Opiods Equivalent compared to Methadone Differential Diagnosis of Misuse of Analgesic Opioids |
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Opiate/Opioid |
Dose |
methadone eq.dose |
remarks |
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Buprenorphine |
8mg |
60mg |
Opiate detoxification if does not want lofexidine. Onset of effects approximately 30 to 60 minutes. Peak effects occur 3 to 8 hours after a dose. Duration of effects are dose related: low doses (e.g. 0.2 to 0.8 mg / analgesia): 4–12 hours, medium doses (e.g. 4 to 8 mg): 12–24 hours high doses (e.g. 12 mg or more): 24–72 hours (2 - 3 days) |
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Codeine |
60mg |
4mg |
antitussive and analgesic opium alcaloide,often part of multiple pdoructsaddictions, Metabolism to morphine is a rate-limiting step that creates a ceiling of analgesia in most people |
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Coproxamol |
2 tabs |
8mg (325mg) |
paracetamol + 32.5mg dextropopxyphene |
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Dihydrocodeine |
60mg |
6mg |
antitussive, analgesic |
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Tramadol |
50mg |
10mg |
Promotes analgesia by a second mechanism: increasing serotonin/ norepinephrine; doses are limited due to risk of seizures. Relatively low rates of abuse and reward documented in some persons |
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Dextromoramide |
5mg |
10mg |
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Diamorphine (oral) |
10mg |
10mg |
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Dipipanone |
10mg |
5mg |
Diconal with 30mg cyclizine |
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Heroine |
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significant effects lasting up to 3–6 hours in regular users. |
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Hydromorphone |
1.3mg |
10mg |
quick onset; relatively high reward value |
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Meptazinol |
200mg |
8mg |
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Methadone |
10mg |
10mg |
long acting opioid used in chronic pain (methadone tablets) and for the treatment of opioid dependence (methadone syrup or solution). Onset of action:30–90 minutes after oral dose. Peak effects: 3–8 hours after dose. Duration of effects in substitution treatment of opioid dependence20–30 hours, allowing once a day dosing. Duration analgesic effects in pain management 8–12 hours, and is usually taken two or three timesa day for pain management. Half-life: 15–30 hours.Approximately 5 half lives to achieve steady-state equilibrium after a dose change. |
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Morphine |
10mg |
10mg |
variable but significant first-pass liver metabolism (the bioavailability of oral morphine is about 25% of injected doses. it has a similar duration of action to heroin, with significant effects for 3–6 hours slow-release oral morphine preparations are available allowing once or twice a day dosing for chronic pain. |
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Oxycodone |
30mg |
20mg |
suppository |
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10mg |
20mg |
tablet controlled release mechanism provides relatively stable blood levels, may be altered or misused |
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Pethidine |
50mg |
5mg |
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Phenazocine |
5mg |
25mg |
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Pentazocine |
25mg |
2mg |
ceiling analgesic effects, some patients experience less reward |
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Lofexidine |
Central alpha-2 agonist blocks autonomic response to opiate withdrawal. Non-opiate, non-addictive and noncontrolled drug. Some advantages over methadone as a detoxification agent. |
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Opiods withdrawal Common detoxification regimes - General exclusion criteria: |
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Buprenorphine |
Opiate withdrawal Sd is hardly ever life-threatening. Only usual exception: risk of preci-pitation of premature labor |
Clonidine The maximum daily dose of clonidine = 12 mcg / kg / day |
patients completing detoxification is greater if the patient first stabilized on methadone. 1st choice: lofexidine |
Lofexidine PODetoxification • methadone on moderate doses (20 to 70mg daily • moderate street heroin 1/4g - 3/4g daily - 2 days less (9days) |
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Total dose |
Opiate detoxification under general anaesthesia is not recommended under any circumstance. |
in 3-4 divided doses. |
Ibuprofen: 400mg tds po prn while metoclopramide: 10mg tds po prn while loperamide: 2mg po after loose stool to a maximum of 16mg daily for 1 week. zopiclone: 7.5-15mg nocte po prn for a max. 2 weeks •quinine for skeletal muscle cramps.300 mg i-ii nocte p.r.n. |
Total dose in 4 div.dos. |
PRN |
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Day 1 |
6 mg ±2 |
< 60 kg body weight: 300 to 400 mcg per day; if > 60 kg body weight: 450 to 600 mcg per day |
0.8mg |
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Day 2 |
8 mg ±4 |
1.2mg |
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Day 3 |
10 mg ±4 |
Clonidine (α-adrenergic agonist) / ‘autonomic’ features (diar-rhoea, nausea, abdominal cramps, sweating, rhinorrhoea) |
1.6mg |
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Day 4 |
8 mg ±2 |
75% of the day 3 |
1.6mg |
0.2mg bd |
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Day 5 |
4 mg ±4 |
50% of the day 3 |
1.6mg |
0.2mg qds |
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Day 6 |
0 to 4 mg |
25% of the day 3 |
1.2mg |
0.2mg qds |
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Day 7 |
0 to 2 mg |
Monitoring |
Titrate clonidine / clinical response |
Rapid detoxification use of naltrexone & sympt. medica. (clonidine, benzodiazepines, antiemetics) |
0.8mg |
0.2mg qds |
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Day 8 |
0 to 1 mg |
0.4mg |
0.2mg qds |
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Day 9 |
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0.2mg |
0.2mg tds |
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Day 10 |
|
0.2mg bd |
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Day 11 |
Naltrexone preventing relapse: start only 5 to 7 days with-out heroin use 10 days without methadone. Poor retention rates |
0.2mg od |
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