Английская Википедия:Equianalgesic

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Шаблон:Short descriptionШаблон:Cs1 configAn 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.Шаблон:Sfn Tables of this general type are also available for NSAIDs, benzodiazepines, depressants, stimulants, anticholinergics and others.

Format

Equianalgesic tables are available in different formats, such as pocket-sized cards for ease of reference.Шаблон:Sfn 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.Шаблон:SfnШаблон:Sfn

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).Шаблон:Sfn Equianalgesic charts are also used when calculating an equivalent dosage of the same drug, but with a different route of administration.Шаблон:Citation needed

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.Шаблон:Sfn 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.Шаблон:Sfn 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.Шаблон:SfnШаблон:SfnШаблон:Sfn

Opioid equivalency table

Шаблон:Contradicts other 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.Шаблон:Citation needed

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.Шаблон:Citation needed

Comparison to oral morphineШаблон:Efn
Analgesic	Strength (relative)	Equivalent dose (10 mg oral morphine)Шаблон:Efn	Bioavailability	Half-life of active metabolites (hours)	Oral-to-parenteral ratio	Speed of onset	Duration
Paracetamol (non-opioid)	Шаблон:Frac	3600 mg	63–89%	1–4		37 min (PO); 8 min (IV)	5–6 hours
Aspirin (NSAID, non-opioid)	Шаблон:Frac	3600 mg	80–100%	3.1–9
Ibuprofen (NSAID, non-opioid)	Шаблон:Frac	2220 mg	87–100%	1.3–3
Diflunisal (NSAID, non-opioid)	Шаблон:Frac	1600 mg	80–90%	8–12
Naproxen (NSAID, non-opioid)	Шаблон:Frac	1380 mg	95%	12–24
Piroxicam (NSAID non-opioid)	Шаблон:Frac (est.)
Indomethacin (NSAID non-opioid)	Шаблон:Frac (est.)
Diclofenac (NSAID, non-opioid)	Шаблон:Frac (est.) (same as Codeine)	100 mg (est.)	50–60%	1–4
Ketorolac (NSAID, non-opioid)	Шаблон:Frac (est.)	30 mg IV (est.)	80–100%	5–7
Nefopam (Centrally-acting non-opioid)	Шаблон:Frac (est.)	16 mg IM (est.)		Nefopam: 3–8, Desmethylnefopam 10–15
Dextropropoxyphene	Шаблон:Frac–Шаблон:Frac	130–200 mg
Codeine	Шаблон:Frac–Шаблон:Frac	100–120 mg (PO)	~90%	2.5–3 (C6G 1.94; morphine 2–3)		15–30 min (PO)	4–6 hours
Tramadol	Шаблон:Frac	~100 mg	75% (IR), 85–90% (ER)	6.0–8.8 (M1)
Opium (oral)	Шаблон:Frac	~100 mg	~25% (morphine)	2.5–3.0 (morphine, codeine)
Tilidine	Шаблон:Frac	100 mg
Dihydrocodeine	Шаблон:Frac	50 mg	20%	4
Anileridine	Шаблон:Frac	40 mg
Alphaprodine	Шаблон:Frac–Шаблон:Frac	40–60 mg
TapentadolШаблон:Sfn	Шаблон:Frac	32 mg	32% (fasting)
Pethidine (meperidine)	Шаблон:Frac	30 mg SC/IM/IV, 300 mg (PO)	50–60%	3–5
Benzylfentanyl	Шаблон:Frac
AH-7921	Шаблон:Frac
Hydrocodone	1	10 mg	70%	3.8–6 (Instant Release; PO)		10–30 min (Instant Release; PO)	4–6
Metopon	1	10 mg
Pentazocine lactate (IV)	1	10 mg SC/IV/IM, 150 mg (PO)
Morphine (oral)	1	10 mg	~25%	2–4	3:1	30 min (PO)	3–6 hours
Oxycodone (oral)	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)
Spiradoline	1.5
Nicomorphine	2–3	3.33–5 mg	20%	4
Oxycodone (IV)	3	3.33 mg	96%	1.5–3 (IV)		5 min (IV)	2-4 hours
Morphine (IV/IM)	3	3.33 mg	100%	2–3	3:1	Instantaneously (from 5 to 15 sec; IV); 5–15 min (IM)	3–7 hours
Clonitazene	3	3.33 mg
Methadone (acute)	3–4	2.5–3.33 mg	40–90%	15–60	2:1
Methadone (chronic)	2.5–5	2–4 mg	40–90%	15–60	2:1
Phenazocine	4	~2.5 mg
Diamorphine (Heroin; IV/IM)	4–5 (iv, im) 2–2.5 (insufflated)	2–2.5 mg	100%	<0.6 (morphine prodrug)		Instantaneously (from 5 to 15 sec; IV); 2 to 5 min (IM)	3 to 7 hours
Dezocine	4–6	1.6–2.5 mg	97% (IM)	2.2
HydromorphoneШаблон:SfnШаблон:SfnШаблон:Sfn	10–15 (SC, IV, IM) 3.75–5 (PO)	0.75 mg (SC, IV, IM) 2 mg (PO)	62%	2–3	5:1
Oxymorphone	8	3.33 mg (PO), 1 mg (IV,IM & Interlaminar)	10%–PO, ≈ 25% Sublabial, ≈ 28% Buccal, (35–40%) Sublingual & Intranasal 43% BA.	7.25–9.43		35 min (PO), Instantaneously (from 5 to 15 sec)(IV)	6–8 hours
U-47700	7.5	1.5 mg		1.5–3
Levorphanol	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)	40	0.25 mg	30% (SL); ~100% (TD); 65% (buccal); 48% (INS)	20–70, mean 37	3:1	45 min	12–24 hours
N-Phenethyl-14-ethoxymetopon	60	160 µg
Etonitazene	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)
Acrylfentanyl	(50–100+)
Buprenorphine (Transdermal)	100–115	0.1 mg (100 µg)	30% (SL); ~100% (TD); 65% (buccal); 48% (INS)		3:1	45–60 minutes	12–24 hours
14-Cinnamoyloxycodeinone	177	77 µg
Remifentanil	100–200	50–100 µg		0.05 (3–6 min context-sensitive half-life; 7–18min elimination half-life)		Instantaneously (from 5 to 15 sec)	15 minutes; rapid offset of effects necessitates continuous infusion for maintenance of anesthesia
Ocfentanil	125–250	40–80 µg
Ro4-1539	240–480	20-40 µg
Sufentanil	500–1,000	10–20 µg		4.4
BDPC	504	~20 µg
C-8813	591
4-Phenylfentanyl	800
3-Methylfentanyl	1000–1500
Etorphine	1,000–3,000	3.3–10 µg
Ohmefentanyl	6300
Acetorphine	8700	1.33 µg
Dihydroetorphine	1,000–12,000	0.83–10 µg (20–40 µg SL)
Carfentanil	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)	(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

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

General and cited references

Books

• Шаблон:Cite journal
• Шаблон:Cite book
• Шаблон:Cite book, Extra information, including printable charts
• Шаблон:Cite book

Articles

• Шаблон:Cite journal
• Шаблон:Cite journal
• Шаблон:Cite journal
• Шаблон:Cite journal

Websites

• Шаблон:Cite web
• Шаблон:Cite web
• Шаблон:Cite web
• Online opioid equianalgesia calculator Electronic calculator that includes logic for bidirectional and dose-dependent conversions