such as pocket-sized cards for ease of reference.<ref name=Joishy99/> A frequently-seen format has the drug names in the left column, the route of administration in the center columns and any notes in the right column.<ref>{{Cite book | ref=harv | title=Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing | last=McPherson | first=Mary Lynn M. | year=2000 | publisher=American Society of Health-System Pharmacists | location=Bethesda MD | page=5 | isbn=1-58528-198-0}}</ref>
Equianalgesic tables are available in different formats, such as pocket-sized cards for ease of reference.{{sfn|Joishy|1999}} A frequently-seen format has the drug names in the left column, the route of administration in the center columns and any notes in the right column.{{sfn|McPherson|2009|loc=p.&nbsp;5}}{{sfn|Natusch|2012}}


==Purpose==
==Purpose==
There are several reasons for switching a patient to a different pain medication. These include practical considerations such as lower cost or unavailability of a drug at the patient's preferred pharmacy, or medical reasons such as lack of effectiveness of the current drug or to minimize adverse effects. Some patients request to be switched to a different narcotic due to stigma associated with a particular drug (e.g. a patient refusing [[methadone]] due to its association with [[opioid]] [[Methadone maintenance|addiction treatment]]).<ref>{{Harvnb | McPherson | 2000 | p=3}}</ref> Equianalgesic charts are also used when calculating an equivalent dosage of the same drug, but with a different [[route of administration]].
There are several reasons for switching a patient to a different pain medication. These include practical considerations such as lower cost or unavailability of a drug at the patient's preferred pharmacy, or medical reasons such as lack of effectiveness of the current drug or to minimize adverse effects. Some patients request to be switched to a different narcotic due to stigma associated with a particular drug (e.g. a patient refusing [[methadone]] due to its association with [[opioid]] [[Methadone maintenance|addiction treatment]]).{{sfn|McPherson|2009|loc=p.&nbsp;3}} Equianalgesic charts are also used when calculating an equivalent dosage of the same drug, but with a different [[route of administration]].{{citation needed|date=February 2022}}


==Precautions==
==Precautions==
Equianalgesic chart are a useful tool, but the user must take care to correct for all relevant variables such as route of administration, [[cross tolerance]], [[half-life]] and the [[bioavailability]] of a drug.<ref>{{Harvnb | McPherson | 2000 | p=4}}</ref> For example, the narcotic [[levorphanol]] is 4–8 times [[Potency (pharmacology)|stronger]] than [[morphine]], but also has a much longer half-life. Simply switching the patient from 40&nbsp;mg of morphine to 10&nbsp;mg of levorphanol would be dangerous due to dose accumulation, and hence frequency of administration should also be taken into account.
An equianalgesic chart can be a useful tool, but the user must take care to correct for all relevant variables such as route of administration, [[cross tolerance]], [[half-life]] and the [[bioavailability]] of a drug.{{sfn|McPherson|2009|loc=p.&nbsp;4}} For example, the narcotic [[levorphanol]] is 4–8 times [[Potency (pharmacology)|stronger]] than [[morphine]], but also has a much longer half-life. Simply switching the patient from 40&nbsp;mg of morphine to 10&nbsp;mg of levorphanol would be dangerous due to dose accumulation, and hence frequency of administration should also be taken into account.


There are other concerns about equianalgesic charts. Many charts derive their data from studies conducted on opioid-naïve patients. Patients with [[Chronic pain|chronic]] (rather than acute) pain may respond differently to analgesia. Repeated administration of a medication is also different from single dosing, as many drugs have active metabolites that can build up in the body.<ref>{{Harvnb | McPherson | 2000 | p=8}}</ref> Patient variables such as sex, age, and organ function may also influence the effect of the drug on the system. These variables are rarely included in equianalgesic charts.<ref>{{Harvnb | McPherson | 2000 | p=9}}</ref>
There are other concerns about equianalgesic charts. Many charts derive their data from studies conducted on opioid-naive patients. Patients with [[Chronic pain|chronic]] (rather than acute) pain may respond to analgesia differently. Repeated administration of a medication is also different from single dosing, as many drugs have active metabolites that can build up in the body.{{sfn|McPherson|2009|loc=p.&nbsp;8}} Patient variables such as sex, age, and organ function may also influence the effect of the drug on the system. These variables are rarely included in equianalgesic charts.{{sfn|McPherson|2009|loc=p.&nbsp;9}}{{sfn|Natusch|2012}}{{sfn|Anderson et al|2001}}


{{anchor | Table}}
==Morphine-centric chart==
[[Opioid]]s are a class of compounds that elicit [[analgesic]] (pain killing) effects in humans and animals by binding to the [[mu opioid receptor|μ-opioid receptor]] within the [[central nervous system]]. The following table lists commonly used opioid drugs and their relative [[Potency (pharmacology)|potencies]]. Values for the potencies of opioids listed on this table are given as taken orally unless another [[route of administration]] is provided. As such, their [[bioavailability|bioavailabilities]] differ, and they may be more potent when taken [[intravenously]]. [[Methadone]] is different from most opioids considering its potency can vary depending on how long it is taken. Acute use; 1–3 days, yields a potency about 4× stronger than that of [[morphine]] and chronic use (7 days+) yields a potency about 7–8× that of morphine due to methadone being stored in fat tissue, thus giving higher serum levels with longer use.


==Opioid equivalency table==
{| class="wikitable" width="1000px" style="background: #FFFFFF; border: 2px silver solid; border-collapse: collapse; font-size: 95%;" align="center"
{{contradicts other|oxycodone|here|morphine vs. oxycodone|section|equianalgesic table in the article on|date=September 2023}}
[[Opioid]]s are a class of compounds that elicit [[analgesic]] (pain killing) effects in humans and animals by binding to the [[mu opioid receptor|μ-opioid receptor]] within the [[central nervous system]]. The following table lists opioid and non-opioid analgesic drugs and their relative [[Potency (pharmacology)|potencies]]. Values for the potencies represent opioids taken orally unless another [[route of administration]] is provided. As such, their [[bioavailability|bioavailabilities]] differ, and they may be more potent when taken [[intravenously]].{{citation needed|date=February 2022}}

===Nonlinearities===
This chart measures pain relief versus mass of medication. Not all medications have a fixed relationship on this scale. [[Methadone]] is different from most opioids because its potency can vary depending on how long it is taken. Acute use (1–3 days) yields a potency about 1.5× stronger than that of [[morphine]] and chronic use (7 days+) yields a potency about 2.5 to 5× that of morphine. Similarly, the effect of [[tramadol]] increases after consecutive dosing due to the accumulation of its active metabolite and an increase of the oral bioavailability in chronic use.{{Citation needed|date=February 2022}}

