Nonopioid analgesic drugs approved for children
RECOMMENDED STARTING DOSE (CHILDREN LESS THAN 50 kg BODY
WEIGHT)a
| APPROXIMATE EQUIANALGESIC ORAL DOSE | APPROXIMATE EQUIANALGESIC PARENTERAL DOSE | ORAL | PARENTERALb | |
| Morphinec | 30 mg every 3-4 hours
(around-the-clock dosing) 60 mg every 3-4 hours (single dose or intermittent dosing) |
10 mg every 3-4 hours | 0.2-0.4 mg/kg every 3-4 hours 0.3-0.6 mg/kg time released every 12 hours | 0.1-0.2 mg/kg IM every 3-4
hours 0.02-0.1 mg/kg IV bolus every 2 hours 0.015 mg/kg every 8 minutes PCA 0.01-0.02 mg/kg/hr IV infusion (neonates) 0.01-0.06 mg/kg/hr IV infusion (child) |
| Fentanyl (Sublimaze) (oral mucosal form-Fentanyl Oralet)d |
Not available | 0.1 mg IV | 5-15 µg/kg; maximum dose 400 µg | 0.5-1.5 µg/kg IV bolus every
1/2 hour 1-2 µg/hr IV infusion |
| Codeinee | 200 mg every 3-4 hours | 130 mg every 3-4 hours | 1 mg/kg every 3-4 hours | Not recommended |
| Hydromorphonec (Dilaudid) |
7.5 mg every 3-4 hours | 1.5 mg every 3-4 hours | 0.04-0.1 mg/kg every 4-6 hours | 0.02-0.1 mg/kg IM every 3-4 hours
0.005-0.2 mg/kg IV bolus every 2 hours
|
| Hydrocodone (in Lorcet, Lortab, Vicodin, others) | 30 mg every 3-4 hours | Not available | 0.2 mg/kg every 3-4 | Not available |
| Levorphanol (Levo-Dromoran) | 4 mg every 6-8 hours | 2 mg every 6-8 hours | 0.04 mg/kg every 6-8 hours | 0.02 mg/kg every 6-8 hours |
| Meperidine (Demerol)f | 300 mg every 2-3 hours | 100 mg every 3 hours | Not recommended | 0.75 mg/kg every 2-3 hours |
| Methadone (Dolophine, others) | 20 mg every 6-8 hours | 10 mg every 6-8 hours | .2 mg/kg every 6-8 hours | 0.1 mg/kg every 6-8 hours |
| Oxycodone (Roxicodone, Oxycontin; also in Percocet, Percodan, Tylox, others) | 30 mg every 3-4 hours | Not available | .2 mg/kg every 3-4 hours | Not available |
Data from Acute Pain Management Guideline Panel: Acute pain management: operative or medical procedures and trauma: clinical practice guideline, AHCPR Pub No 92-0032, Rockville, MD, 1992, Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services; and Berde C and others: Report of the subcommittee on disease-related pain in childhood cancer, Pediatrics 86(5, Pt 2):820, 1990. IV, Intravenous; IM; intramuscular; PCA, patient-controlled analgesia.
Note: Published tables vary in the suggested doses that are equianalgesic to morphine. Clinical response is the criterion that must be applied for each patient; titration to clinical response is necessary. Because there is not complete cross-tolerance among these drugs, it is usually necessary to use a lower than equianalgesic dose when changing drugs and to retitrate to response. Caution: Recommended doses do not apply to patients with renal or hepatic insufficiency or other conditions affecting drug metabolism and kinetics.
Caution: Doses listed for patients with body weight less than 50 kg cannot be used as initial starting doses in infants less than 6 months of age. For nonventilated infants under 6 months of age, the initial opioid dose should be about one fourth to one third of the dose recommended for older infants and children. For example, morphine could be used at a dose of 0.03 mg/kg instead of the traditional 0.1 mg/kg.
bIM injections should not be used.
cFor morphine, hydromorphone, and oxymorphone, rectal administration is an alternate route for patients unable to take oral medications, but equianalgesic doses may differ from oral and parenteral doses because of pharmacokinetic differences.
dFentanyl Oralet is indicated for use in a hospital setting only (1) as an anesthetic premedication in the operating room setting or (2) to induce conscious sedation before a diagnostic or therapeutic procedure in other monitored anesthesia care settings in hospital; is contraindicated in children who weigh less than 15 kg (33 lb).
eCaution: Codeine doses above 65 mg often are not appropriate because of diminishing incremental analgesia with increasing doses but continually increasing constipation and other side effects. Dosages are from McCaffery M, Beebe A: Pain: Clinical manual for nursing practice, St Louis, 1989, Mosby.
fMeperidine is not recommended for continuous pain control, i.e., postoperatively, because of risk of normeperidine toxicity (see Notes on Meperidine).
gCaution: Doses of aspirin and acetaminophen in combination with opioid/NSAID preparations must also be adjusted to patient's body weight.
March 15, 2002
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