What should be considered in PRN dosing of opioid equivalents for breakthrough pain?

Updated: Jan 29, 2018
  • Author: Stephen Kishner, MD, MHA; Chief Editor: Erik D Schraga, MD  more...
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Answer

Answer

See the list below:

  • Augment around-the-clock scheduled opioid doses with PRN doses of short-acting opioids for acute exacerbation of chronic pain.

  • Short-acting opioid doses are approximately 10-20% of total 24-hour scheduled opioid dose (eg, 24-hour scheduled morphine totals 150 mg, therefore give short-acting morphine 15 mg PO q1h PRN for breakthrough pain).

  • Reassess efficacy and adverse effects at 60 minutes.

    • If the pain score is unchanged or increased, increase PRN dose 50-100%.

    • If the pain score is decreased, continue current effective PRN dose.


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