<!-- Please place drugs by relative strength, in opioid or non-opioid section. -->
{{sticky table start}}
{| class="wikitable sortable sticky-table-row1" style="background: #FFFFFF; border: 2px #FFFFFF solid; border-collapse: collapse; font-size: 95%;"
|+ colspan="9" style="background:#3A5274; color: #FFFFFF; text-align: center; border: 5px #ffffff solid;" | '''Comparison to oral morphine{{efn|Approximate. There is a wide range of values in [[controlled trials]].{{sfn|Pereira et al|2001}}}}'''
|-
! Analgesic
! Strength<br /><small>(relative)</small>
! Equivalent dose<br /><small>(10&nbsp;mg oral morphine)</small>{{efn| 10&nbsp;mg oral morphine is equivalent to n&nbsp;mg analgesic drug x, e.g. 10&nbsp;mg morphine is equivalent to 3600&nbsp;mg paracetamol or 1.5&nbsp;mg hydromorphone}}
! Bioavailability
! Half-life of active metabolites<br /><small>(hours)</small>
! Oral-to-parenteral ratio
! Speed of onset
! Duration
|- style="background: #F2F7F3"
|[[Paracetamol]] (non-opioid)
|{{frac|1|360}}
|3600&nbsp;mg
|63–89%
|1–4
|
|37 min ([[Oral administration|PO]]); 8 min ([[Intravenous therapy|IV]])
|5–6 hours
|- style="background: #F2F7F3"
| [[Aspirin]] ([[NSAID]], non-opioid)
| {{frac|1|360}}
| 3600&nbsp;mg
| 80–100%
| 3.1–9
|
|
|
|- style="background: #F2F7F3"
| [[Ibuprofen]]<ref name="www3.us.elsevierhealth.com">{{cite web|url=http://www3.us.elsevierhealth.com/PAIN/pdf/Chart2a.pdf|title=Dosing Guidelines for Acetaminophen and Selected NSAIDs|publisher=Mosby|website=Elsevier Health|access-date=2022-11-22|language=en|date=1999}}</ref> ([[NSAID]], non-opioid)
| {{frac|1|222}}
| 2220&nbsp;mg
| 87–100%
| 1.3–3
|
|
|
|- style="background: #F2F7F3"
| [[Diflunisal]] ([[NSAID]], non-opioid)
| {{frac|1|160}}
| 1600&nbsp;mg
| 80–90%
| 8–12
|
|
|
|- style="background: #F2F7F3"
| [[Naproxen]]<ref name="www3.us.elsevierhealth.com"/> ([[NSAID]], non-opioid)
| {{frac|1|138}}
| 1380&nbsp;mg
| 95%
| 12–24
|
|
|
|- style="background: #F2F7F3"
|[[Piroxicam]] (NSAID non-opioid)
|{{frac|1|120}} (est.)
|
|
|
|
|
|
|- style="background: #F2F7F3"
|[[Indomethacin]] (NSAID non-opioid)
|{{frac|1|64}} (est.)
|
|
|
|
|
|
|- style="background: #F2F7F3"
| [[Diclofenac]]<ref name="www3.us.elsevierhealth.com"/><ref>{{Cite web |title=Diclofenac (Voltaren®) vs Naproxen (Aleve®, Naprosyn®) - eMedExpert.com |url=https://www.emedexpert.com/compare-meds/diclofenac-vs-naproxen.shtml |access-date=2022-11-22 |website=www.emedexpert.com}}</ref> ([[NSAID]], non-opioid)
| {{frac|1|10}} (est.) (same as Codeine)
| 100&nbsp;mg (est.)
| 50–60%
| 1–4
|
|
|
|- style="background: #F2F7F3"
|[[Ketorolac]]<ref>Pharma Guide Pre-Work 3rd Edition</ref> ([[NSAID]], non-opioid)
|{{frac|1|3}} (est.)
|30&nbsp;mg IV (est.)
|80–100%
|5–7
|
|
|
|- style="background: #F2F7F3"
| [[Nefopam]] (Centrally-acting non-opioid)
| {{frac|5|8}} (est.)
| 16&nbsp;mg IM (est.)
|
| [[Nefopam]]: 3–8, Desmethylnefopam 10–15
|
|
|
|
{| width="100%" cellpadding="4" cellspacing="0" style="background: #FFFFFF; border: 5px #FFFFFF solid; border-collapse: collapse; font-size: 95%;" align="center"
| colspan="5" style="background:#3A5274; color: #FFFFFF; text-align: center; border: 5px #ffffff solid" | <big><big>'''Equianalgesia'''</big></big><br/><big>'''(morphine)'''</big>
|-
|-
| [[Dextropropoxyphene]]<ref name="dea.gov">{{cite book |chapter=Ch. 4 Narcotics: Synthetic Narcotics: Dextropropoxyphene |chapter-url=http://www.dea.gov/pubs/abuse/4-narc.htm#Dextropropoxyphene |title=Drugs of Abuse |publisher=Drug Enforcement Administration, U.S. Department of Justice |year=2005 |url=http://www.dea.gov/pubs/abuse/index.htm |url-status=dead |archive-url=https://web.archive.org/web/20061102144639/http://www.dea.gov/pubs/abuse/index.htm |archive-date=2006-11-02 }}</ref>
| style="text-align:center; border: 1px solid #000000;" valign="top" | '''Analgesic'''
| {{frac|1|13}}–{{frac|1|20}}
| style="text-align:center; border: 1px solid #000000;" valign="top" | '''Strength'''<br/><small>'''(relative)'''</small>
| 130–200&nbsp;mg
| style="text-align:center; border: 1px solid #000000;" valign="top" | '''Equivalent dose'''<br/><small>'''(10 [[Milligram|mg]])'''</small>
|
| style="text-align:center; border: 1px solid #000000;" valign="top" | '''Bioavailability'''
|
| style="text-align:center; border: 1px solid #000000;" valign="top" | '''Half-life of active metabolites'''<br/><small>'''(hours)'''<small>
|
|
|
|-
|-
| [[Codeine]]
| style="border: 1px solid #000000;" | [[Aspirin]] (non-opioid)
| {{frac|1|10}}–{{frac|3|20}}
| style="border: 1px solid #000000;" | {{frac|1|360}}
| 100–120&nbsp;mg ([[Oral administration|PO]])
| style="border: 1px solid #000000;" | no equivalent dose
| ~90%
| style="border: 1px solid #000000;" | [[aspirin|total]]
| 2.5–3 ([[Codeine-6-glucuronide|C6G]] 1.94;<ref>{{cite journal |author=KuKanich B |title=Pharmacokinetics of acetaminophen, codeine, and the codeine metabolites morphine and codeine-6-glucuronide in healthy Greyhound dogs |journal=J. Vet. Pharmacol. Ther. |volume=33 |issue=1 |pages=15–21 |date=February 2010 |pmid=20444020 |pmc=2867071 |doi=10.1111/j.1365-2885.2009.01098.x }}</ref> morphine 2–3)
| style="border: 1px solid #000000;" | 3.1–9
|
|15–30 min ([[Oral administration|PO]])
|4–6 hours
|-
|-
| [[Tramadol]]
| style="border: 1px solid #000000;" | [[Diflunisal]] ([[NSAID]], non-opioid)
| style="border: 1px solid #000000;" | {{frac|1|160}}
| {{frac|1|10}}
| ~100&nbsp;mg
| style="border: 1px solid #000000;" | 1600&nbsp;mg
| 75% (IR), 85–90% (ER)
| style="border: 1px solid #000000;" | 80–90%
| 6.0–8.8<ref>{{Cite web|url=http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020281s032s033lbl.pdf|title=ULTRAM® (tramadol hydrochloride) Tablets Full Prescribing Information|date=March 2008|website=US Food and Drug Administration|publisher=Ortho-McNeil Pharmaceutical, Inc.|page=4|access-date=December 28, 2016|quote=The mean terminal plasma elimination half-lives of racemic tramadol and racemic M1 are 6.3 ± 1.4 and 7.4 ± 1.4 hours, respectively. The plasma elimination half-life of racemic tramadol increased from approximately six hours to seven hours upon multiple dosing.}}</ref> (M1)
| style="border: 1px solid #000000;" | 8–12
|
|
|
|-
|-
| [[Opium]] ([[Oral administration|oral]])
| style="border: 1px solid #000000;" | [[Dextropropoxyphene]]<ref name="dea.gov">{{cite book |chapter=Ch. 4 Narcotics: Synthetic Narcotics: Dextropropoxyphene |chapterurl=http://web.archive.org/web/20061102144639/http://www.dea.gov/pubs/abuse/4-narc.htm#Dextropropoxyphene |title=Drugs of Abuse |publisher=Drug Enforcement Administration, U.S. Department of Justice |year=2005 |url=http://web.archive.org/web/20061102144639/http://www.dea.gov/pubs/abuse/index.htm#Contents}}</ref>
| {{frac|1|10}}
| style="border: 1px solid #000000;" | {{frac|1|13}} to {{frac|1|20}}
| ~100&nbsp;mg
| style="border: 1px solid #000000;" | 130–200 mg
| ~25% ([[morphine]])
| style="border: 1px solid #000000;" |
| 2.5–3.0 ([[morphine]], [[codeine]])
| style="border: 1px solid #000000;" |
|
|
|
|-
|-
| [[Tilidine]]
| style="border: 1px solid #000000;" | [[Codeine]]
| style="border: 1px solid #000000;" | {{frac|1|10}} || 100 mg
| {{frac|1|10}}
| 100&nbsp;mg
| style="border: 1px solid #000000;" | ≈90% || 2.5–3 ([[Codeine-6-glucuronide|C6G]] 1.94;<ref>{{cite journal |author=KuKanich B |title=Pharmacokinetics of acetaminophen, codeine, and the codeine metabolites morphine and codeine-6-glucuronide in healthy Greyhound dogs |journal=J. Vet. Pharmacol. Ther. |volume=33 |issue=1 |pages=15–21 |year=2010 |month=February |pmid=20444020 |pmc=2867071 |doi=10.1111/j.1365-2885.2009.01098.x }}</ref> morphine 2–3)
|
|
|
|
|
|-
|-
| [[Dihydrocodeine]]
| style="border: 1px solid #000000;" | [[Tramadol]]
| style="border: 1px solid #000000;" | {{frac|1|10}}
| {{frac|1|5}}
| 50&nbsp;mg
| style="border: 1px solid #000000;" | 100 mg
| 20%
| style="border: 1px solid #000000;" | 68–72%
| 4
| style="border: 1px solid #000000;" | 5.5–7 (≈9){{clarify|date=January 2012}}
|
|
|
|-
|-
| [[Anileridine]]<ref>{{cite web |title=Anileridine |work=DrugBank Version: 3.0 |publisher=DrugBank |url=http://www.drugbank.ca/drugs/DB00913}}</ref>
| style="border: 1px solid #000000;" | [[Dihydrocodeine]]
| style="border: 1px solid #000000;" | {{frac|1|5}}
| {{frac|1|4}}
| 40&nbsp;mg
| style="border: 1px solid #000000;" | 50 mg
|
| style="border: 1px solid #000000;" | 20%
|
| style="border: 1px solid #000000;" | 4
|
|
|
|-
|-
| [[Prodine|Alphaprodine]]
| style="border: 1px solid #000000;" | [[Tapentadol]]
| style="border: 1px solid #000000;" | {{frac|1|10}}
| {{frac|1|4}}–{{frac|1|6}}
| 40–60&nbsp;mg
| style="border: 1px solid #000000;" | 100 mg
|
| style="border: 1px solid #000000;" | 95%
|
| style="border: 1px solid #000000;" |
|
|
|
|-
|-
| [[Tapentadol]]{{sfn|Cupp|2012}}
| style="border: 1px solid #000000;" | [[Anileridine]]<ref>{{cite web |title=Anileridine |work=DrugBank Version: 3.0 |publisher=DrugBank |url=http://www.drugbank.ca/drugs/DB00913}}<br/>http://designer-drugs.com/pte/12.162.180.114/dcd/chemistry/anileridine.html</ref>
| style="border: 1px solid #000000;" | {{frac|1|4}}
| {{frac|3|10}}
| 32&nbsp;mg
