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Equianalgesic#Opioid equivalency table

{{Short description|Comparison of equivalent doses of pain medications}}{{cs1 config|name-list-style=vanc}}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.{{sfn|Joishy|1999}} 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.{{sfn|Joishy|1999}} 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.{{sfn|McPherson|2009|loc=p. 5}}{{sfn|Natusch|2012}}

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).{{sfn|McPherson|2009|loc=p. 3}} Equianalgesic charts are also used when calculating an equivalent dosage of the same drug, but with a different route of administration.{{citation needed|date=February 2022}}

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.{{sfn|McPherson|2009|loc=p. 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-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.{{sfn|McPherson|2009|loc=p. 8}} 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.{{sfn|McPherson|2009|loc=p. 9}}{{sfn|Natusch|2012}}{{sfn|Anderson et al|2001}}

{{anchor | Table}}

Opioid equivalency table

{{contradicts other|oxycodone|here|morphine vs. oxycodone|section|equianalgesic table in the article on|date=September 2023}}

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.{{cite journal |last1=Cyriac |first1=JM |last2=James |first2=E |title=Switch over from intravenous to oral therapy: A concise overview. |journal=Journal of Pharmacology & Pharmacotherapeutics |date=April 2014 |volume=5 |issue=2 |pages=83–7 |doi=10.4103/0976-500X.130042 |pmid=24799810 |doi-access=free |pmc=4008927}}

=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.{{cite journal |title=WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents |journal= |date=2018 |url=https://www.ncbi.nlm.nih.gov/books/NBK537482/table/appannex6.tab2/ |access-date=14 April 2025 |publisher=World Health Organization}}{{cite journal |last1=Talal |first1=Andrew H. |last2=Ding |first2=Yuxin |last3=Venuto |first3=Charles S. |last4=Chakan |first4=Lindsay M. |last5=McLeod |first5=Anthony |last6=Dharia |first6=Arpan |last7=Morse |first7=Gene D. |last8=Brown |first8=Lawrence S. |last9=Markatou |first9=Marianthi |last10=Kharasch |first10=Evan D. |title=Toward precision prescribing for methadone: Determinants of methadone deposition |journal=PLOS ONE |date=17 April 2020 |volume=15 |issue=4 |pages=e0231467 |doi=10.1371/journal.pone.0231467 |pmid=32302325 |doi-access=free |pmc=7164646|bibcode=2020PLoSO..1531467T }} 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.{{cite journal |last1=Dayer |first1=Pierre |last2=Desmeules |first2=Jules |last3=Collart |first3=Laurence |title=Pharmacologie du tramadol |journal=Drugs |date=1997 |volume=53 |issue=Supplement 2 |pages=18–24 |doi=10.2165/00003495-199700532-00006 |pmid=9190321 |url=https://pubmed.ncbi.nlm.nih.gov/9190321/ |access-date=14 April 2025 |language=French}}{{Cite web|url=http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020281s032s033lbl.pdf|title=ULTRAM® (tramadol hydrochloride) Tablets Full Prescribing Information|date=March 2008|website=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.}}

{{sticky table start}}

class="wikitable sortable sticky-table-row1" style="background: #FFFFFF; border: 2px #FFFFFF solid; border-collapse: collapse; font-size: 95%;"

|+ colspan="9" style="background:#3A5274; color: #FFFFFF; text-align: center; border: 5px #ffffff solid;" | Comparison to oral morphine{{efn|Approximate. There is a wide range of values in controlled trials.{{sfn|Pereira et al|2001}}}}

Analgesic

! Strength
(relative)

! Equivalent dose
(10 mg oral morphine){{efn| 10 mg oral morphine is equivalent to n mg analgesic drug x, e.g. 10 mg morphine is equivalent to 3600 mg paracetamol or 1.5 mg hydromorphone}}

! Bioavailability

! Half-life of active metabolites
(hours)

! Oral-to-parenteral ratio

! Speed of onset

! Duration

style="background: #F2F7F3"

|Paracetamol (non-opioid)

|data-sort-value="0.0027777778"|{{frac|1|360}}

|3600 mg

|63–89%

|1–4

|

|37 min (PO); 8 min (IV)

|5–6 hours

style="background: #F2F7F3"

| Aspirin (NSAID, non-opioid)

|data-sort-value="0.0027777778"|{{frac|1|360}}

| 3600 mg

| 80–100%

| 3.1–9

|

|

|

style="background: #F2F7F3"

| Ibuprofen{{cite web|url=http://www3.us.elsevierhealth.com/PAIN/pdf/Chart2a.pdf|title=Dosing Guidelines for Acetaminophen and Selected NSAIDs|publisher=Mosby|website=Elsevier Health|access-date=2022-11-22|language=en|date=1999}} (NSAID, non-opioid)

|data-sort-value="0.0045045045"|{{frac|1|222}}

| 2220 mg

| 87–100%

| 1.3–3

|

|

|

style="background: #F2F7F3"

| Diflunisal (NSAID, non-opioid)

|data-sort-value="0.0062500000"|{{frac|1|160}}

| 1600 mg

| 80–90%

| 8–12

|

|

|

style="background: #F2F7F3"

| Naproxen (NSAID, non-opioid)

|data-sort-value="0.0072463768"|{{frac|1|138}}

| 1380 mg

| 95%

| 12–24

|

|

|

style="background: #F2F7F3"

