Narcotic Analgesics For Pain Relief (Systemic)

Brand name(s): ph

Proper Use of This Medicine

Some narcotic analgesics given by injection may be given at home to patients who do not need to be in the hospital. If you are using an injection form of this medicine at home, make sure you clearly understand and carefully follow your doctor's instructions.

To take long-acting hydromorphone capsules:

• These capsules must be swallowed whole. Do not chew, crush or dissolve.
• If the capsules is not swallowed whole, you could overdose on this medicine.
• Check with your doctor right away if you are not sure how to take extended-release hydromorphone capsules.

To take the syrup form of meperidine:

• Unless otherwise directed by your medical doctor or dentist, take this medicine mixed with a half glass (4 ounces) of water to lessen the numbing effect of the medicine on your mouth and throat.

To take the oral liquid forms of methadone:

• This medicine may have to be mixed with water or another liquid before you take it. Read the label carefully for directions. If you have any questions about this, check with your health care professional.

To take the dispersible tablet form of methadone:

• These tablets must be stirred into water or fruit juice just before each dose is taken. Read the label carefully for directions . If you have any questions about this, check with your health care professional.

To take oral liquid forms of morphine:

• This medicine may be mixed with a glass of fruit juice just before you take it, if desired, to improve the taste.

To take long-acting morphine and oxycodone tablets :

• These tablets must be swallowed whole. Do not break, crush, or chew them before swallowing.

To take long-acting morphine capsules:

• These capsules must be swallowed whole. Do not chew, crush or dissolve.
• Or, the capsule can be opened and all of the beads inside sprinkled over applesauce and used right away. The beads must not be chewed, crushed, or dissolved.
• If capsules or beads from the capsules are not swallowed whole, you could overdose on this medicine.
• Check with your doctor right away if you are not sure how to take long-acting morphine capsules.

To use suppositories:

• If the suppository is too soft to insert, chill it in the refrigerator for 30 minutes or run cold water over it before removing the foil wrapper.
• To insert the suppository: First remove the foil wrapper and moisten the suppository with cold water. Lie down on your side and use your finger to push the suppository well up into the rectum.

Take this medicine only as directed by your medical doctor or dentist. Do not take more of it, do not take it more often, and do not take it for a longer time than your medical doctor or dentist ordered. This is especially important for young children and elderly patients, who are especially sensitive to the effects of narcotic analgesics. If too much is taken, the medicine may become habit-forming (causing mental or physical dependence) or lead to medical problems because of an overdose.

If you think this medicine is not working properly after you have been taking it for a few weeks, do not increase the dose. Instead, check with your doctor.

Dosing-

The dose of these medicines will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The number of capsules or tablets or teaspoonfuls of oral solution or syrup that you take, or the amount of injection that you are directed to use, depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the narcotic you are taking, whether or not you are taking a long-acting form of the medicine, and the reason you are taking the medicine.

For anileridine
• For oral dosage form:
  • For pain
    • Adults and teenagers-25 to 50 milligrams (mg) every 6 hours as needed.
    • Children up to 13 years of age-Dose must be determined by your doctor.

For buprenorphine
• For injection dosage form:
  • For pain:
    • Adults and teenagers-0.3 milligrams (mg), injected into a muscle or a vein every six hours as needed.
    • Children up to 2 years of age-Dose must be determined by your doctor.
    • Children 2 to 12 years of age-0.002 to 0.006 mg per kilogram (kg) (0.0008 to 0.0024 mg per pound) of body weight, injected into a muscle or a vein every four to six hours as needed.

For butorphanol
• For injection dosage form:
  • For pain:
    • Adults-1 to 4 milligrams (mg) (usually 2 mg), injected into a muscle every three or four hours as needed. Some people may receive 0.5 to 2 mg (usually 1 mg) injected into a vein every three or four hours as needed.
    • Children and teenagers-Dose must be determined by your doctor.