| style="border: 1px solid #000000;" | 40 mg
| 32% (fasting)
| style="border: 1px solid #000000;" |
|
| style="border: 1px solid #000000;" |
|
|
|
|-
|-
| [[Pethidine]] (meperidine)
| style="border: 1px solid #000000;" | [[Prodine|Alphaprodine]]
| {{frac|1|3}}
| style="border: 1px solid #000000;" | {{frac|1|4}}–{{frac|1|6}}
| 30&nbsp;mg [[Subcutaneous administration|SC]]/[[Intravenous therapy|IV]]/[[Intramuscular injection|IM]]
| style="border: 1px solid #000000;" | 40–60 mg
300&nbsp;mg ([[Oral administration|PO]])
| style="border: 1px solid #000000;" |
| 50–60% Orally, 100% [[Subcutaneous administration|SC]]/[[Intravenous therapy|IV]]/[[Intramuscular injection|IM]]
| style="border: 1px solid #000000;" |
| 3–5
|
|5–15 sec if [[Intravenous therapy|IV]], 15–25 min if orally
|
|-
|-
|[[Dipipanone]]<ref>{{Citation |title=Dipipanone |date=2024-06-14 |work=Wikipedia |url=https://en.wikipedia.org/wiki/Dipipanone |access-date=2024-10-19 |language=en}}</ref><ref>{{cite journal | pmc=1381337 | date=1992 | title=Pharmacokinetics of dipipanone after a single oral dose | journal=British Journal of Clinical Pharmacology | volume=33 | issue=4 | pages=449–450 | doi=10.1111/j.1365-2125.1992.tb04066.x | pmid=1349495 | vauthors = Paterson S }}</ref>
| [[Pethidine]] (meperidine hydrochloride)
| style="border: 1px solid #000000;" | {{frac|1|3}}
|{{frac|2|5}}
|25 mg ([[Oral administration|PO]])
| style="border: 1px solid #000000;" | 28&nbsp;mg
|
| style="border: 1px solid #000000;" | 50–60%
|3.2–3.8 hours
| style="border: 1px solid #000000;" | 3–5
|
|
| ±4 hours
|-
|-
|[[Benzylfentanyl]]
| style="border: 1px solid #000000;" | [[Hydrocodone]]
| {{frac|1|2}}
| style="border: 1px solid #000000;" | 1
|
| style="border: 1px solid #000000;" | 10 mg
|
| style="border: 1px solid #000000;" | ≥80%
|
| style="border: 1px solid #000000;" | 3.8–6
|
|
|
|-
|-
|[[AH-7921]]
| style="border: 1px solid #000000;" | [[Metopon]]
| {{frac|4|5}}
| style="border: 1px solid #000000;" | 1
|
| style="border: 1px solid #000000;" | 10&nbsp;mg
|
| style="border: 1px solid #000000;" |
|
| style="border: 1px solid #000000;" |
|
|
|
|-
|-
| [[Hydrocodone]]
| style="border: 1px solid #000000;" | [[Pentazocine|Pentazocine lactate]] (IV) <ref name='mono'>{{ cite web | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=1d225639-c326-4d9e-bc8d-e380e7958b8f | title = TALWIN (pentazocine lactate) injection, solution | work = DailyMed | publisher = National Institute of Health | accessdate = 2011-12-10 }}</ref>
| 1
| style="border: 1px solid #000000;" | 1
| 10&nbsp;mg
| style="border: 1px solid #000000;" | 10 mg (6.7–13.3 mg)
| 70%<ref name="pmid19118954">{{cite journal | vauthors = Zacny JP, Gutierrez S | title = Within-subject comparison of the psychopharmacological profiles of oral hydrocodone and oxycodone combination products in non-drug-abusing volunteers | journal = Drug Alcohol Depend | volume = 101 | issue = 1–2 | pages = 107–14 | date = April 2009 | pmid = 19118954 | doi = 10.1016/j.drugalcdep.2008.11.013 | url = https://zenodo.org/record/896375}}</ref>
| style="border: 1px solid #000000;" |
| 3.8–6 ([[Modified-release dosage|Instant Release]]; [[Oral administration|PO]])
| style="border: 1px solid #000000;" |
|
|10–30 min ([[Modified-release dosage|Instant Release]]; [[Oral administration|PO]])
|4–6
|-
|-
| [[Metopon]]
| style="border: 1px solid #000000; background: #CFB53B" | [[Morphine]] (oral)
| 1
| style="border: 1px solid #000000; background: #CFB53B" | (1)
| 10&nbsp;mg
| style="border: 1px solid #000000; background: #CFB53B" | (10 mg)
|
| style="border: 1px solid #000000; background: #CFB53B" | ≈25%
|
| style="border: 1px solid #000000; background: #CFB53B" |
|
|
|
|-
|-
| [[Pentazocine|Pentazocine lactate]] (IV)<ref name="mono">{{ cite web | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=1d225639-c326-4d9e-bc8d-e380e7958b8f | title = TALWIN (pentazocine lactate) injection, solution | work = DailyMed | publisher = National Institute of Health | access-date = 2011-12-10 }}</ref>
| style="border: 1px solid #000000;" | [[Oxycodone]]<ref>{{cite web|title=Equianalgesic Conversion|url=http://globalrph.com/narcoticonv.htm|publisher=GlobalRPH}}</ref>
| 1
| style="border: 1px solid #000000;" | 1.5
| 10&nbsp;mg [[Subcutaneous administration|SC]]/[[Intravenous therapy|IV]]/[[Intramuscular injection|IM]], 150&nbsp;mg ([[Oral administration|PO]])
| style="border: 1px solid #000000;" | 5.0&nbsp;mg
|
| style="border: 1px solid #000000;" | ≤87%
|
| style="border: 1px solid #000000;" | 3–4.5
|
|
|
|-
|-
|[[SR-17018]]
| style="border: 1px solid #000000; background: #EDE3B5" | [[Morphine]] ([[Intravenous|IV]]/[[Intramuscular|IM]])
|{{frac|4|5}}/1
| style="border: 1px solid #000000; background: #EDE3B5" | 3
|10–12 mg
| style="border: 1px solid #000000; background: #EDE3B5" | 3.33 mg
|100% IV (Presumably)
| style="border: 1px solid #000000; background: #EDE3B5" | 100%
Unknown (researches are still being made)
| style="border: 1px solid #000000; background: #EDE3B5" | 2–3
|
|
|5–10 seconds if used [[Intravenous therapy|IV]] and 15-25 min Orally ([[Oral administration|PO]])
|
|- style="background: #FCFC97"
|''' [[Morphine]] ([[Oral administration|oral]])'''
|''' 1'''
|''' 10&nbsp;mg'''
|''' ~25%'''
| 2–4
|3:1
|30 min ([[Oral administration|PO]])
|3–6 hours
|-
|-
| [[Oxycodone]] ([[Oral administration|oral]])<ref name=Converter>{{cite web|title=Equianalgesic Conversion|url=http://globalrph.com/narcoticonv.htm|publisher=GlobalRPH}}</ref>
| style="border: 1px solid #000000;" | [[Clonitazene]]
| 1.5
| style="border: 1px solid #000000;" | 3
| 6.67&nbsp;mg
| style="border: 1px solid #000000;" | 3.33 mg
| (60–87 / ±75% [[Oral administration|PO]]) / 78.2%<ref name=":5">{{cite journal | pmc=4006196 | date=2011 | title=Pharmacokinetics of intranasal Crushed OxyContin and Intravenous Oxycodone in Nondependent Prescription Opioid Abusers | journal=Journal of Clinical Pharmacology | volume=52 | issue=4 | pages=600–606 | doi=10.1177/0091270011401620 | pmid=21610203 | vauthors = Lofwall MR, Moody DE, Fang WB, Nuzzo PA, Walsh SL }}</ref> ([[Nasal administration|IN]]) / 100%
| style="border: 1px solid #000000;" |
([[Intravenous therapy|IV]]/[[Intramuscular injection|IM]]) or other parental administrations apart from spinal administration
| style="border: 1px solid #000000;" |
| 2–3 hours ([[Modified-release dosage|Instant Release]])([[Oral administration|PO]]); 4.5 hours ([[Modified-release dosage|Controlled Release]])([[Oral administration|PO]])
|
|10–30 min ([[Modified-release dosage|Instant Release]])([[Oral administration|PO]]); 1 hour ([[Modified-release dosage|Controlled Release]])([[Oral administration|PO]])
|3–6 hours ([[Modified-release dosage|Instant Release]])([[Oral administration|PO]]); 10–12 hours ([[Modified-release dosage|Controlled Release]])([[Oral administration|PO]])<ref name="sunshine1996">{{cite journal |author1=Sunshine, A. |author2=Olson, N. |author3=Colon, A. |author4=Rivera, J. |author5=Kaiko, R.F. |author6=Fitzmartin, R.D. |author7=Reder, R.F. |author8=Goldenheim, P.D. |title=Analgesic Efficacy of Controlled-Release Oxycodone in Postoperative Pain |journal=Journal of Clinical Pharmacology |date=July 1996 |volume=36 |issue=7 |pages=595–603 |doi=10.1002/j.1552-4604.1996.tb04223.x |pmid=8844441 |s2cid=35076787 }}</ref>
|-
|-
|[[Spiradoline]]
| style="border: 1px solid #000000;" | [[Methadone]] (acute) <ref>http://www.psicofarmacos.info/images/graficos/Tabla4_opiaceos.JPG</ref><ref name="jaoa.org">{{cite journal |author=Manfredonia JF |title=Prescribing methadone for pain management in end-of-life care |journal=J Am Osteopath Assoc |volume=105 |issue=3 Suppl 1 |pages=S18–21 |year=2005 |month=March |pmid=18154194 |url=http://www.jaoa.org/cgi/pmidlookup?view=long&pmid=18154194 |chapter=Table 2: Conversion Ratio of Oral Morphine to Methadone |chapterurl=http://www.jaoa.org/content/105/3_suppl/18S/T2.expansion.html}}</ref>
|1.5
| style="border: 1px solid #000000;" | 3–4
|
| style="border: 1px solid #000000;" | 2.5–3.33 mg
|
| style="border: 1px solid #000000;" | 40–90%
|
| style="border: 1px solid #000000;" | 15–60
|
|
|
|-
|-
| [[Nicomorphine]]
| style="border: 1px solid #000000;" | [[Heroin|Diamorphine]] (Heroin; IV/IM)<ref>{{cite journal |author=Reichle CW, Smith GM, Gravenstein JS, Macris SG, Beecher HK |title=Comparative analgesic potency of heroin and morphine in postoperative patients |journal=J. Pharmacol. Exp. Ther. |volume=136 |issue=1 |pages=43–6 |year=1962 |month=April |pmid=14491157 |url=http://jpet.aspetjournals.org/content/136/1/43.short}}</ref>
| 2–3
| style="border: 1px solid #000000;" | 4–5
| 3.33–5&nbsp;mg
| style="border: 1px solid #000000;" | 2–2.5 mg
| 20%
| style="border: 1px solid #000000;" | 100%
| 4
| style="border: 1px solid #000000;" | <0.6
|
|
|
|-
|-
