Oral to iv morphine conversion

Initially, inject 5 mg epidurally in the lumbar region and assess the patient in 1 hour; if pain relief is not adequate at that time, administer incremental doses of 1 to 2 mg, with sufficient time between injections to appropriately assess for efficacy. The manufacturer recommends a maximum of 10 mg per 24 hours. For continuous epidural infusion, initiate at 2 to 4 mg per 24 hours, with additional doses of 1 to 2 mg given if pain relief is not initially achieved. The incidence of early and late respiratory depression is dramatically increased with thoracic administration. Use preservative-free formulations only.

In fact, more recent data demonstrates that these conversion ratios may be too simplistic and can vary based on many factors such as chronicity of opioid use, total daily dose, ethnicity, age, and can even differ depending on the direction of conversion (. conversion from morphine to hydromorphone ¹ hydromorphone to morphine). Increasing research in the area of pharmacogenetics examines how genetic polymorphisms of liver metabolic enzymes can explain some of these highly variable effects seen from patient to patient. An expert panel (Fine et al.) suggested the need to revise these tables with different conversion values that take into account this complexity. In addition updated approaches on opioid switching have been discussed in several resources. Of particular note are substantial changes to calculations when converting to PO methadone, which is more potent than originally thought. Due to potential for serious adverse patient outcomes equianalgesic dose calculations are now adjusted based on the total daily dose of morphine equivalents with higher daily doses requiring increasingly less methadone.

Less than or equal to 4 weeks:
Use preservative-free formulation:
Initial: mg/kg IM, IV, or subcutaneously every 4 to 8 hours titrating carefully to effect
Maximum dose: mg/kg/dose
Continuous Infusion: mg/kg/hour continuous IV infusion. Do not exceed infusion rates of to mg/kg/hour.

Greater than or equal to 1 month but less than 12 years:
Oral: to mg/kg/dose every 4 to 6 hours (tablets/solution) or to mg/kg/dose every 12 hours (extended release)
IM,subcutaneous, IV: to mg/kg/dose (up to 15 mg) every 4 hours as needed.
IV/subcutaneous Continuous: to mg/kg/hour (sickle cell or cancer pain) or to mg/kg/hour (postop pain)
Epidural (use preservative-free formulation): mg/kg/dose every 6 to 8 hours (postop pain). Maximum per 24 hours: 5 mg.

Greater than or equal to 12 years:
Premedication for anesthesia IV: 3 to 4 mg once, may repeat in 5 minutes if necessary.
Oral: to mg/kg/dose every 4 to 6 hours (tablets/solution) or to mg/kg/dose every 12 hours (extended release)
IM,subcutaneous, IV: to mg/kg/dose (up to 15 mg) every 4 hours as needed
IV/subcutaneous Continuous: to mg/kg/hour (sickle cell or cancer pain) or to mg/kg/hour (postop pain)
Epidural (use preservative-free formulation): mg/kg/dose every 6 to 8 hours (postop pain). Maximum per 24 hours: 5 mg.
IV patient controlled analgesia: mg/kg/dose (postop pain); lockout period of 10 minutes; 4 hour limit of mg/kg.

Monitor patients with significant chronic obstructive pulmonary disease or cor pulmonale , and patients having a substantially decreased respiratory reserve, hypoxia , hypercapnia , or pre-existing respiratory depression for respiratory depression, particularly when initiating therapy and titrating with AVINZA, as in these patients, even usual therapeutic doses of AVINZA may decrease respiratory drive to the point of apnea [see Life-Threatening Respiratory Depression ]. Consider the use of alternative non-opioid analgesics in these patients if possible.

Oral to iv morphine conversion

oral to iv morphine conversion

Monitor patients with significant chronic obstructive pulmonary disease or cor pulmonale , and patients having a substantially decreased respiratory reserve, hypoxia , hypercapnia , or pre-existing respiratory depression for respiratory depression, particularly when initiating therapy and titrating with AVINZA, as in these patients, even usual therapeutic doses of AVINZA may decrease respiratory drive to the point of apnea [see Life-Threatening Respiratory Depression ]. Consider the use of alternative non-opioid analgesics in these patients if possible.

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