|Indomethacin{{cite book |author1=Akul Munjal |author2=Abdallah E. Allam |title=Indomethacin |date=28 May 2024 |publisher=StatPearls Publishing |pmid=32310396 |url=https://www.ncbi.nlm.nih.gov/books/NBK555936 |access-date=23 March 2025}}{{cite journal |last1=El-Mashad |first1=Abd El-Rahman |last2=El-Mahdy |first2=Heba |last3=El Amrousy |first3=Doaa |last4=Elgendy |first4=Marwa |title=Comparative study of the efficacy and safety of paracetamol, ibuprofen, and indomethacin in closure of patent ductus arteriosus in preterm neonates |journal=European Journal of Pediatrics |date=February 2017 |volume=176 |issue=2 |pages=233–240 |doi=10.1007/s00431-016-2830-7 |pmid=28004188 |url=https://pubmed.ncbi.nlm.nih.gov/28004188/ |access-date=23 March 2025}} (NSAID non-opioid)

|data-sort-value="0.0156250000"|{{frac|1|64}}

|

|

|

|

|

|

style="background: #F2F7F3"

| Diclofenac{{Cite web |title=Diclofenac (Voltaren®) vs Naproxen (Aleve®, Naprosyn®) - eMedExpert.com |url=https://www.emedexpert.com/compare-meds/diclofenac-vs-naproxen.shtml |access-date=2022-11-22 |website=www.emedexpert.com}} (NSAID, non-opioid)

|data-sort-value="0.1000000000"|{{frac|1|10}}

| 100 mg (est.)

| 50–60%

| 1–4

|

|

|

style="background: #F2F7F3"

|KetorolacPharma Guide Pre-Work 3rd Edition (NSAID, non-opioid)

|data-sort-value="0.3333333333"|{{frac|1|3}}

|30 mg IV (est.)

|80–100%

|5–7

|

|

|

style="background: #F2F7F3"

| Nefopam{{cite journal |last1=Sunshine |first1=Abraham |last2=Laska |first2=Eugene |title=Nefopam and morphine in man |journal=Clinical Pharmacology & Therapeutics |date=November 1975 |volume=18 |issue=5part1 |pages=530–534 |doi=10.1002/cpt1975185part1530 |pmid=1102231 |url=https://pubmed.ncbi.nlm.nih.gov/1102231/ |access-date=23 March 2025}} (Centrally-acting non-opioid)

|data-sort-value="0.6250000000"|{{frac|5|8}}

| 16 mg IM (est.)

|

| Nefopam: 3–8, Desmethylnefopam 10–15

|

|

|

style="background: #F2F7F3"

| Piroxicam{{cite journal |last1=Moore |first1=R Andrew |last2=Edwards |first2=Jayne |last3=Loke |first3=Yoon Kong K |last4=Derry |first4=Sheena |last5=McQuay |first5=Henry J |title=Single dose oral piroxicam for acute postoperative pain |journal=Cochrane Database of Systematic Reviews |date=23 October 2000 |volume=2019 |issue=5 |pages=CD002762 |doi=10.1002/14651858.CD002762 |pmid=11034755 |pmc=4176623}}{{cite journal |last1=Brogden |first1=R.N. |last2=Heel |first2=R.C. |last3=Speight |first3=T.M. |last4=Avery |first4=G.S. |title=Piroxicam: A Review of its Pharmacological Properties and Therapeutic Efficacy |journal=Drugs |date=September 1981 |volume=22 |issue=3 |pages=165–187 |doi=10.2165/00003495-198122030-00001 |pmid=7021122 |url=https://pubmed.ncbi.nlm.nih.gov/7021122/ |access-date=23 March 2025}}{{cite journal |last1=Dionne |first1=Raymond A. |last2=Berthold |first2=Charles |last3=Cooper |first3=Stephen A. |title=Therapeutic Uses of Non-Opioid Analgesics |journal=Management of Pain & Anxiety in the Dental Office |date=2002 |pages=97–113 |doi=10.1016/B0-7216-7278-7/50011-3 |url=https://www.sciencedirect.com/topics/medicine-and-dentistry/piroxicam |access-date=23 March 2025 |isbn=9780721672786}} (NSAID non-opioid)

|3

|6.66 mg

|

|

|

|2-4 hours

|40 hours

Dextropropoxyphene{{cite book |chapter=Ch. 4 Narcotics: Synthetic Narcotics: Dextropropoxyphene |chapter-url=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 |url-status=dead |archive-url=https://web.archive.org/web/20061102144639/http://www.dea.gov/pubs/abuse/index.htm |archive-date=2006-11-02 }}

|data-sort-value="0.0500000000"|{{frac|1|20}}

| 130–200 mg

|

|

|

|

|

Codeine{{cite journal |last1=Knotkova PhD |first1=Helena |last2=Fine MD |first2=Perry G. |last3=Portenoy MD |first3=Russell K. |title=Opioid Rotation: The Science and the Limitations of the Equianalgesic Dose Table |journal=Journal of Pain and Symptom Management |date=September 2009 |volume=38 |issue=3 |pages=426–439 |doi=10.1016/j.jpainsymman.2009.06.001 |pmid=19735903 |url=https://www.sciencedirect.com/science/article/pii/S0885392409006307 |access-date=23 March 2025 |issn=0885-3924}}