| [[Oxycodone]] ([[Intravenous therapy|IV]]/[[Intramuscular injection|IM]]) or other parental administrations apart from spinal administration<ref name="Silvasti et al">{{cite journal |last1=Silvasti |first1=M |last2=Rosenberg |first2=P |last3=Seppälä |first3=T |last4=Svartling |first4=N |last5=Pitkänen |first5=M |title=Comparison of analgesic efficacy of oxycodone and morphine in postoperative intravenous patient-controlled analgesia |journal=Acta Anaesthesiologica Scandinavica |date=May 1998 |volume=42 |issue=5 |pages=576–580 |doi=10.1111/j.1399-6576.1998.tb05169.x |pmid=9605375 |s2cid=25763059 |url=https://pubmed.ncbi.nlm.nih.gov/9605375/ |access-date=10 August 2022}}</ref>
| style="border: 1px solid #000000;" | [[Hydromorphone]]<ref>http://www.palliative.org/PC/ClinicalInfo/PCareTips/MorphineVSHydromorphine.html</ref>
| 3–4
| style="border: 1px solid #000000;" | 5
| 2.5–3.33&nbsp;mg
| style="border: 1px solid #000000;" | 2 mg
| (60–87 / ±75% [[Oral administration|PO]]) / 78.2%<ref name=":5" /> ([[Nasal administration|IN]]) / 100%
| style="border: 1px solid #000000;" | 30–35%
([[Intravenous therapy|IV]]/[[Intramuscular injection|IM]]) or other parental administrations apart from spinal administration
| style="border: 1px solid #000000;" | 2–3
|1.5–3 ([[Intravenous therapy|IV]]/[[Intramuscular injection|IM]])
|
|5 min ([[Intravenous therapy|IV]])<ref name="Silvasti et al" />
|2–4 hours
|- style="background: #F5F5C4"
| [[Morphine]] ([[Intravenous therapy|IV]]/[[Intramuscular injection|IM]]) or other parental administrations apart from spinal administration
| 3–4
| 2.5–3.33&nbsp;mg
| 100%
| 3–4
|3:1/4:1
|Instantaneously (from 5 to 15 sec; [[Intravenous therapy|IV]]); 5–15 min ([[Intramuscular injection|IM]])
|3–7 hours
|-
|-
| [[Clonitazene]]
| style="border: 1px solid #000000;" | [[Oxymorphone]]<ref>{{cite web|title=Equianalgesic Conversion|url=http://globalrph.com/narcoticonv.htm|publisher=Global RPH}}</ref>
| 3
| style="border: 1px solid #000000;" | 7
| 3.33&nbsp;mg
| style="border: 1px solid #000000;" | 3.33 mg
|
| style="border: 1px solid #000000;" | 10%
|
| style="border: 1px solid #000000;" | 7.25–9.43
|
|
|
|-
|-
| [[Methadone]] (acute)<ref>[http://www.psicofarmacos.info/images/graficos/Tabla4_opiaceos.JPG Tabla de equivalencia opiáceos]</ref><ref name="jaoa.org">{{cite journal |author=Manfredonia JF |title=Prescribing methadone for pain management in end-of-life care |journal=J Am Osteopath Assoc |volume=105 |issue=3 Suppl 1 |pages=S18–21 |date=March 2005 |pmid=18154194 |url=http://www.jaoa.org/cgi/pmidlookup?view=long&pmid=18154194 }}{{Dead link|date=March 2024 |bot=InternetArchiveBot |fix-attempted=yes }} [https://archive.today/20120911144851/http://www.jaoa.org/content/105/3_suppl/18S/T2.expansion.html Table 2: Conversion Ratio of Oral Morphine to Methadone].</ref>
| style="border: 1px solid #000000;" | [[Methadone]] (chronic) <ref name="jaoa.org"/>
| 3–4
| style="border: 1px solid #000000;" | 7.5
| 2.5–3.33&nbsp;mg
| style="border: 1px solid #000000;" | 1.35&nbsp;mg
| style="border: 1px solid #000000;" | 40–90%
| 40–90%
| 15–60
| style="border: 1px solid #000000;" | 15–60
|2:1
|
|
|-
|-
| [[Methadone]] (chronic)<ref name="jaoa.org" />
| style="border: 1px solid #000000;" | [[Levorphanol]]<ref name="redpoll">{{cite web |title=Levorphanol |work=DrugBank Version: 3.0 |publisher=DrugBank |url=http://www.drugbank.ca/drugs/APRD00764}}</ref>
| 2.5–5
| style="border: 1px solid #000000;" | 8
| 2–4&nbsp;mg
| style="border: 1px solid #000000;" | 1.3 mg
| 40–90%
| style="border: 1px solid #000000;" | 70%
| 15–60
| style="border: 1px solid #000000;" | 11–16
|2:1
|
|
|-
|-
|[[Phenazocine]]
| style="border: 1px solid #000000;" | [[7-Hydroxymitragynine]]
|4
| style="border: 1px solid #000000;" | 17
|~2.5&nbsp;mg
| style="border: 1px solid #000000;" | ≈.6 mg
|
| style="border: 1px solid #000000;" |
|
| style="border: 1px solid #000000;" |
|
|
|
|-
|-
| [[Heroin|Diamorphine]] (Heroin;
| style="border: 1px solid #000000;" | [[Buprenorphine]]<ref name="dea.gov"/>
[[Intravenous therapy|IV]]/[[Intramuscular injection|IM]]) or other parental administrations apart from spinal administration<ref>{{cite journal |vauthors=Reichle CW, Smith GM, Gravenstein JS, Macris SG, Beecher HK |title=Comparative analgesic potency of heroin and morphine in postoperative patients |journal=J. Pharmacol. Exp. Ther. |volume=136 |issue=1 |pages=43–6 |date=April 1962 |pmid=14491157 |url=http://jpet.aspetjournals.org/content/136/1/43.short}}</ref>
| style="border: 1px solid #000000;" | 40
| 4–5 ([[Intravenous therapy|IV]],[[Intramuscular injection|IM]])
| style="border: 1px solid #000000;" | 0.25 mg
2–2.5 [[Insufflation|(insufflated)]]<ref>{{Cite journal |last1=Cone |first1=E. J. |last2=Holicky |first2=B. A. |last3=Grant |first3=T. M. |last4=Darwin |first4=W. D. |last5=Goldberger |first5=B. A. |date=October 1993 |title=Pharmacokinetics and pharmacodynamics of intranasal 'snorted' heroin |url=https://pubmed.ncbi.nlm.nih.gov/8271778/ |journal=Journal of Analytical Toxicology |volume=17 |issue=6 |pages=327–337 |doi=10.1093/jat/17.6.327 |issn=0146-4760 |pmid=8271778}}</ref>
| style="border: 1px solid #000000;" | 35–40% (sublingual)
| 2–2.5&nbsp;mg
| style="border: 1px solid #000000;" | 20–70, mean 37
| 100%
| <0.6 (morphine [[prodrug]])<ref name=":4">{{cite journal | vauthors = Sawynok J | title = The therapeutic use of heroin: a review of the pharmacological literature | journal = Canadian Journal of Physiology and Pharmacology | volume = 64 | issue = 1 | pages = 1–6 | date = January 1986 | pmid = 2420426 | doi = 10.1139/y86-001 }}</ref>
|
|Instantaneously (from 5 to 15 sec; [[Intravenous therapy|IV]]); 2 to 5 min ([[Intramuscular injection|IM]])
|3 to 7 hours
(morphine [[prodrug]])<ref name=":4" />
|-
|-
|[[Dezocine]]
| style="border: 1px solid #000000;" | [[Fentanyl]]
|4–6
| style="border: 1px solid #000000;" | 50–100
|1.6–2.5&nbsp;mg
| style="border: 1px solid #000000;" | 0.1–0.2 mg
|97% (IM)
| style="border: 1px solid #000000;" | 33% (oral); 92% (transdermal)
|2.2
| style="border: 1px solid #000000;" | 0.04 (IV); 7 (transdermal)
|
|
|
|-
|-
|[[6-Monoacetylmorphine|6-MAM]]<ref>{{Cite journal |last1=Perekopskiy |first1=David |last2=Kiyatkin |first2=Eugene A. |date=2019-08-21 |title=6-Monoacetylmorphine (6-MAM), Not Morphine, Is Responsible for the Rapid Neural Effects Induced by Intravenous Heroin |url=https://pubmed.ncbi.nlm.nih.gov/31268284/ |journal=ACS Chemical Neuroscience |volume=10 |issue=8 |pages=3409–3414 |doi=10.1021/acschemneuro.9b00305 |issn=1948-7193 |pmid=31268284}}</ref>
| style="border: 1px solid #000000;" | [[Sufentanil]]
|6–7
| style="border: 1px solid #000000;" | 500–1,000
([[Intravenous therapy|IV]],[[Intramuscular injection|IM]])
| style="border: 1px solid #000000;" | 10–20 [[microgram|μg]]
|1.25–1.6
| style="border: 1px solid #000000;" |
|100% ([[Intravenous therapy|IV]],[[Intramuscular injection|IM]])
| style="border: 1px solid #000000;" | 4.4
|<0.6 (morphine [[prodrug]])<ref name=":4" />
|presumably 2:1
|Instantaneously (from 5 to 15 sec; [[Intravenous therapy|IV]]); 2 to 5 min ([[Intramuscular injection|IM]])
|3 to 7 hours
(morphine [[prodrug]])<ref name=":4" />
|-
|-
| [[Hydromorphone]]{{sfn|Toronto Surgery|2014}}{{sfn|Walker|2001}}{{sfn|Cupp|2012}}
| style="border: 1px solid #000000;" | [[Bromadol]] <ref group="notes" name="nonhuman" />
| 10 ([[Subcutaneous injection|SC]], [[Intravenous therapy|IV]], [[Intramuscular injection|IM]])<br />3–3.75 ([[Oral administration|PO]])
| style="border: 1px solid #000000;" | 504
| 0.5–0.75&nbsp;mg (SC, IV, IM)<br />2.5&nbsp;mg (PO)
| style="border: 1px solid #000000;" | ≈ 20 µg
| Orally: 30–35%, Intranasal: 52–58%, IV/IM: 100%
| style="border: 1px solid #000000;" |
62%
| style="border: 1px solid #000000;" |
| 2–3
|5:1
|
|
|-
|-
| [[Oxymorphone]]<ref name=Converter/>
| style="border: 1px solid #000000;" | [[Etorphine]] <ref group="notes" name="nonhuman">Because of their extreme potency, etorphine, carfentanil, and other similarly powerful opiates are only used for the sedation of large animals. Sufentanil is the strongest opioid used in human medicine.</ref>
| 10 ([[Subcutaneous injection|SC]], [[Intravenous therapy|IV]], [[Intramuscular injection|IM]])<br />3–4([[Oral administration|PO]])
| style="border: 1px solid #000000;" | 1,000–3,000
| 3.33&nbsp;mg ([[Oral administration|PO]]), 0.333&nbsp;mg ([[Intravenous therapy|IV,IM & Interlaminar]])
| style="border: 1px solid #000000;" | 3.3–10 μg
|PO: 10%
| style="border: 1px solid #000000;" |
Buccal: 28%
| style="border: 1px solid #000000;" |
Sublingual: 37.5%
Intranasal: 43%
IV, IM & IT: 100%
| 7.25–9.43
|
|35 min ([[Oral administration|PO]]), Instantaneously (from 5 to 15 sec)([[Intravenous therapy|IV]])
|6–8 hours orally
2–6 hours parenteral
|-
|-
|[[U-47700]]
| style="border: 1px solid #000000;" | [[Etonitazene]]
|7.5
| style="border: 1px solid #000000;" | 2,000
|1.5&nbsp;mg
| style="border: 1px solid #000000;" | 5.0 µg
|
| style="border: 1px solid #000000;" |
|1.5–3
| style="border: 1px solid #000000;" |
|
|
|
|-
|-
| [[Levorphanol]]<ref name="redpoll">{{cite web |title=Levorphanol |work=DrugBank Version: 3.0 |publisher=DrugBank |url=http://www.drugbank.ca/drugs/APRD00764}}</ref>
| style="border: 1px solid #000000;" | [[Dihydroetorphine]] <ref group="notes" name="nonhuman" />
| 8
| style="border: 1px solid #000000;" | 1,000–12,000
| 1.25&nbsp;mg
| style="border: 1px solid #000000;" | 20–40 µg