For codeine
• For oral dosage forms (oral solution or tablets):
  • For pain:
    • Adults-15 to 60 milligrams (mg) (usually 30 mg) every three to six hours as needed.
    • Children-0.5 mg per kilogram (kg) (0.2 mg per pound) of body weight every four to six hours as needed. Young children will probably take the oral solution, rather than tablets. Small doses may need to be measured by a special dropper instead of a teaspoon.
  • For cough:
    • Adults-10 to 20 mg every four to six hours.
    • Children up to 2 years of age-Use is not recommended.
    • Children 2 years of age-3 mg every four to six hours, up to a maximum of 12 mg a day. Children this young will probably take the oral solution, rather than tablets. Small doses may need to be measured by a special dropper instead of a teaspoon.
    • Children 3 years of age-3.5 mg every four to six hours, up to a maximum of 14 mg a day. Children this young will probably take the oral solution, rather than tablets. Small doses may need to be measured by a special dropper instead of a teaspoon.
    • Children 4 years of age-4 mg every four to six hours, up to a maximum of 16 mg a day. Children this young will probably take the oral solution, rather than tablets. Small doses may need to be measured by a special dropper instead of a teaspoon.
    • Children 5 years of age-4.5 mg every four to six hours, up to a maximum of 18 mg a day. Children this young will probably take the oral solution, rather than tablets. Small doses may need to be measured by a special dropper instead of a teaspoon.
    • Children 6 to 12 years of age-5 to 10 mg every four to six hours, up to a maximum of 60 mg a day.
• For injection dosage form:
  • For pain:
    • Adults-15 to 60 mg (usually 30 mg), injected into a muscle or a vein or under the skin every four to six hours as needed.
    • Children-0.5 mg per kg (0.2 mg per pound) of body weight, injected into a muscle or under the skin every four to six hours as needed.

For hydrocodone
• For oral dosage form (syrup or tablets):
  • For pain:
    • Adults-5 to 10 milligrams (mg) every four to six hours as needed.
    • Children-0.15 mg per kilogram (kg) (0.06 mg per pound) of body weight every six hours as needed.
  • For cough:
    • Adults-5 mg every four to six hours as needed.
    • Children-Dose must be determined by your doctor.

For hydromorphone
• For short-acting oral dosage form (oral solution or tablets):
  • For pain:
    • Adults-2 or 2.5 milligrams (mg) every three to six hours as needed.
    • Children-Dose must be determined by your doctor.
• For long-acting oral dosage forms (extended-release capsules):
  • For severe, chronic pain (severe pain that lasts a long time):
    • Adults-Long-acting forms of hydromorphone are usually used for patients who have already been receiving narcotics to relieve pain. The starting dose will depend on the amount of narcotic you have been receiving every day. Your doctor will then adjust the dose according to your individual needs. To be helpful, these medicines need to be taken at regularly scheduled times according to your doctor's instructions. It is important that you take the dose at the time and as often as your doctor tells you.
    • Children-Dose must be determined by your doctor.
• For injection dosage form:
  • For pain:
    • Adults-1 or 2 mg, injected into a muscle or under the skin every three to six hours as needed. Some people may receive 0.5 mg, injected slowly into a vein every three hours as needed.
    • Children-Dose must be determined by your doctor.
• For rectal suppository dosage form:
  • For pain:
    • Adults-3 mg every four to eight hours as needed.
    • Children-Dose must be determined by your doctor.

For levorphanol
• For oral dosage form (tablets):
  • For pain:
    • Adults-2 milligrams (mg). Some people with severe pain may need 3 or 4 mg.
    • Children-Dose must be determined by your doctor.
• For injection dosage form:
  • For pain:
    • Adults-2 mg, injected under the skin or into a vein. Some people may need 3 mg.
    • Children-Dose must be determined by your doctor.

For meperidine
• For oral dosage form (syrup or tablets):
  • For pain:
    • Adults-50 to 150 milligrams (mg) (usually 100 mg) every three or four hours as needed.
    • Children-1.1 to 1.76 mg per kilogram (kg) (0.44 to 0.8 mg per pound) of body weight, up to a maximum of 100 mg, every three or four hours as needed. Young children will probably take the syrup, rather than tablets. Small doses may need to be measured by a special dropper instead of a teaspoon.
• For injection dosage form:
  • For pain:
    • Adults-50 to 150 milligrams (mg) (usually 100 mg), injected into a muscle or under the skin every three or four hours as needed. The medicine may also be injected continuously into a vein at a rate of 15 to 35 mg an hour.
    • Children-1.1 to 1.76 mg per kg (0.44 to 0.8 mg per pound) of body weight, up to a maximum of 100 mg, injected into a muscle or under the skin every three or four hours as needed.