|data-sort-value="0.1500000000"|{{frac|3|20}}

| 100–120 mg (PO)

| ~90%

| 2.5–3 (C6G 1.94;{{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 }} morphine 2–3)

|

|15–30 min (PO)

|4–6 hours

Tramadol

|data-sort-value="0.1000000000"|{{frac|1|10}}

| ~100 mg

| 75% (IR), 85–90% (ER)

| 6.0–8.8 (M1)

|

|

|

Opium{{cite book |title=Opium Consumption |date=2021 |publisher=International Agency for Research on Cancer |isbn=978-9283201656 |edition=IARC Working Group on the Identification of Carcinogenic Hazards to Humans |url=https://www.ncbi.nlm.nih.gov/books/NBK586388/ |access-date=23 March 2025 |chapter=126}} (oral)

|data-sort-value="0.1000000000"|{{frac|1|10}}

| ~100 mg

| ~25% (morphine)

| 2.5–3.0 (morphine, codeine)

|

|

|

Tilidine{{cite journal |last1=Jasinski |first1=Donald R. |last2=Preston |first2=Kenzie L. |title=Evaluation of tilidine for morphine-like subjective effects and euphoria |journal=Drug and Alcohol Dependence |date=November 1986 |volume=18 |issue=3 |pages=273–292 |doi=10.1016/0376-8716(86)90059-1 |pmid=3803198 |url=https://pubmed.ncbi.nlm.nih.gov/3803198/ |access-date=14 April 2025}}

| data-sort-value="0.1000000000"|{{frac|1|10}}

| 100 mg

| 6% (parent drug), 99% (active metabolite){{cite journal |last1=Vollmer |first1=KO |last2=Thomann |first2=P |last3=Hengy |first3=H |title=Pharmacokinetics of tilidine and metabolites in man. |journal=Arzneimittel-Forschung |date=October 1989 |volume=39 |issue=10 |pages=1283–8 |pmid=2610722 |url=https://pubmed.ncbi.nlm.nih.gov/2610722/ |access-date=14 April 2025}}

| nortilidine 3.3 (PO) & 4.9 IV, bisnortilidine 5 (PO) & 6.9 (IV)

| 2.2:1

| 10-15 minutes (oral) 25-50 minutes (peak analgesic effect)

| 3-4 hours

Dihydrocodeine

|data-sort-value="0.2000000000"|{{frac|1|5}}{{Citation needed|date=March 2025}}

| 50 mg

| 20%

| 4

|

|

|

Anileridine{{cite web |title=Anileridine |work=DrugBank Version: 3.0 |publisher=DrugBank |url=http://www.drugbank.ca/drugs/DB00913}}

|data-sort-value="0.2500000000"|{{frac|1|4}}

| 40 mg

|

|

|

|

|

Alphaprodine

|data-sort-value="0.1666666667"|{{frac|1|6}}{{Citation needed|date=March 2025}}

| 40–60 mg

|

|

|

|

|

Tapentadol{{sfn|Cupp|2012}}

|data-sort-value="0.3000000000"|{{frac|3|10}}

| 32 mg

| 32% (fasting)

|

|

|

|

Pethidine (meperidine){{cite book |last1=Anderson |first1=Brian J. |editor1-last=Coté |editor1-first=Charles J. |title=A practice of anesthesia for infants and children |date=2019 |publisher=Elsevier |location=Philadelphia, PA | doi=10.1016/B978-0-323-42974-0.00007-0 |isbn=978-0-323-42974-0 |edition=Sixth |url=https://www.sciencedirect.com/topics/nursing-and-health-professions/pethidine |access-date=14 April 2025 |chapter=7 - Pharmacokinetics and Pharmacology of Drugs Used in Children|pages=100–176.e45 }}

|data-sort-value="0.3333333333"|{{frac|1|3}}

| 30 mg SC/IV/IM

300 mg (PO)

| 50–60% Orally, 100% SC/IV/IM

| 3–5

|

|5–15 sec if IV, 15–25 min if orally

|

Dipipanone{{Citation |title=Dipipanone |date=2024-06-14 |work=Wikipedia |url=https://en.wikipedia.org/wiki/Dipipanone |access-date=2024-10-19 |language=en}}{{cite journal | pmc=1381337 | date=1992 | title=Pharmacokinetics of dipipanone after a single oral dose | journal=British Journal of Clinical Pharmacology | volume=33 | issue=4 | pages=449–450 | doi=10.1111/j.1365-2125.1992.tb04066.x | pmid=1349495 | vauthors = Paterson S }}

|data-sort-value="0.4000000000"|{{frac|2|5}}

|25 mg (PO)

|

|3.2–3.8 hours

|

|

| ±4 hours

Benzylfentanyl

|data-sort-value="0.5000000000"|{{frac|1|2}}{{Citation needed|date=March 2025}}

|

|

|

|

|

|

AH-7921

|data-sort-value="0.8000000000"|{{frac|4|5}}{{Citation needed|date=March 2025}}

|

|

|

|

|

|

SR-17018{{cite journal |last1=Pantouli |first1=Fani |last2=Grim |first2=Travis W. |last3=Schmid |first3=Cullen L. |last4=Acevedo-Canabal |first4=Agnes |last5=Kennedy |first5=Nicole M. |last6=Cameron |first6=Michael D. |last7=Bannister |first7=Thomas D. |last8=Bohn |first8=Laura M. |title=Comparison of morphine, oxycodone and the biased MOR agonist SR-17018 for tolerance and efficacy in mouse models of pain |journal=Neuropharmacology |date=March 2021 |volume=185 |pages=108439 |doi=10.1016/j.neuropharm.2020.108439 |pmid=33345829 |pmc=7887086}}