| 70%
| style="border: 1px solid #000000;" |
| 11–16
| style="border: 1px solid #000000;" |
|1:1
|
|
|-
|-
|[[Desomorphine]] (Krokodil)
| style="border: 1px solid #000000;" | [[Carfentanil]] <ref group="notes" name="nonhuman" /><ref name="redpoll" />
|8–10
| style="border: 1px solid #000000;" | 10,000–100,000
|1–1.25&nbsp;mg
| style="border: 1px solid #000000;" | 0.1–1.0 μg
|~100% ([[Intravenous therapy|IV]])
| style="border: 1px solid #000000;" |
|2–3
| style="border: 1px solid #000000;" | 7.7
|
|Instantaneously (from 5 to 15 sec)([[Intravenous therapy|IV]]); 2–5 min ([[Intramuscular injection|IM]])
|3–4 hours
|-
|-
|[[N-Phenethylnormorphine]]
| colspan="5" style=" border: 1px solid #000000; text-align:center;" |<small>"Strength" is defined as analgesic [[potency (pharmacology)|potency]] relative to morphine.<br/>[[Drug tolerance|Tolerance]], [[Reverse tolerance|sensitization]], [[cross-tolerance]], [[Drug metabolism|metabolism]], and [[hyperalgesia]] may be complex factors in some individuals.<br/>[[Drug interaction|Interaction]]s caused by [[polypharmacy]], [[food|food and drink]], and other factors, may potentiate or inhibit the effectiveness of certain analgesics.<br/> Because some analgesics are [[prodrug]]s, individual variation in liver enzymes (e.g., cytochrome P450 enzyme CYP2D6) may result in significantly altered effects.</small>
|8–14
|}
|
|
|
|
|
|
|-
|[[Alfentanyl]]
|10–25
|
|
|1.5 (90–111 minutes)
|
|Instantaneously (from 5 to 15 sec); 4× more rapid than fentanyl
|0.25 hr (15 min); up to 54 minutes until offset of effects
|-
|[[Trefentanil]]
|(10–25)+
|
|
|
|
|
|
|-
|[[Brifentanil]]
|(10–25)+
|
|
|
|
|
|
|-
|[[Acetylfentanyl]]
|15
|
|
|
|
|
|
|-
| [[7-Hydroxymitragynine]]
| 17
| ~0.6&nbsp;mg
|
|
|
|
|
|-
|[[Furanylfentanyl]]
|20
|
|
|
|
|
|
|-
|[[Butyrfentanyl]]
|25
|
|
|
|
|
|
|-
|[[Enadoline]]
|25
|15&nbsp;μg (threshold) and 0.160&nbsp;mg/kg (dissociative effects)
|
|
|
|
|
|-
| [[Buprenorphine]] ([[Sublingual administration|SL]])<ref name="dea.gov"/>
| 40
| 0.25&nbsp;mg
| 30% ([[Sublingual administration|SL]]);<ref name=":0">Mendelson J, Upton RA, Everhart ET, Jacob P 3rd, Jones RT (1997). "Bioavailability of sublingual buprenorphine". ''Journal of Clinical Pharmacology''. '''37''' (1): 31–7. [[Digital object identifier|doi]]:10.1177/009127009703700106. [[PubMed Identifier|PMID]] 9048270</ref> ~100% ([[Transdermal|TD]]); 65% (buccal);<ref name=":1">{{Cite web|url=https://www.pbm.va.gov/PBM/clinicalguidance/abbreviatedreviews/Buprenorphine_NX_Buccal_Film_BUNAVAIL_%20Abbreviated_Review.pdf|title=Buprenorphine / Naloxone Buccal Film (BUNAVAIL) C-III|date=September 2014|website=Pharmacy Benefits Management (PBM) Services}}</ref><ref name=":2">''[https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/205637s000lbl.pdf <nowiki>BUNAVAIL (buprenorphine and naloxone) buccal film, CIII [prescribing information online]</nowiki>]''. BioDelivery BioDelivery Sciences International, Inc. (BDSI), Raleigh, NC. Jun 2014.</ref> 48% ([[Nasal administration|INS]])<ref name=":3">Eriksen J, Jensen NH, Kamp-Jensen M, Bjarnø H, Friis P, Brewster D (1989). "The systemic availability of buprenorphine administered by nasal spray". ''J. Pharm. Pharmacol''. '''41''' (11): 803–5. [[Digital object identifier|doi]]:10.1111/j.2042-7158.1989.tb06374.x</ref>
| 20–70, mean 37
|3:1
|45 min
|12–24 hours
|-
|[[N-Phenethyl-14-ethoxymetopon]]
|60
|160&nbsp;μg
|
|
|
|
|
|-
|[[Phenomorphan]]
|60–80
|0.13–0.16&nbsp;mg
|
|
|
|
|
|-
|[[N-Phenethylnordesomorphine]]
|85
|
|
|
|
|
|
|-
|[[Phenaridine]]
|(50–100)−
|
|
|
|
|
|
|-
| [[Fentanyl]]
| 50–100
| 0.1&nbsp;mg (100&nbsp;μg) IM/IV
| 33% ([[Sublingual|SL]]); 92% ([[transdermal|TD]]); 89% ([[intranasal|INS]]); 50% ([[buccal administration|buc]])
| 0.04 (IV); 7 ([[transdermal|TD]])
|
|5 min ([[transdermal|TD]]/[[Intravenous therapy|IV]])
|30–60 minutes ([[Intravenous therapy|IV]])
|-
|Metonitazene
|100
|0.1&nbsp;mg/100&nbsp;μg
|
|
|
|
|
|-
|[[Acrylfentanyl]]
|(50–100+)
|
|
|
|
|
|
|-
|[[Buprenorphine]] ([[Transdermal]])<ref>Khanna, IK; Pillarisetti, S (2015). "[https://www.dovepress.com/buprenorphine-ndash-an-attractive-opioid-with-underutilized-potential--peer-reviewed-article-JPR Buprenorphine - an attractive opioid with underutilized potential in treatment of chronic pain]". ''Journal of pain research''. '''8''': 859–70. [[Digital object identifier|doi]]:10.2147/JPR.S85951. [[PubMed Identifier|PMID]] 26672499</ref><ref>Cote, J; Montgomery, L (July 2014). "[https://academic.oup.com/painmedicine/article/15/7/1171/1878236 Sublingual buprenorphine as an analgesic in chronic pain: a systematic review]". ''Pain medicine (Malden, Mass.)''. '''15''' (7): 1171–8. [[Digital object identifier|doi]]:10.1111/pme.12386. [[PubMed Identifier|PMID]] 24995716</ref>
|100–115
|0.1&nbsp;mg (100&nbsp;μg)
|30% ([[Sublingual administration|SL]]);<ref name=":0" /> ~100% ([[Transdermal|TD]]); 65% (buccal);<ref name=":1" /><ref name=":2" /> 48% ([[Nasal administration|INS]])<ref name=":3" />
|
|3:1
|45–60 minutes
|12–24 hours
|-
|[[14-Cinnamoyloxycodeinone]]
|177
|77&nbsp;μg
|
|
|
|
|
|-
|[[Etonitazepyne]]
|180-190
|55–60&nbsp;μg
|
|
|
|
|
|-
|[[Protonitazepyne]]
|180-190
|55–60&nbsp;μg
|
|
|
|
|
|-
|[[Remifentanil]]
|100–200
|50–100&nbsp;μg
|
|0.05 (3–6 min context-sensitive half-life; 7–18 min elimination half-life)
|
|Instantaneously (from 5 to 15 sec)
|15 minutes; rapid offset of effects necessitates continuous infusion for maintenance of anesthesia
|-
|[[Protonitazene]]
|200
|50&nbsp;μg
|
|
|
|
|
|-
|[[Ocfentanil]]
|125–250
|40–80&nbsp;μg
|
|
|
|
|
|-
|[[Ro4-1539]]
|240–480
|20–40&nbsp;μg
|
|
|
|
|
|-
|[[Isotonitazene]]
|500
|20&nbsp;μg
|
|
|
|
|
|-
| [[Sufentanil]]
| 500–1,000
| 10–20&nbsp;μg
|
| 4.4
|
|
|
|-
| [[BDPC]]
| 504
| ~20&nbsp;μg
|
|
|
|
|
|-
|[[C-8813]]
|591
|
|
|
|
|
|
|-
|[[4-Phenylfentanyl]]
|800
|
|
|
|
|
|
|-
| [[Etonitazene]]
| 1000–1500
| 6.6–10&nbsp;μg
|
|
|
|
|
|-
| [[3-Methylfentanyl]]
| 1000–1500
|
|
|
|
|
|
|-
|[[N-Desethylisotonitazene|N-Desetylisotonitazene]]
|1000–2000
|5–10&nbsp;μg
|
|
|
|
|
|-
| [[Etorphine]]
| 1,000–3,000
| 3.3–10&nbsp;μg
|
|
|
|
|
|-
|[[Ohmefentanyl]]
|6300
|
|
|
|
|
|
|-
|[[Acetorphine]]
|8700
|1.33&nbsp;μg
|
|
|
|
|
|-
| [[Dihydroetorphine]]<ref>{{Cite journal|last1=Ohmori|first1=Satoshi|last2=Morimoto|first2=Yasunori|date=2002|title=Dihydroetorphine: a potent analgesic: pharmacology, toxicology, pharmacokinetics, and clinical effects|journal=CNS Drug Reviews|volume=8|issue=4|pages=391–404|issn=1080-563X|pmid=12481194|pmc=6741694|quote=Dihydroetorphine (DHE) is one of the strongest analgesic opioid alkaloids known; it is 1000 to 12,000 times more potent than morphine. ... <br />{{in5}}MOR is the most commonly used opioid analgesic for pain relief, and its oral daily dose (20 to 1000 mg) is relatively high (44). On the other hand, DHE produces rapid analgesic effects at an extremely low dose, 20 ìg sublingually in humans (60, 78). ...|doi=10.1111/j.1527-3458.2002.tb00236.x}}</ref>
| 1,000–12,000
| 0.83–10&nbsp;μg (20–40&nbsp;μg SL)
|
|
|
|
|
|-
| [[Carfentanil]]<ref name="Carfentanil">{{cite web |title=Carfentanil |work=DrugBank Version: 3.0 |publisher=DrugBank |url=https://www.drugbank.ca/drugs/DB01535}}</ref>
| 10,000
| 1.0&nbsp;μg
|
| 7.7
|
|
|
|-
|2-Fluorohmefentanil
|18,000
|
|
|
|
|
|
|-
|4-Carboethoxyohmefentanil
|30,000
|
|
|
|
|
|
|-
|[[Ohmecarfentanil]]
|(30,000)
|
|
|
|
|
|
|-
|[[R-30490]]
|(10,000–100,000)−
|
|
|
|
|
|
|-
|[[Lofentanil]]
|(10,000–100,000)+
|
|
|
|
|
|
|-
|[[14-Methoxymetopon]] (intraspinally)<ref>{{cite journal |last1=King |first1=Michael A |last2=Su |first2=Wendy |last3=Nielan |first3=Claire L |last4=Chang |first4=Albert H |last5=Schütz |first5=Johannes |last6=Schmidhammer |first6=Helmut |last7=Pasternak |first7=Gavril W |title=14-Methoxymetopon, a very potent μ-opioid receptor-selective analgesic with an unusual pharmacological profile |journal=European Journal of Pharmacology |date=17 January 2003 |volume=459 |issue=2 |page=205 |doi=10.1016/s0014-2999(02)02821-2 |pmid=12524147 |url=https://www.sciencedirect.com/science/article/pii/S0014299902028212 |access-date=19 February 2024}}</ref>
|(1,000,000)
|
|
|
|
|
|
|-
|colspan="9" style=" border: 1px solid #000000; text-align:center;" |<small>PO: oral • IV: intravenous injection • IM: intramuscular injection • SC: subcutaneous injection • SL: sublingual • TD: transdermal<br />"Strength" is defined as analgesic [[Potency (pharmacology)|potency]] relative to oral morphine.<br />[[Drug tolerance|Tolerance]], [[Reverse tolerance|sensitization]], [[cross-tolerance]], [[Drug metabolism|metabolism]], and [[hyperalgesia]] may be complex factors in some individuals.<br />[[Drug interaction|Interactions]] with [[Polypharmacy|other drugs]], [[Food|food and drink]], and other factors may increase or decrease the effect of certain analgesics and alter their half-life.<br />Because some listed analgesics are [[prodrug]]s or have [[active metabolite]]s, individual variation in liver enzymes (e.g., [[CYP2D6]] enzyme) may result in significantly altered effects.</small>
|}
|}
{{Sticky table end}}


