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词条 Equianalgesic
释义

  1. Format

  2. Purpose

  3. Precautions

  4. Opioid equivalency table

  5. See also

  6. References

  7. External links

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 as well.

Format

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]

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 addiction treatment).[3] Equianalgesic charts are also used when calculating an equivalent dosage of the same drug, but with a different route of administration.

Precautions

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.[4] 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-naïve 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.[5] 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.[6]

Opioid equivalency table

{{anchor | Table}}

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. 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 1.5× stronger than that of morphine and chronic use (7 days+) yields a potency about 2.5 to 5× that of morphine due to methadone being stored in fat tissue, thus giving higher serum levels with longer use.{{Citation needed|date=September 2014}} 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; this effect becomes less significant again with even longer use as tolerance develops.{{Citation needed|date=September 2014}}

Opioid Equivalency Table
(morphine, oral)
Analgesic Strength
(relative)		 Equivalent dose
(10 mg oral morphine)		 Bioavailability Half-life of active metabolites
(hours)		 Oral-to-parenteral ratio Speed of onset Duration Chemical / structural class
Paracetamol (non-opioid)1|360}}3600 mg63–89%1–437 min (PO); 8 min (IV)5 – 6 hours
Aspirin (NSAID, non-opioid)1|360}} 3600 mg 80–100% 3.1–9
Ibuprofen[7] (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[7] (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[7][8] (NSAID, non-opioid)1|14}} (est.) 160 mg (est.) 50–60% 1–4
Nefopam (Centrally-acting non-opioid)5|8}} (est.)
Dextropropoxyphene[9]1|13}}–{{frac|1|20}} 130–200 mg
Codeine1|10}}–{{frac|3|20}} 67–100 mg (PO) ~90% 2.5–3 (C6G 1.94;[10] morphine 2–3)15–30 min (PO)4–6 hours
Tramadol1|10}} ~100 mg 75% (IR), 85–90% (ER) 6.0–8.8[11] (M1)
Opium (oral)1|10}} ~100 mg ~25% (morphine) 2.5–3.0 (morphine, codeine)
Tilidine1|5}} 50 mg
Dihydrocodeine1|5}} 50 mg 20% 4
Anileridine[12]1|4}} 40 mg
Alphaprodine1|4}}–{{frac|1|6}} 40–60 mg
Tapentadol3|10}}[13] 32 mg 32% (fasting)
Pethidine (meperidine)1|3}} 30 mg SC/IM/IV, 300 mg (PO) 50–60% 3–5
Benzylfentanyl1|2}}
AH-79214|5}}
Hydrocodone 1 10 mg =80% 3.8–6
Metopon 1 10 mg
Pentazocine lactate (IV)[14] 1 10 mg SC/IV/IM, 150 mg (PO)
Morphine (oral) 1 10 mg ~25% 2-43:130 min (PO)3–5 hours
Oxycodone[15] 1.5 6.67 mg 60 - 87% 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)[16]
Spiradoline1.5
Nicomorphine 2–3 3.33-5 mg 20% 4
Morphine (IV/IM) 3 3.33 mg 100% 2–33:15 min (IV); 15 min (IM)3–7 hours
Clonitazene 3 3.33 mg
Methadone (acute)[17][18] 3–4 2.5–3.33 mg 40–90% 15–602:1
Methadone (chronic)[18] 2.5–5 3.33  mg 40–90% 15–602:1
Phenazocine4~2.5 mg
Diamorphine (heroin; IV/IM)[19] 4–5 2–2.5 mg 100% <0.6Instantaneously (from 5 - 15 sec)(IV); 2 - 5 min (IM)4 to 5 hours
Dezocine4–61.6–2.5 mg97% (IM)2.2
Hydromorphone[20] 4 1.5 mg (SC)/(IV)/(IM), 7.5 mg (PO) 62% 2–35:1
Oxymorphone[15] 3–7 10 mg (PO), 1 mg (IV) 10%– 7.25–9.4335 min (PO), Instantaneously (from 5 - 15 sec)(IV)6–8 hours
U-477007.51.5 mg1.5-3
Levorphanol[21] 8 1.25 mg 70% 11–161:1
Desomorphine (Krokodil)8–101–1.25 mg~100% (IV)2–3Instantaneously (from 5 - 15 sec)(IV); 2 - 5 min (IM)3 – 4 hours
N-Phenethylnormorphine8–14
Alfentanyl10–25
Trefentanil(10–25)+
Brifentanil(10–25)+
Acetylfentanyl15
7-Hydroxymitragynine 17 ~0.6 mg
Furanylfentanyl20
Butyrfentanyl25
Enadoline25
Buprenorphine[9] 40 0.4 mg 35–40% (SL) 20–70, mean 3745 min16–30 hours
N-Phenethyl-14-ethoxymetopon60
Etonitazene 60 160 µg
Phenomorphan60–800.13–0.16 mg
N-Phenethylnordesomorphine85
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)
Acrylfentanyl(50–100+)
14-Cinnamoyloxycodeinone177
Remifentanil100–20050–100 µg
Ocfentanil125–25040–80 µg
Ro4-1539240–480
Sufentanil 500–1,000 10–20 µg 4.4
BDPC 504 ~20 µg
C-8813591
4-Phenylfentanyl800
3-Methylfentanyl1000–1500
Etorphine 1,000–3,000 3.3–10 µg
Ohmefentanyl6300
Acetorphine8700
Dihydroetorphine[22] 1,000–12,000 0.83–10 µg (20–40 µg SL)
2-Fluorohmefentanil18,000
4-carboethoxyohmefentanil30,000
R-30490(10,000–100,000)−
Carfentanil[23] 10,000 1.0 µg 7.7
Lofentanil(10,000–100,000)+
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

