SC or IM injection, 5 mg repeated every 4 hours if necessary (up to 10 mg for heavier well-muscled patients)
by slow IV injection, quarter to half corresponding intramuscular dose
by slow IV injection (1 mg/minute)
5 mg followed by a further 2.5–5 mg if necessary
elderly or frail patients, reduce dose by half
by slow IV injection (1 mg/minute) 2.5–5 mg
Oral, SC or IM 5–10 mg regularly every 4 hours
dose may be increased according to needs
IM dose should be approx. half corresponding oral dose, and approx. one third corresponding oral morphine dose, by subcutaneous infusion (using syringe driver) in palliative care
Fentanyl by A. McLeod
Indications: breakthrough pain in patients already receiving opioid therapy for chronic cancer pain (lozenges); chronic intractable pain (patches).
Group: Opioid analgesics. Fentanyl is about 80x more potent than morphine
Duragesic: is a fentanyl transdermal patch used in chronic pain management. Duragesic patches work by releasing fentanyl into subcutaneous fats, which then slowly release the drug into the blood stream over 72 hours, allowing for long lasting relief from pain.
Duragesic is manufactured in five patch sizes: 12.5 µg/h, 25 µg/h, 50 µg/h, 75 µg/h, and 100 µg/h. Dosage is based on the size of the patch, since the transdermal absorption rate is generally constant at skin temperature. Dosages above 25 µg/h should not be prescribed unless the patient is opioid tolerant (seek senior advice).
Pethidine by A. McLeod