==See also==
==See also ==
* [[Oripavine]] – for more on the comparative strength of oripavine derivatives
* [[Oripavine]] – for more on the comparative strength of oripavine derivatives

==Notes==
{{Reflist|group="notes"}}


==References==
==References==
'''Explanatory notes'''
{{notelist}}

'''Citations'''
{{Reflist}}
{{Reflist}}


'''Bibliography'''
==External links==
::'''Books'''
*[http://www3.us.elsevierhealth.com/pain/charts.html Equianalgesic Charts]
{{refbegin|30em}}
*[http://www.americanpainsociety.org/library/cp_guidelines.htm American Pain Society Guidelines]
* {{Cite journal|last=Cupp|first=Melanie|title=Equianalgesic Dosing of Opioids for Pain Management. PL Detail-Document #280801|url=https://www.nhms.org/sites/default/files/Pdfs/Opioid-Comparison-Chart-Prescriber-Letter-2012.pdf|journal=Pharmacist's Letter|date=August 2012|access-date=2016-02-05|archive-date=2015-02-13|archive-url=https://web.archive.org/web/20150213072552/http://www.nhms.org/sites/default/files/Pdfs/Opioid-Comparison-Chart-Prescriber-Letter-2012.pdf|url-status=dead}}
*[http://www.healthquality.va.gov/Chronic_Opioid_Therapy_COT.asp Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain]
* {{Cite book | last=Joishy | first=S. K. | title=Palliative medicine secrets |year=1999 | publisher=Hanley & Belfus | location=Philadelphia | page=97 | isbn=978-1-56053-304-7}}
*[http://clincalc.com/Opioids Online opioid equianalgesia calculator] Electronic calculator that includes logic for bidirectional and dose-dependent conversions
* {{cite book|last1=McCaffery|first1=Margo|last2=Pasero|first2=Chris|title=Pain: Clinical Manual|url=https://books.google.com/books?id=B5JtAAAAMAAJ|year=1999|publisher=[[Mosby (publisher)|Mosby]]|isbn=978-0-8151-5609-3|edition=2nd}}, ''[http://www3.us.elsevierhealth.com/PAIN/index.html Extra information, including printable charts]''
*[http://www.ncbi.nlm.nih.gov/pubmed/19735901 Opioid equianalgesic tables: are they all equally dangerous?]
* {{Cite book | last=McPherson | first=Mary Lynn M. | title=Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing | url=https://books.google.com/books?id=6oBA9z5wl9wC | year=2009 | publisher=[[American Society of Health-System Pharmacists]] | location=Bethesda MD | page=5 | isbn=978-1-58528-297-5 }}
{{refend}}

::'''Articles'''
{{refbegin|30em}}
* {{cite journal |last1=Anderson |first1=Robert |last2=Saiers |first2=Joseph H |last3=Abram |first3=Stephen |last4=Schlicht |first4=Christian |title=Accuracy in Equianalgesic Dosing |journal=[[Journal of Pain and Symptom Management]] |date=May 2001 |volume=21 |issue=5 |pages=397–406 |doi=10.1016/S0885-3924(01)00271-8|pmid=11369161 |doi-access=free|ref={{harvid|Anderson et al|2001}}}}
* {{cite journal |last1=Natusch |first1=Douglas |title=Equianalgesic doses of opioids – their use in clinical practice |journal=British Journal of Pain |date=February 2012 |volume=6 |issue=1 |pages=43–46 |doi=10.1177/2049463712437628|pmid=26516465 |pmc=4590088 |doi-access=free}}
* {{cite journal |last1=Pereira |first1=Jose |last2=Lawlor |first2=Peter |last3=Vigano |first3=Antonio |last4=Dorgan |first4=Marlene |last5=Bruera |first5=Eduardo| title=Equianalgesic Dose Ratios for Opioids |journal=[[Journal of Pain and Symptom Management]] |date=August 2001 |volume=22 |issue=2 |pages=672–687 |doi=10.1016/s0885-3924(01)00294-9 |doi-access=free|pmid=11495714|ref={{harvid|Pereira et al|2001}}}}
* {{Cite journal |last1=Shaheen |first1=Philip E. |last2=Walsh |first2=Declan |last3=Lasheen |first3=Wael |last4=Davis |first4=Mellar P. |last5=Lagman |first5=Ruth L. |date=September 2009 |title=Opioid equianalgesic tables: are they all equally dangerous? |journal=Journal of Pain and Symptom Management |volume=38 |issue=3 |pages=409–417 |doi=10.1016/j.jpainsymman.2009.06.004 |issn=1873-6513 |pmid=19735901|doi-access=free }}
{{refend}}

::'''Websites'''
{{refbegin|30em}}
* {{cite web |title=Opioid Equianalgesic Table |url=https://surgery.utoronto.ca/file/1330/download?token=AwhfeyiE |website=Lecture Notes |publisher=Department of Surgery, [[University of Toronto]] |access-date=26 February 2020 |date=November 2014 |ref={{harvid|Toronto Surgery|2014}} |archive-date=26 February 2020 |archive-url=https://web.archive.org/web/20200226183108/https://surgery.utoronto.ca/file/1330/download%3Ftoken%3DAwhfeyiE |url-status=dead }}
* {{cite web|last=Walker|first=Paul|title=Issue 17. Morphine vs Hydromorphone vs Oxycodone vs The Patch|website=Palliative Care Tips: Info for Health Professionals|publisher=Palliative & End of Life Care (PEOLC), [[Alberta Health Services]]|date=2001|url=http://www.palliative.org/PC/ClinicalInfo/PCareTips/MorphineVSHydromorphine.html|archive-url=https://web.archive.org/web/20011224112255/http://www.palliative.org/PC/ClinicalInfo/PCareTips/MorphineVSHydromorphine.html|archive-date=December 24, 2001|url-status=dead}}
* {{cite web |title=Management of Opioid Therapy (OT) for Chronic Pain (2017) |url=https://www.healthquality.va.gov/guidelines/Pain/cot/VADoDOTCPG022717.pdf |department=VA/DoD Clinical Practice Guidelines |publisher=[[Department of Veterans Affairs]] |access-date=26 February 2020 |page=99 |ref={{harvid|VA|2017}} }}
* [http://clincalc.com/Opioids Online opioid equianalgesia calculator] Electronic calculator that includes logic for bidirectional and dose-dependent conversions
{{refend}}

{{Analgesics}}
{{Opioid receptor modulators}}


[[Category:Analgesics]]
[[Category:Anesthesia]]
[[Category:Anesthesia]]
[[Category:Clinical pharmacology]]
[[Category:Comparison of psychoactive substances]]
[[Category:Medical terminology]]
[[Category:Medical terminology]]
[[Category:Nociception]]
[[Category:Nociception]]
[[Category:Opioids]]
[[Category:Opioids]]
[[Category:Pain]]
[[Category:Pain]]
[[Category:Pharmacology]]

Latest revision as of 00:20, 3 January 2025

An equianalgesic chart is a conversion chart that lists equivalent doses of analgesics (drugs used to relieve pain). Equianalgesic charts are used for calculation of an equivalent dose (a dose which would offer an equal amount of analgesia) between different analgesics.[1] Tables of this general type are also available for NSAIDs, benzodiazepines, depressants, stimulants, anticholinergics and others.

Format

[edit]

Equianalgesic tables are available in different formats, such as pocket-sized cards for ease of reference.[1] A frequently-seen format has the drug names in the left column, the route of administration in the center columns and any notes in the right column.[2][3]

Purpose

[edit]

There are several reasons for switching a patient to a different pain medication. These include practical considerations such as lower cost or unavailability of a drug at the patient's preferred pharmacy, or medical reasons such as lack of effectiveness of the current drug or to minimize adverse effects. Some patients request to be switched to a different narcotic due to stigma associated with a particular drug (e.g. a patient refusing methadone due to its association with opioid addiction treatment).[4] Equianalgesic charts are also used when calculating an equivalent dosage of the same drug, but with a different route of administration.[citation needed]

Precautions

[edit]

An equianalgesic chart can be a useful tool, but the user must take care to correct for all relevant variables such as route of administration, cross tolerance, half-life and the bioavailability of a drug.[5] For example, the narcotic levorphanol is 4–8 times stronger than morphine, but also has a much longer half-life. Simply switching the patient from 40 mg of morphine to 10 mg of levorphanol would be dangerous due to dose accumulation, and hence frequency of administration should also be taken into account.