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

References

1. ^1 {{Cite book | ref=harv | title=Palliative medicine secrets | last=Joishy | first=S. K. | year=1999 | publisher=Hanley & Belfus | location=Philadelphia PA | page=97 | isbn=978-1-56053-304-7}}
2. ^{{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=978-1-58528-198-5}}
3. ^{{Harvnb | McPherson | 2000 | p=3}}
4. ^{{Harvnb | McPherson | 2000 | p=4}}
5. ^{{Harvnb | McPherson | 2000 | p=8}}
6. ^{{Harvnb | McPherson | 2000 | p=9}}
7. ^1 2 {{cite web|url=http://www3.us.elsevierhealth.com/PAIN/pdf/Chart2a.pdf|title=Dosing Guidelines for Acetaminophen and Selected NSAIDs|work=www3.us.elsevierhealth.com}}
8. ^http://www.emedexpert.com/compare-meds/diclofenac-vs-naproxen.shtml
9. ^1 {{cite book|chapter=Ch. 4 Narcotics: Synthetic Narcotics: Dextropropoxyphene |chapterurl=https://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://www.dea.gov/pubs/abuse/index.htm |deadurl=bot: unknown |archiveurl=https://web.archive.org/web/20061102144639/http://www.dea.gov/pubs/abuse/index.htm |archivedate=2006-11-02 |df= }}
10. ^{{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 }}
11. ^{{Cite web|url=http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020281s032s033lbl.pdf|title=ULTRAM® (tramadol hydrochloride) Tablets Full Prescribing Information|last=|first=|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.}}
12. ^{{cite web |title=Anileridine |work=DrugBank Version: 3.0 |publisher=DrugBank |url=http://www.drugbank.ca/drugs/DB00913}}
13. ^{{Cite web|url = https://www.nhms.org/sites/default/files/Pdfs/Opioid-Comparison-Chart-Prescriber-Letter-2012.pdf|title = Equianalgesic Dosing of Opioids for Pain Management |date = August 2012}}
14. ^{{ 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 }}
15. ^1 {{cite web|title=Equianalgesic Conversion|url=http://globalrph.com/narcoticonv.htm|publisher=GlobalRPH}}
16. ^{{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 }}
17. ^Tabla de equivalencia opiáceos
18. ^1 {{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}} Table 2: Conversion Ratio of Oral Morphine to Methadone.
19. ^{{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}}
20. ^{{cite web|url=http://www.palliative.org/PC/ClinicalInfo/PCareTips/MorphineVSHydromorphine.html|title=MORPHINE vs HYDROMORPHINE vs OXYCODONE vs THE PATCH|archiveurl=https://web.archive.org/web/20011224112255/http://www.palliative.org/PC/ClinicalInfo/PCareTips/MorphineVSHydromorphine.html|archivedate=December 24, 2001|deadurl=y|author=Paul Walker}}
21. ^{{cite web |title=Levorphanol |work=DrugBank Version: 3.0 |publisher=DrugBank |url=http://www.drugbank.ca/drugs/APRD00764}}
22. ^{{Cite journal|last=Ohmori|first=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|quote=Dihydroetorphine (DHE) is one of the strongest analgesic opioid alkaloids known; it is 1000 to 12,000 times more potent than morphine. ...
{{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}}
23. ^{{cite web |title=Carfentanil |work=DrugBank Version: 3.0 |publisher=DrugBank |url=https://www.drugbank.ca/drugs/DB01535}}

External links

  • Equianalgesic Charts
  • [https://web.archive.org/web/20130227022743/http://www.americanpainsociety.org/library/cp_guidelines.htm American Pain Society Guidelines]
  • Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain
  • Online opioid equianalgesia calculator Electronic calculator that includes logic for bidirectional and dose-dependent conversions
  • [https://www.ncbi.nlm.nih.gov/pubmed/19735901 Opioid equianalgesic tables: are they all equally dangerous?]
{{Analgesics}}{{Opioid receptor modulators}}

7 : Analgesics|Anesthesia|Medical terminology|Nociception|Opioids|Pain|Clinical pharmacology
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