This information is provided for educational purposes only. The information presented represents the views and opinions of the NIPC Task Force and does not constitute the opinion or endorsement of, or promotion by, the American Pain Foundation, or the program grantor(s). Reasonable efforts have been made to present educational subject matter in a balanced, unbiased fashion and in compliance with regulatory requirements. Healthcare professionals and other individuals should review and consider other publications and materials relevant to the subject matter rather than relying solely on the information contained herein, particularly as it may relate to patient diagnostic or treatment decisions.

Providing references to other organizations, sources of information, or links to other websites does not imply and should not be construed as an endorsement by APF of the organizations or contents of their websites.

Please refer to the manufacturer’s full package/prescribing information for any of the agents discussed.

Efforts have been made to ensure that dosage information is correct, but dosages are provided as examples for educational purposes only. Dosing schedules and information change from time to time, and patients exhibit variable responses to medications; thus, when treating any patient, you are urged to check the manufacturer’s package information for recommended dosages, proper administration, and adverse effects and contraindications.

Dose ratios should be considered a guide. In particular, deviations from predicted doses may arise from incomplete cross tolerance, ie, a patient may have become relatively tolerant to one opioid but have little tolerance to a new opioid. Incomplete cross tolerance is not possible to predict and probably depends on genetic factors, disease states, and concomitant medications. Understanding the differences among opioids is critical to understanding their equianalgesic dose ratios and for adjusting therapy following rotation to a new analgesic. Although analgesic dose tables are generally used to determine new doses in cases in which opioid type or route of administration requires changing, the evidence to support the ratios indicated in equianalgesic tables largely refers to the single-dose administration. The applicability of these ratios to the chronic pain setting needs investigation.

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