There are other concerns about equianalgesic charts. Many charts derive their data from studies conducted on opioid-naive patients. Patients with chronic (rather than acute) pain may respond to analgesia differently. Repeated administration of a medication is also different from single dosing, as many drugs have active metabolites that can build up in the body.[6] Patient variables such as sex, age, and organ function may also influence the effect of the drug on the system. These variables are rarely included in equianalgesic charts.[7][3][8]

Opioid equivalency table

[edit]

Opioids are a class of compounds that elicit analgesic (pain killing) effects in humans and animals by binding to the μ-opioid receptor within the central nervous system. The following table lists opioid and non-opioid analgesic drugs and their relative potencies. Values for the potencies represent opioids taken orally unless another route of administration is provided. As such, their bioavailabilities differ, and they may be more potent when taken intravenously.[citation needed]

Nonlinearities

[edit]

This chart measures pain relief versus mass of medication. Not all medications have a fixed relationship on this scale. Methadone is different from most opioids because its potency can vary depending on how long it is taken. Acute use (1–3 days) yields a potency about 1.5× stronger than that of morphine and chronic use (7 days+) yields a potency about 2.5 to 5× that of morphine. Similarly, the effect of tramadol increases after consecutive dosing due to the accumulation of its active metabolite and an increase of the oral bioavailability in chronic use.[citation needed]

Comparison to oral morphine[a]
Analgesic Strength
(relative) 		Equivalent dose
(10 mg oral morphine)[b] 		Bioavailability Half-life of active metabolites
(hours) 		Oral-to-parenteral ratio Speed of onset Duration
Paracetamol (non-opioid) 1⁄360 3600 mg 63–89% 1–4 37 min (PO); 8 min (IV) 5–6 hours
Aspirin (NSAID, non-opioid) 1⁄360 3600 mg 80–100% 3.1–9
Ibuprofen[10] (NSAID, non-opioid) 1⁄222 2220 mg 87–100% 1.3–3
Diflunisal (NSAID, non-opioid) 1⁄160 1600 mg 80–90% 8–12
Naproxen[10] (NSAID, non-opioid) 1⁄138 1380 mg 95% 12–24
Piroxicam (NSAID non-opioid) 1⁄120 (est.)
Indomethacin (NSAID non-opioid) 1⁄64 (est.)
Diclofenac[10][11] (NSAID, non-opioid) 1⁄10 (est.) (same as Codeine) 100 mg (est.) 50–60% 1–4
Ketorolac[12] (NSAID, non-opioid) 1⁄3 (est.) 30 mg IV (est.) 80–100% 5–7
Nefopam (Centrally-acting non-opioid) 5⁄8 (est.) 16 mg IM (est.) Nefopam: 3–8, Desmethylnefopam 10–15
Dextropropoxyphene[13] 1⁄13–1⁄20 130–200 mg
Codeine 1⁄10–3⁄20 100–120 mg (PO) ~90% 2.5–3 (C6G 1.94;[14] morphine 2–3) 15–30 min (PO) 4–6 hours
Tramadol 1⁄10 ~100 mg 75% (IR), 85–90% (ER) 6.0–8.8[15] (M1)
Opium (oral) 1⁄10 ~100 mg ~25% (morphine) 2.5–3.0 (morphine, codeine)
Tilidine 1⁄10 100 mg
Dihydrocodeine 1⁄5 50 mg 20% 4
Anileridine[16] 1⁄4 40 mg
Alphaprodine 1⁄4–1⁄6 40–60 mg
Tapentadol[17] 3⁄10 32 mg 32% (fasting)
Pethidine (meperidine) 1⁄3 30 mg SC/IV/IM

300 mg (PO)

50–60% Orally, 100% SC/IV/IM 3–5 5–15 sec if IV, 15–25 min if orally
Dipipanone[18][19] 2⁄5 25 mg (PO) 3.2–3.8 hours ±4 hours
Benzylfentanyl 1⁄2
AH-7921 4⁄5
Hydrocodone 1 10 mg 70%[20] 3.8–6 (Instant Release; PO) 10–30 min (Instant Release; PO) 4–6
Metopon 1 10 mg
Pentazocine lactate (IV)[21] 1 10 mg SC/IV/IM, 150 mg (PO)
SR-17018 4⁄5/1 10–12 mg 100% IV (Presumably)

Unknown (researches are still being made)

5–10 seconds if used IV and 15-25 min Orally (PO)
Morphine (oral) 1 10 mg ~25% 2–4 3:1 30 min (PO) 3–6 hours
Oxycodone (oral)[22] 1.5 6.67 mg (60–87 / ±75% PO) / 78.2%[23] (IN) / 100%

(IV/IM) or other parental administrations apart from spinal administration

2–3 hours (Instant Release)(PO); 4.5 hours (Controlled Release)(PO) 10–30 min (Instant Release)(PO); 1 hour (Controlled Release)(PO) 3–6 hours (Instant Release)(PO); 10–12 hours (Controlled Release)(PO)[24]
Spiradoline 1.5
Nicomorphine 2–3 3.33–5 mg 20% 4
Oxycodone (IV/IM) or other parental administrations apart from spinal administration[25] 3–4 2.5–3.33 mg (60–87 / ±75% PO) / 78.2%[23] (IN) / 100%

(IV/IM) or other parental administrations apart from spinal administration

1.5–3 (IV/IM) 5 min (IV)[25] 2–4 hours
Morphine (IV/IM) or other parental administrations apart from spinal administration 3–4 2.5–3.33 mg 100% 3–4 3:1/4:1 Instantaneously (from 5 to 15 sec; IV); 5–15 min (IM) 3–7 hours
Clonitazene 3 3.33 mg
Methadone (acute)[26][27] 3–4 2.5–3.33 mg 40–90% 15–60 2:1
Methadone (chronic)[27] 2.5–5 2–4 mg 40–90% 15–60 2:1
Phenazocine 4 ~2.5 mg
Diamorphine (Heroin;

IV/IM) or other parental administrations apart from spinal administration[28]

4–5 (IV,IM)

2–2.5 (insufflated)[29]

2–2.5 mg 100% <0.6 (morphine prodrug)[30] Instantaneously (from 5 to 15 sec; IV); 2 to 5 min (IM) 3 to 7 hours

(morphine prodrug)[30]

Dezocine 4–6 1.6–2.5 mg 97% (IM) 2.2
6-MAM[31] 6–7

(IV,IM)

1.25–1.6 100% (IV,IM) <0.6 (morphine prodrug)[30] presumably 2:1 Instantaneously (from 5 to 15 sec; IV); 2 to 5 min (IM) 3 to 7 hours

(morphine prodrug)[30]

Hydromorphone[32][33][17] 10 (SC, IV, IM)
3–3.75 (PO) 		0.5–0.75 mg (SC, IV, IM)
2.5 mg (PO) 		Orally: 30–35%, Intranasal: 52–58%, IV/IM: 100%

62%

2–3 5:1
Oxymorphone[22] 10 (SC, IV, IM)
3–4(PO) 		3.33 mg (PO), 0.333 mg (IV,IM & Interlaminar) PO: 10%

Buccal: 28% Sublingual: 37.5% Intranasal: 43% IV, IM & IT: 100%

7.25–9.43 35 min (PO), Instantaneously (from 5 to 15 sec)(IV) 6–8 hours orally

2–6 hours parenteral

U-47700 7.5 1.5 mg 1.5–3
Levorphanol[34] 8 1.25 mg 70% 11–16 1:1
Desomorphine (Krokodil) 8–10 1–1.25 mg ~100% (IV) 2–3 Instantaneously (from 5 to 15 sec)(IV); 2–5 min (IM) 3–4 hours
N-Phenethylnormorphine 8–14
Alfentanyl 10–25 1.5 (90–111 minutes) Instantaneously (from 5 to 15 sec); 4× more rapid than fentanyl 0.25 hr (15 min); up to 54 minutes until offset of effects
Trefentanil (10–25)+
Brifentanil (10–25)+
Acetylfentanyl 15
7-Hydroxymitragynine 17 ~0.6 mg
Furanylfentanyl 20
Butyrfentanyl 25
Enadoline 25 15 μg (threshold) and 0.160 mg/kg (dissociative effects)
Buprenorphine (SL)[13] 40 0.25 mg 30% (SL);[35] ~100% (TD); 65% (buccal);[36][37] 48% (INS)[38] 20–70, mean 37 3:1 45 min 12–24 hours
N-Phenethyl-14-ethoxymetopon 60 160 μg
Phenomorphan 60–80 0.13–0.16 mg
N-Phenethylnordesomorphine 85
Phenaridine (50–100)−
Fentanyl 50–100 0.1 mg (100 μg) IM/IV 33% (SL); 92% (TD); 89% (INS); 50% (buc) 0.04 (IV); 7 (TD) 5 min (TD/IV) 30–60 minutes (IV)
Metonitazene 100 0.1 mg/100 μg
Acrylfentanyl (50–100+)
Buprenorphine (Transdermal)[39][40] 100–115 0.1 mg (100 μg) 30% (SL);[35] ~100% (TD); 65% (buccal);[36][37] 48% (INS)[38] 3:1 45–60 minutes 12–24 hours
14-Cinnamoyloxycodeinone 177 77 μg
Etonitazepyne 180-190 55–60 μg
Protonitazepyne 180-190 55–60 μg
Remifentanil 100–200 50–100 μg 0.05 (3–6 min context-sensitive half-life; 7–18 min elimination half-life) Instantaneously (from 5 to 15 sec) 15 minutes; rapid offset of effects necessitates continuous infusion for maintenance of anesthesia
Protonitazene 200 50 μg
Ocfentanil 125–250 40–80 μg
Ro4-1539 240–480 20–40 μg
Isotonitazene 500 20 μg
Sufentanil 500–1,000 10–20 μg 4.4
BDPC 504 ~20 μg
C-8813 591
4-Phenylfentanyl 800
Etonitazene 1000–1500 6.6–10 μg
3-Methylfentanyl 1000–1500
N-Desetylisotonitazene 1000–2000 5–10 μg
Etorphine 1,000–3,000 3.3–10 μg
Ohmefentanyl 6300
Acetorphine 8700 1.33 μg
Dihydroetorphine[41] 1,000–12,000 0.83–10 μg (20–40 μg SL)
Carfentanil[42] 10,000 1.0 μg 7.7
2-Fluorohmefentanil 18,000
4-Carboethoxyohmefentanil 30,000
Ohmecarfentanil (30,000)
R-30490 (10,000–100,000)−
Lofentanil (10,000–100,000)+
14-Methoxymetopon (intraspinally)[43] (1,000,000)
PO: oral • IV: intravenous injection • IM: intramuscular injection • SC: subcutaneous injection • SL: sublingual • TD: transdermal
"Strength" is defined as analgesic potency relative to oral morphine.
Tolerance, sensitization, cross-tolerance, metabolism, and hyperalgesia may be complex factors in some individuals.
Interactions with other drugs, food and drink, and other factors may increase or decrease the effect of certain analgesics and alter their half-life.
Because some listed analgesics are prodrugs or have active metabolites, individual variation in liver enzymes (e.g., CYP2D6 enzyme) may result in significantly altered effects.