| data-sort-value="0.8000000000"|{{frac|4|5}}

| 10–12 mg

| 100% IV (Presumably) Unknown (researches are still being made)

|

|

| 5–10 seconds if used IV and 15-25 min Orally (PO)

|

Nalbuphine{{cite journal |last1=Beaver |first1=WT |last2=Feise |first2=GA |title=A comparison of the analgesic effect of intramuscular nalbuphine and morphine in patients with postoperative pain. |journal=The Journal of Pharmacology and Experimental Therapeutics |date=February 1978 |volume=204 |issue=2 |pages=487–96 |doi=10.1016/S0022-3565(25)31162-6 |pmid=340643 |url=https://pubmed.ncbi.nlm.nih.gov/340643/ |access-date=14 April 2025 }}

| data-sort-value="0.9000000000"|{{frac|9|10}}

| 10-11 mg

| ~33% (PO), 76% (SC), 81% (IM){{cite book |last1=Bissonnette |first1=Bruno |last2=Dalens |first2=Bernard J. |title=Pediatric anesthesia: principles & practice |date=2002 |publisher=McGraw-Hill, Medical Publ. Division |location=New York |isbn=9780071354547 |page=398 |url=https://www.isbns.net/isbn/9780071354547/ |access-date=14 April 2025}}

| 3-6

|

| 3 minutes, 10 minutes (peak effect)

| 3-6 hours{{cite journal |last1=Deslandes |first1=Marvin |last2=Deicke |first2=Martin |last3=Grannemann |first3=Julia Johanna |last4=Hinkelbein |first4=Jochen |last5=Hoyer |first5=Annika |last6=Kalmbach |first6=Matthias |last7=Kobiella |first7=André |last8=Strickmann |first8=Bernd |last9=Plappert |first9=Thomas |last10=Jansen |first10=Gerrit |title=Effectiveness and safety of prehospital analgesia with nalbuphine and paracetamol versus morphine by paramedics - an observational study |journal=Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |date=10 May 2024 |volume=32 |issue=1 |page=41 |doi=10.1186/s13049-024-01215-z |doi-access=free |pmid=38730453 |pmc=11084095 }}

Hydrocodone{{cite journal |last1=Stanos |first1=Steven P. |last2=Tyburski |first2=Mark D. |last3=Parikh |first3=Sagar S. |title=Minor and Short-Acting Analgesics, Including Opioid Combination Products |journal=Practical Management of Pain |date=2014 |pages=508–529.e6 |doi=10.1016/B978-0-323-08340-9.00037-2 |url=https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/hydrocodone |access-date=23 March 2025 |isbn=9780323083409}}

| 1

| 10 mg

| 70%{{cite journal | vauthors = Zacny JP, Gutierrez S | title = Within-subject comparison of the psychopharmacological profiles of oral hydrocodone and oxycodone combination products in non-drug-abusing volunteers | journal = Drug Alcohol Depend | volume = 101 | issue = 1–2 | pages = 107–14 | date = April 2009 | pmid = 19118954 | doi = 10.1016/j.drugalcdep.2008.11.013 | url = https://zenodo.org/record/896375}}

| 3.8–6 (Instant Release; PO)

|

|10–30 min (Instant Release; PO)

|4–6

Metopon

| 1{{Citation needed|date=March 2025}}

| 10 mg

|

|

|

|

|

Pentazocine lactate (IV){{ 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 | access-date = 2011-12-10 }}

| 1

| 10 mg SC/IV/IM, 150 mg (PO)

|

|

|

|

|

style="background: #FCFC97"

| Morphine (oral)

| 1

| 10 mg

| ~25%

| 2–4

|3:1

|30 min (PO)

|3–6 hours

Oxycodone (oral){{cite web|title=Equianalgesic Conversion|url=http://globalrph.com/narcoticonv.htm|publisher=GlobalRPH}}

| 1.5

| 6.67 mg

| (60–87 / ±75% PO) / 78.2%{{cite journal | pmc=4006196 | date=2011 | title=Pharmacokinetics of intranasal Crushed OxyContin and Intravenous Oxycodone in Nondependent Prescription Opioid Abusers | journal=Journal of Clinical Pharmacology | volume=52 | issue=4 | pages=600–606 | doi=10.1177/0091270011401620 | pmid=21610203 | vauthors = Lofwall MR, Moody DE, Fang WB, Nuzzo PA, Walsh SL }} (IN) / 100%

(IV/IM) or other parenteral administrations apart from spinal administration

| 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){{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 |s2cid=35076787 }}

