Immediate-release oral opioids for chronic pain in adults

Immediate-release preparation	Starting dose for opioid-naïve adult	Half-life
Hydromorphone	2 to 4 mg (tablets or oral solution) orally every 4 to 6 hours as needed	2 to 3 hours
Morphine	5 to 15 mg orally every 4 hours as needed*	2 to 3 hours
Oxycodone	2.5 to 10 mg mg orally every 4 to 6 hours as needed	2 to 3 hours
Oxymorphone	2.5 to 5 mg orally every 4 to 6 hours as needed	7 to 9 hours
Tapentadol	50 mg orally every six hours as needed	4 hours
Tramadol	25 to 50 mg orally every 6 hours as needed	6 to 9 hours (includes active metabolite)

The initial dose selected should be individualized based on pain severity and patient-specific factors including relevant co-morbidities. Doses should be lowered and dosing intervals extended for older patients, and for patients with hepatic or kidney dysfunction. Doses may also require adjustment for patients with known pharmacogenetic differences in opioid metabolism, and for patients who are receiving medications that inhibit or induce cytochrome P450 enzymes.

* The lowest strength immediate-release morphine oral tablet available in the United States is 15 mg. Oral liquids are available and may be useful for prescribing oral morphine doses less than 7.5 mg.

Data from:

American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc 2009; 57:1331.

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Immediate-release oral opioids for chronic pain in adults