See also

[edit]
  • Oripavine – for more on the comparative strength of oripavine derivatives

References

[edit]

Explanatory notes

  1. ^ Approximate. There is a wide range of values in controlled trials.[9]
  2. ^ 10 mg oral morphine is equivalent to n mg analgesic drug x, e.g. 10 mg morphine is equivalent to 3600 mg paracetamol or 1.5 mg hydromorphone

Citations

  1. ^ a b Joishy 1999.
  2. ^ McPherson 2009, p. 5.
  3. ^ a b Natusch 2012.
  4. ^ McPherson 2009, p. 3.
  5. ^ McPherson 2009, p. 4.
  6. ^ McPherson 2009, p. 8.
  7. ^ McPherson 2009, p. 9.
  8. ^ Anderson et al 2001.
  9. ^ Pereira et al 2001.
  10. ^ a b c "Dosing Guidelines for Acetaminophen and Selected NSAIDs" (PDF). Elsevier Health. Mosby. 1999. Retrieved 2022-11-22.
  11. ^ "Diclofenac (Voltaren®) vs Naproxen (Aleve®, Naprosyn®) - eMedExpert.com". www.emedexpert.com. Retrieved 2022-11-22.
  12. ^ Pharma Guide Pre-Work 3rd Edition
  13. ^ a b "Ch. 4 Narcotics: Synthetic Narcotics: Dextropropoxyphene". Drugs of Abuse. Drug Enforcement Administration, U.S. Department of Justice. 2005. Archived from the original on 2006-11-02.
  14. ^ KuKanich B (February 2010). "Pharmacokinetics of acetaminophen, codeine, and the codeine metabolites morphine and codeine-6-glucuronide in healthy Greyhound dogs". J. Vet. Pharmacol. Ther. 33 (1): 15–21. doi:10.1111/j.1365-2885.2009.01098.x. PMC 2867071. PMID 20444020.
  15. ^ "ULTRAM® (tramadol hydrochloride) Tablets Full Prescribing Information" (PDF). US Food and Drug Administration. Ortho-McNeil Pharmaceutical, Inc. March 2008. p. 4. Retrieved December 28, 2016. The mean terminal plasma elimination half-lives of racemic tramadol and racemic M1 are 6.3 ± 1.4 and 7.4 ± 1.4 hours, respectively. The plasma elimination half-life of racemic tramadol increased from approximately six hours to seven hours upon multiple dosing.
  16. ^ "Anileridine". DrugBank Version: 3.0. DrugBank.
  17. ^ a b Cupp 2012.
  18. ^ "Dipipanone", Wikipedia, 2024-06-14, retrieved 2024-10-19
  19. ^ Paterson S (1992). "Pharmacokinetics of dipipanone after a single oral dose". British Journal of Clinical Pharmacology. 33 (4): 449–450. doi:10.1111/j.1365-2125.1992.tb04066.x. PMC 1381337. PMID 1349495.
  20. ^ Zacny JP, Gutierrez S (April 2009). "Within-subject comparison of the psychopharmacological profiles of oral hydrocodone and oxycodone combination products in non-drug-abusing volunteers". Drug Alcohol Depend. 101 (1–2): 107–14. doi:10.1016/j.drugalcdep.2008.11.013. PMID 19118954.
  21. ^ "TALWIN (pentazocine lactate) injection, solution". DailyMed. National Institute of Health. Retrieved 2011-12-10.
  22. ^ a b "Equianalgesic Conversion". GlobalRPH.
  23. ^ a b Lofwall MR, Moody DE, Fang WB, Nuzzo PA, Walsh SL (2011). "Pharmacokinetics of intranasal Crushed OxyContin and Intravenous Oxycodone in Nondependent Prescription Opioid Abusers". Journal of Clinical Pharmacology. 52 (4): 600–606. doi:10.1177/0091270011401620. PMC 4006196. PMID 21610203.
  24. ^ Sunshine, A., Olson, N., Colon, A., Rivera, J., Kaiko, R.F., Fitzmartin, R.D., Reder, R.F., Goldenheim, P.D. (July 1996). "Analgesic Efficacy of Controlled-Release Oxycodone in Postoperative Pain". Journal of Clinical Pharmacology. 36 (7): 595–603. doi:10.1002/j.1552-4604.1996.tb04223.x. PMID 8844441. S2CID 35076787.
  25. ^ a b Silvasti M, Rosenberg P, Seppälä T, Svartling N, Pitkänen M (May 1998). "Comparison of analgesic efficacy of oxycodone and morphine in postoperative intravenous patient-controlled analgesia". Acta Anaesthesiologica Scandinavica. 42 (5): 576–580. doi:10.1111/j.1399-6576.1998.tb05169.x. PMID 9605375. S2CID 25763059. Retrieved 10 August 2022.
  26. ^ Tabla de equivalencia opiáceos
  27. ^ a b Manfredonia JF (March 2005). "Prescribing methadone for pain management in end-of-life care". J Am Osteopath Assoc. 105 (3 Suppl 1): S18–21. PMID 18154194.[permanent dead link‍] Table 2: Conversion Ratio of Oral Morphine to Methadone.
  28. ^ Reichle CW, Smith GM, Gravenstein JS, Macris SG, Beecher HK (April 1962). "Comparative analgesic potency of heroin and morphine in postoperative patients". J. Pharmacol. Exp. Ther. 136 (1): 43–6. PMID 14491157.
  29. ^ Cone EJ, Holicky BA, Grant TM, Darwin WD, Goldberger BA (October 1993). "Pharmacokinetics and pharmacodynamics of intranasal 'snorted' heroin". Journal of Analytical Toxicology. 17 (6): 327–337. doi:10.1093/jat/17.6.327. ISSN 0146-4760. PMID 8271778.
  30. ^ a b c d Sawynok J (January 1986). "The therapeutic use of heroin: a review of the pharmacological literature". Canadian Journal of Physiology and Pharmacology. 64 (1): 1–6. doi:10.1139/y86-001. PMID 2420426.
  31. ^ Perekopskiy D, Kiyatkin EA (2019-08-21). "6-Monoacetylmorphine (6-MAM), Not Morphine, Is Responsible for the Rapid Neural Effects Induced by Intravenous Heroin". ACS Chemical Neuroscience. 10 (8): 3409–3414. doi:10.1021/acschemneuro.9b00305. ISSN 1948-7193. PMID 31268284.
  32. ^ Toronto Surgery 2014.
  33. ^ Walker 2001.
  34. ^ "Levorphanol". DrugBank Version: 3.0. DrugBank.
  35. ^ a b Mendelson J, Upton RA, Everhart ET, Jacob P 3rd, Jones RT (1997). "Bioavailability of sublingual buprenorphine". Journal of Clinical Pharmacology. 37 (1): 31–7. doi:10.1177/009127009703700106. PMID 9048270
  36. ^ a b "Buprenorphine / Naloxone Buccal Film (BUNAVAIL) C-III" (PDF). Pharmacy Benefits Management (PBM) Services. September 2014.
  37. ^ a b BUNAVAIL (buprenorphine and naloxone) buccal film, CIII [prescribing information online]. BioDelivery BioDelivery Sciences International, Inc. (BDSI), Raleigh, NC. Jun 2014.
  38. ^ a b Eriksen J, Jensen NH, Kamp-Jensen M, Bjarnø H, Friis P, Brewster D (1989). "The systemic availability of buprenorphine administered by nasal spray". J. Pharm. Pharmacol. 41 (11): 803–5. doi:10.1111/j.2042-7158.1989.tb06374.x
  39. ^ Khanna, IK; Pillarisetti, S (2015). "Buprenorphine - an attractive opioid with underutilized potential in treatment of chronic pain". Journal of pain research. 8: 859–70. doi:10.2147/JPR.S85951. PMID 26672499
  40. ^ Cote, J; Montgomery, L (July 2014). "Sublingual buprenorphine as an analgesic in chronic pain: a systematic review". Pain medicine (Malden, Mass.). 15 (7): 1171–8. doi:10.1111/pme.12386. PMID 24995716
  41. ^ Ohmori S, Morimoto Y (2002). "Dihydroetorphine: a potent analgesic: pharmacology, toxicology, pharmacokinetics, and clinical effects". CNS Drug Reviews. 8 (4): 391–404. doi:10.1111/j.1527-3458.2002.tb00236.x. ISSN 1080-563X. PMC 6741694. PMID 12481194. Dihydroetorphine (DHE) is one of the strongest analgesic opioid alkaloids known; it is 1000 to 12,000 times more potent than morphine. ...
         MOR is the most commonly used opioid analgesic for pain relief, and its oral daily dose (20 to 1000 mg) is relatively high (44). On the other hand, DHE produces rapid analgesic effects at an extremely low dose, 20 ìg sublingually in humans (60, 78). ...
  42. ^ "Carfentanil". DrugBank Version: 3.0. DrugBank.
  43. ^ King MA, Su W, Nielan CL, Chang AH, Schütz J, Schmidhammer H, Pasternak GW (17 January 2003). "14-Methoxymetopon, a very potent μ-opioid receptor-selective analgesic with an unusual pharmacological profile". European Journal of Pharmacology. 459 (2): 205. doi:10.1016/s0014-2999(02)02821-2. PMID 12524147. Retrieved 19 February 2024.

Bibliography

Books
Articles
Websites
Retrieved from "https://en.wikipedia.org/enwiki/w/index.php?title=Equianalgesic&oldid=1266957303"