Spiradoline

|1.5{{Citation needed|date=March 2025}}

|

|

|

|

|

|

Nicomorphine

| 2–3{{Citation needed|date=March 2025}}

| 3.33–5 mg

| 20%

| 4

|

|

|

Butorphanol{{cite journal |last1=Tavakoli |first1=M. |last2=Corssen |first2=G. |last3=Caruso |first3=F. S. |title=Butorphanol and Morphine: A Double-Blind Comparison of Their Parenteral Analgesic Activity |journal=Anesthesia & Analgesia |date=May 1976 |volume=55 |issue=3 |pages=394–401 |doi=10.1213/00000539-197605000-00025 |pmid=776040 |url=https://pubmed.ncbi.nlm.nih.gov/776040/ |access-date=14 April 2025 }}

| 2.3

| 4.3 mg

| ~12% (PO), 25%-35% (SL), 70% (NAS){{cite journal |last1=Koyyalagunta |first1=Dhanalakshmi |last2=Waldman |first2=Steven D. |title=Opioid Analgesics |journal=Pain Management |date=2011 |volume=2 |pages=890–912 |doi=10.1016/B978-1-4377-0721-2.00122-7 |url=https://www.sciencedirect.com/topics/medicine-and-dentistry/butorphanol |access-date=14 April 2025 |publisher=W.B. Saunders |isbn=9781437707212}}

| 3 (IM/IV) 4.5-5.5 (NAS)

| 5.8:1

| 15 minutes

| 3-4 hours

Oxycodone (IV/IM) or other parental administrations apart from spinal administration{{cite journal |last1=Silvasti |first1=M |last2=Rosenberg |first2=P |last3=Seppälä |first3=T |last4=Svartling |first4=N |last5=Pitkänen |first5=M |title=Comparison of analgesic efficacy of oxycodone and morphine in postoperative intravenous patient-controlled analgesia |journal=Acta Anaesthesiologica Scandinavica |date=May 1998 |volume=42 |issue=5 |pages=576–580 |doi=10.1111/j.1399-6576.1998.tb05169.x |pmid=9605375 |s2cid=25763059 |url=https://pubmed.ncbi.nlm.nih.gov/9605375/ |access-date=10 August 2022}}

| 3–4

| 2.5–3.33 mg

| (60–87 / ±75% PO) / 78.2% (IN) / 100%

(IV/IM) or other parental administrations apart from spinal administration

|1.5–3 (IV/IM)

|

|5 min (IV)

|2–4 hours

style="background: #F5F5C4"

| Morphine{{cite journal |last1=Hoskin |first1=Pj |last2=Hanks |first2=Gw |last3=Aherne |first3=Gw |last4=Chapman |first4=D. |last5=Littleton |first5=P. |last6=Filshie |first6=J. |title=The bioavailability and pharmacokinetics of morphine after intravenous, oral and buccal administration in healthy volunteers. |journal=British Journal of Clinical Pharmacology |date=April 1989 |volume=27 |issue=4 |pages=499–505 |doi=10.1111/j.1365-2125.1989.tb05399.x |pmid=2719903 |pmc=1379730}} (IV/IM) or other parental administrations apart from spinal administration

| 3–4

| 2.5–3.33 mg

| 100%

| 3–4

|3:1/4:1

|Instantaneously (from 5 to 15 sec; IV); 5–15 min (IM)

|3–7 hours

Clonitazene

| 3{{Citation needed|date=March 2025}}

| 3.33 mg

|

|

|

|

|

Methadone (acute)[http://www.psicofarmacos.info/images/graficos/Tabla4_opiaceos.JPG Tabla de equivalencia opiáceos]{{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 }} [https://archive.today/20120911144851/http://www.jaoa.org/content/105/3_suppl/18S/T2.expansion.html Table 2: Conversion Ratio of Oral Morphine to Methadone].

| 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{{Citation needed|date=March 2025}}

|~2.5 mg

|

|

|

|

|

Diamorphine (Heroin;

IV/IM) or other parental administrations apart from spinal administration{{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 |doi=10.1016/S0022-3565(25)26258-9 |pmid=14491157 |url=http://jpet.aspetjournals.org/content/136/1/43.short}}

| 4–5 (IV,IM)

2–2.5 (insufflated){{Cite journal |last1=Cone |first1=E. J. |last2=Holicky |first2=B. A. |last3=Grant |first3=T. M. |last4=Darwin |first4=W. D. |last5=Goldberger |first5=B. A. |date=October 1993 |title=Pharmacokinetics and pharmacodynamics of intranasal 'snorted' heroin |url=https://pubmed.ncbi.nlm.nih.gov/8271778/ |journal=Journal of Analytical Toxicology |volume=17 |issue=6 |pages=327–337 |doi=10.1093/jat/17.6.327 |issn=0146-4760 |pmid=8271778}}

| 2–2.5 mg

| 100%

| <0.6 (morphine prodrug){{cite journal | vauthors = Sawynok J | title = The therapeutic use of heroin: a review of the pharmacological literature | journal = Canadian Journal of Physiology and Pharmacology | volume = 64 | issue = 1 | pages = 1–6 | date = January 1986 | pmid = 2420426 | doi = 10.1139/y86-001 }}

|

|Instantaneously (from 5 to 15 sec; IV); 2 to 5 min (IM)

|3 to 7 hours

(morphine prodrug)

Dezocine

|4–6{{Citation needed|date=March 2025}}

|1.6–2.5 mg

|97% (IM)

|2.2

|

|

|

6-MAM{{Cite journal |last1=Perekopskiy |first1=David |last2=Kiyatkin |first2=Eugene A. |date=2019-08-21 |title=6-Monoacetylmorphine (6-MAM), Not Morphine, Is Responsible for the Rapid Neural Effects Induced by Intravenous Heroin |url=https://pubmed.ncbi.nlm.nih.gov/31268284/ |journal=ACS Chemical Neuroscience |volume=10 |issue=8 |pages=3409–3414 |doi=10.1021/acschemneuro.9b00305 |issn=1948-7193 |pmid=31268284}}

|6–7

(IV,IM)

|1.25–1.6

|100% (IV,IM)

|<0.6 (morphine prodrug)

|presumably 2:1

|Instantaneously (from 5 to 15 sec; IV); 2 to 5 min (IM)

|3 to 7 hours

(morphine prodrug)

Hydromorphone{{sfn|Toronto Surgery|2014}}{{sfn|Walker|2001}}{{sfn|Cupp|2012}}

| 10 (SC, IV, IM)
3–3.75 (PO)

| 0.5–0.75 mg (SC, IV, IM)
2.5 mg (PO)

| Orally: 30–35%, Intranasal: 52–58%, IV/IM: 100%

62%

| 2–3

|5:1

|

|

Oxymorphone

| 10 (SC, IV, IM)
3–4(PO)

| 3.33 mg (PO), 0.333 mg (IV,IM & Interlaminar)

|PO: 10%

Buccal: 28%

Sublingual: 37.5%

Intranasal: 43%

IV, IM & IT: 100%

| 7.25–9.43

|

|35 min (PO), Instantaneously (from 5 to 15 sec)(IV)

|6–8 hours orally

2–6 hours parenteral

U-47700

|7.5{{Citation needed|date=March 2025}}

|1.5 mg

|

|1.5–3

|

|

|

Levorphanol{{cite web |title=Levorphanol |work=DrugBank Version: 3.0 |publisher=DrugBank |url=http://www.drugbank.ca/drugs/APRD00764}}

| 8

| 1.25 mg

| 70%

| 11–16

|1:1

|

|

Desomorphine

|8–10{{Citation needed|date=March 2025}}

|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{{Citation needed|date=March 2025}}

|

|

|

|

|

|

Alfentanyl{{cite web |title=Relative Doses of Opioids |url=https://www.westmidspallcare.co.uk/wmpcp/guide/pain/relative-doses-of-opioids/ |website=West Midlands Palliative Care Physicians |publisher=West Midlands Palliative Care |access-date=23 March 2025}}

|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

|data-sort-value="17.5"|10-25{{Citation needed|date=March 2025}}

|

|

|

|

|

|

Brifentanil

|data-sort-value="17.5"|10-25{{Citation needed|date=March 2025}}

|

|

|

|

|

|

Acetylfentanyl

|15{{Citation needed|date=March 2025}}

|

|

|

|

|

|

7-Hydroxymitragynine

| 17{{Citation needed|date=March 2025}}

| ~0.6 mg

|

|

|

|

|

Furanylfentanyl

|20{{Citation needed|date=March 2025}}

|

|

|

|

|

|

Butyrfentanyl

|25{{Citation needed|date=March 2025}}

|

|

|

|

|

|

Enadoline

|25{{Citation needed|date=March 2025}}

|15 μg (threshold) and 0.160 mg/kg (dissociative effects)

|

|

|

|

|

Buprenorphine (SL)

| 40

| 0.25 mg

| 30% (SL);{{cite journal | doi=10.1177/009127009703700106 | title=Bioavailability of Sublingual Buprenorphine | date=1997 | journal=The Journal of Clinical Pharmacology | volume=37 | issue=1 | pages=31–37 | pmid=9048270 | vauthors = Mendelson J, Upton RA, Everhart ET, Iii PJ, Jones RT }} ~100% (TD); 65% (buccal);{{Cite web|url=https://www.pbm.va.gov/PBM/clinicalguidance/abbreviatedreviews/Buprenorphine_NX_Buccal_Film_BUNAVAIL_%20Abbreviated_Review.pdf|title=Buprenorphine / Naloxone Buccal Film (BUNAVAIL) C-III|date=September 2014|website=Pharmacy Benefits Management (PBM) Services}}[https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/205637s000lbl.pdf BUNAVAIL (buprenorphine and naloxone) buccal film, CIII [prescribing information online]]. BioDelivery BioDelivery Sciences International, Inc. (BDSI), Raleigh, NC. Jun 2014. 48% (INS)Eriksen J, Jensen NH, Kamp-Jensen M, Bjarnø H, Friis P, Brewster D (1989). "The systemic availability of buprenorphine administered by nasal spray". J. Pharm. Pharmacol. 41 (11): 803–5. doi:10.1111/j.2042-7158.1989.tb06374.x

| 20–70, mean 37

|3:1

|45 min

|12–24 hours

N-Phenethyl-14-ethoxymetopon

|60{{Citation needed|date=March 2025}}

|160 μg

|

|

|

|

|

Phenomorphan

|60–80{{Citation needed|date=March 2025}}

|0.13–0.16 mg

|

|

|

|

|

N-Phenethylnordesomorphine

|85{{Citation needed|date=March 2025}}

|

|

|

|

|

|

Phenaridine

|data-sort-value="75"|50-100{{Citation needed|date=March 2025}}

|

|

|

|

|

|

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)

Metonitazene

|100{{Citation needed|date=March 2025}}

|0.1 mg/100 μg

|

|

|

|

|

Acrylfentanyl

|data-sort-value="75"|50-100+{{Citation needed|date=March 2025}}

|

|

|

|

|

|

Buprenorphine (Transdermal){{cite journal | doi=10.2147/JPR.S85951 | doi-access=free | title=Buprenorphine – an attractive opioid with underutilized potential in treatment of chronic pain | date=2015 | journal=Journal of Pain Research | volume=8 | pages=859–870 | pmid=26672499 | pmc=4675640 | vauthors = Pillarisetti S, Khanna I }}{{cite journal | doi=10.1111/pme.12386 | title=Sublingual Buprenorphine as an Analgesic in Chronic Pain: A Systematic Review | date=2014 | journal=Pain Medicine | volume=15 | issue=7 | pages=1171–1178 | pmid=24995716 | vauthors = Cote J, Montgomery L }}

|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{{Citation needed|date=March 2025}}

|77 μg

|

|

|

|

|

Etonitazepyne

|180-190{{Citation needed|date=March 2025}}

|55–60 μg

|

|

|

|

|

Protonitazepyne

|180-190{{Citation needed|date=March 2025}}

|55–60 μg

|

|

|

|

|

Remifentanil

|100–200{{Citation needed|date=March 2025}}

|50–100 μg

|

|0.05 (3–6 min context-sensitive half-life; 7–18 min elimination half-life)

|

|Instantaneously (from 5 to 15 sec)

|15 minutes; rapid offset of effects necessitates continuous infusion for maintenance of anesthesia

Protonitazene

|200{{Citation needed|date=March 2025}}

|50 μg

|

|

|

|

|

Ocfentanil

|125–250{{Citation needed|date=March 2025}}

|40–80 μg

|

|

|

|

|

Ro4-1539

|240–480{{Citation needed|date=March 2025}}

|20–40 μg

|

|

|

|

|

Isotonitazene

|500{{Citation needed|date=March 2025}}

|20 μg

|

|

|

|

|

Sufentanil

| 500–1,000

| 10–20 μg

|

| 4.4

|

|

|

BDPC

| 504{{Citation needed|date=March 2025}}

| ~20 μg

|

|

|

|

|

C-8813

|591{{Citation needed|date=March 2025}}

|

|

|

|

|

|

4-Phenylfentanyl

|800{{Citation needed|date=March 2025}}

|

|

|

|

|

|

Etonitazene

| 1000–1500{{Citation needed|date=March 2025}}

| 6.6–10 μg

|

|

|

|

|

3-Methylfentanyl

| 1000–1500{{Citation needed|date=March 2025}}

|

|

|

|

|

|

N-Desetylisotonitazene

|1000–2000{{Citation needed|date=March 2025}}

|5–10 μg

|

|

|

|

|

Etorphine

| 1,000–3,000{{Citation needed|date=March 2025}}

| 3.3–10 μg

|

|

|

|

|

Ohmefentanyl

|6300{{Citation needed|date=March 2025}}

|

|

|

|

|

|

Acetorphine

|8700{{Citation needed|date=March 2025}}

|1.33 μg

|

|

|

|

|

Dihydroetorphine{{Cite journal|last1=Ohmori|first1=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|pmc=6741694|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}}

| 1,000–12,000

| 0.83–10 μg (20–40 μg SL)

|

|

|

|

|

Carfentanil{{cite web |title=Carfentanil |work=DrugBank Version: 3.0 |publisher=DrugBank |url=https://www.drugbank.ca/drugs/DB01535}}

| 10,000

| 1.0 μg

|

| 7.7

|

|

|

2-Fluorohmefentanil

|18,000{{Citation needed|date=March 2025}}

|

|

|

|

|

|

4-Carboethoxyohmefentanil

|30,000{{Citation needed|date=March 2025}}

|

|

|

|

|

|

Ohmecarfentanil

|data-sort-value="30000"|30,000{{Citation needed|date=March 2025}}

|

|

|

|

|

|

R-30490

|data-sort-value="55000"|10,000-100,000{{Citation needed|date=March 2025}}

|

|

|

|

|

|

Lofentanil

|data-sort-value="55000"|10,000-100,000{{Citation needed|date=March 2025}}

|

|

|

|

|

|

14-Methoxymetopon (intraspinally){{cite journal |last1=King |first1=Michael A |last2=Su |first2=Wendy |last3=Nielan |first3=Claire L |last4=Chang |first4=Albert H |last5=Schütz |first5=Johannes |last6=Schmidhammer |first6=Helmut |last7=Pasternak |first7=Gavril W |title=14-Methoxymetopon, a very pote⁸nt μ-opioid receptor-selective analgesic with an unusual pharmacological profile |journal=European Journal of Pharmacology |date=17 January 2003 |volume=459 |issue=2 |page=205 |doi=10.1016/s0014-2999(02)02821-2 |pmid=12524147 |url=https://www.sciencedirect.com/science/article/pii/S0014299902028212 |access-date=19 February 2024}}

|data-sort-value="1000000"|1,000,000

|

|

|

|

|

|

class=sortbottom

|colspan="9" style=" border: 1px solid #000000; text-align:center;" |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.

{{Sticky table end}}

See also

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

References

Explanatory notes

{{notelist}}

Citations

{{Reflist}}

Bibliography

::Books

{{refbegin|30em}}

  • {{Cite journal|last=Cupp|first=Melanie|title=Equianalgesic Dosing of Opioids for Pain Management. PL Detail-Document #280801|url=https://www.nhms.org/sites/default/files/Pdfs/Opioid-Comparison-Chart-Prescriber-Letter-2012.pdf|journal=Pharmacist's Letter|date=August 2012|access-date=2016-02-05|archive-date=2015-02-13|archive-url=https://web.archive.org/web/20150213072552/http://www.nhms.org/sites/default/files/Pdfs/Opioid-Comparison-Chart-Prescriber-Letter-2012.pdf|url-status=dead}}
  • {{Cite book | last=Joishy | first=S. K. | title=Palliative medicine secrets |year=1999 | publisher=Hanley & Belfus | location=Philadelphia | page=97 | isbn=978-1-56053-304-7}}
  • {{cite book|last1=McCaffery|first1=Margo|last2=Pasero|first2=Chris|title=Pain: Clinical Manual|url=https://books.google.com/books?id=B5JtAAAAMAAJ|year=1999|publisher=Mosby|isbn=978-0-8151-5609-3|edition=2nd}}, [http://www3.us.elsevierhealth.com/PAIN/index.html Extra information, including printable charts]
  • {{Cite book | last=McPherson | first=Mary Lynn M. | title=Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing | url=https://books.google.com/books?id=6oBA9z5wl9wC | year=2009 | publisher=American Society of Health-System Pharmacists | location=Bethesda MD | page=5 | isbn=978-1-58528-297-5 }}

{{refend}}

::Articles

{{refbegin|30em}}

  • {{cite journal |last1=Anderson |first1=Robert |last2=Saiers |first2=Joseph H |last3=Abram |first3=Stephen |last4=Schlicht |first4=Christian |title=Accuracy in Equianalgesic Dosing |journal=Journal of Pain and Symptom Management |date=May 2001 |volume=21 |issue=5 |pages=397–406 |doi=10.1016/S0885-3924(01)00271-8|pmid=11369161 |doi-access=free|ref={{harvid|Anderson et al|2001}}}}
  • {{cite journal |last1=Natusch |first1=Douglas |title=Equianalgesic doses of opioids – their use in clinical practice |journal=British Journal of Pain |date=February 2012 |volume=6 |issue=1 |pages=43–46 |doi=10.1177/2049463712437628|pmid=26516465 |pmc=4590088 |doi-access=free}}
  • {{cite journal |last1=Pereira |first1=Jose |last2=Lawlor |first2=Peter |last3=Vigano |first3=Antonio |last4=Dorgan |first4=Marlene |last5=Bruera |first5=Eduardo| title=Equianalgesic Dose Ratios for Opioids |journal=Journal of Pain and Symptom Management |date=August 2001 |volume=22 |issue=2 |pages=672–687 |doi=10.1016/s0885-3924(01)00294-9 |doi-access=free|pmid=11495714|ref={{harvid|Pereira et al|2001}}}}
  • {{Cite journal |last1=Shaheen |first1=Philip E. |last2=Walsh |first2=Declan |last3=Lasheen |first3=Wael |last4=Davis |first4=Mellar P. |last5=Lagman |first5=Ruth L. |date=September 2009 |title=Opioid equianalgesic tables: are they all equally dangerous? |journal=Journal of Pain and Symptom Management |volume=38 |issue=3 |pages=409–417 |doi=10.1016/j.jpainsymman.2009.06.004 |issn=1873-6513 |pmid=19735901|doi-access=free }}

{{refend}}

::Websites

{{refbegin|30em}}

  • {{cite web |title=Opioid Equianalgesic Table |url=https://surgery.utoronto.ca/file/1330/download?token=AwhfeyiE |website=Lecture Notes |publisher=Department of Surgery, University of Toronto |access-date=26 February 2020 |date=November 2014 |ref={{harvid|Toronto Surgery|2014}} |archive-date=26 February 2020 |archive-url=https://web.archive.org/web/20200226183108/https://surgery.utoronto.ca/file/1330/download%3Ftoken%3DAwhfeyiE |url-status=dead }}
  • {{cite web|last=Walker|first=Paul|title=Issue 17. Morphine vs Hydromorphone vs Oxycodone vs The Patch|website=Palliative Care Tips: Info for Health Professionals|publisher=Palliative & End of Life Care (PEOLC), Alberta Health Services|date=2001|url=http://www.palliative.org/PC/ClinicalInfo/PCareTips/MorphineVSHydromorphine.html|archive-url=https://web.archive.org/web/20011224112255/http://www.palliative.org/PC/ClinicalInfo/PCareTips/MorphineVSHydromorphine.html|archive-date=December 24, 2001|url-status=dead}}
  • {{cite web |title=Management of Opioid Therapy (OT) for Chronic Pain (2017) |url=https://www.healthquality.va.gov/guidelines/Pain/cot/VADoDOTCPG022717.pdf |department=VA/DoD Clinical Practice Guidelines |publisher=Department of Veterans Affairs |access-date=26 February 2020 |page=99 |ref={{harvid|VA|2017}} }}
  • [http://clincalc.com/Opioids Online opioid equianalgesia calculator] Electronic calculator that includes logic for bidirectional and dose-dependent conversions

{{refend}}

{{Analgesics}}

{{Opioid receptor modulators}}

Category:Anesthesia

Category:Clinical pharmacology

Category:Comparison of psychoactive substances

Category:Medical terminology

Category:Nociception

Category:Opioids

Category:Pain