For methadone
• For oral solution dosage form:
  • For pain:
    • Adults-5 to 20 mg every four to eight hours.
    • Children-Dose must be determined by your doctor.
  • For narcotic addiction:
    • Adults 18 years of age or older-
      • For detoxification: At first, 15 to 40 mg once a day. Your doctor will gradually decrease the dose you take every day until you do not need the medicine any more.
      • For maintenance: Dose must be determined by the needs of the individual patient, up to a maximum of 120 mg a day.
    • Children up to 18 years of age-Special conditions must be met before methadone can be used for narcotic addiction in patients younger than 18 years of age. Use and dose must be determined by your doctor.
• For oral tablet dosage form:
  • For pain:
    • Adults-2.5 to 10 mg every three or four hours as needed.
    • Children-Dose must be determined by your doctor.
  • For narcotic addiction:
    • Adults 18 years of age or older-
      • For detoxification: At first, 15 to 40 mg once a day. Your doctor will gradually decrease the dose you take every day until you do not need the medicine any more.
      • For maintenance: Dose must be determined by the needs of the individual patient, up to a maximum of 120 mg a day.
    • Children up to 18 years of age-Special conditions must be met before methadone can be used for narcotic addiction in patients younger than 18 years of age. Use and dose must be determined by your doctor.
• For injection dosage form:
  • For pain:
    • Adults-2.5 to 10 mg, injected into a muscle or under the skin, every three or four hours as needed.
    • Children-Dose must be determined by your doctor.
  • For narcotic addiction:
    • Adults 18 years of age and older-For detoxification only, in patients unable to take medicine by mouth: At first, 15 to 40 mg a day. Your doctor will gradually decrease the dose you receive every day until you do not need the medicine any more.
    • Children younger than 18 years of age-Use and dose must be determined by your doctor.

For morphine
• For short-acting oral dosage forms (capsules, oral solution, syrup, or tablets):
  • For severe, chronic pain (severe pain that lasts a long time):
    • Adults-At first, 10 to 30 milligrams (mg) every four hours. Your doctor will then adjust the dose according to your individual needs. If you have already been taking other narcotics to relieve severe, chronic pain, your starting dose will depend on the amount of other narcotic you were taking every day.
    • Children-Dose must be determined by your doctor.
• For long-acting oral dosage forms (extended-release capsules or tablets):
  • For severe, chronic pain (severe pain that lasts a long time):
    • Adults-Long-acting forms of morphine are usually used for patients who have already been receiving narcotics to relieve pain. The starting dose will depend on the amount of narcotic you have been receiving every day. Your doctor will then adjust the dose according to your individual needs. To be helpful, these medicines need to be taken at regularly scheduled times according to your doctor's instructions. It is important that you take the dose at the time and as often as your doctor tells you. Some people may need to take a short-acting form of morphine if breakthrough pain occurs between doses of the long-acting medicine.
    • Children-Dose must be determined by your doctor.
• For once daily long-acting oral dosage forms (extended-release capsules):
  • For severe, chronic pain (severe pain that lasts a long time):
    • Adults-Long-acting forms of morphine are usually used for patients who have already been receiving narcotics to relieve pain. The starting dose will depend on the amount of narcotic you have been receiving every day. Your doctor will then adjust the dose according to your individual needs. To be helpful, these medicines need to be taken once a day at regularly scheduled times according to your doctor's instructions. It is important that you take the dose at the time and as often as your doctor tells you. Some people may need to take a short-acting form of morphine if breakthrough pain occurs between doses of the long-acting medicine.
    • Children-Dose must be determined by your doctor.
• For injection dosage form:
  • For pain:
    • Adults-5 to 20 mg (usually 10 mg), injected into a muscle or under the skin every four hours as needed. Some people may receive 4 to 10 mg, injected slowly into a vein. Morphine may also be injected continuously into a vein or under the skin at a rate that depends on the needs of the patient. This medicine may also be injected into the spinal area. The dose will depend on where and how the medicine is injected into the spinal area and on the needs of the patient.
    • Children-0.1 to 0.2 mg per kg (0.04 or 0.09 mg per pound) of body weight, up to a maximum of 15 mg, injected under the skin every four hours as needed. Some patients may receive 0.05 to 0.1 mg per kg (0.02 to 0.04 mg per pound) of body weight, injected slowly into a vein.
• For rectal suppository dosage form:
  • For pain:
    • Adults-10 to 30 mg every four to six hours as needed.
    • Children-Dose must be determined by your doctor.

For nalbuphine
• For injection dosage form:
  • For pain:
    • Adults-10 milligrams (mg) every three to six hours as needed, injected into a muscle or a vein or under the skin.
    • Children-Dose must be determined by your doctor.

For opium
• For injection dosage form:
  • For pain:
    • Adults-5 to 20 milligrams (mg), injected into a muscle or under the skin every four to five hours as needed.
    • Children-Dose must be determined by your doctor.

For oxycodone
• For oral dosage form (oral solution or tablets):
  • For pain:
    • Adults-5-15 milligrams (mg) every 4-6 hours as needed.
    • Children-Dose must be determined by your doctor. Children up to 6 years of age will probably take the oral solution, rather than tablets. Small doses may need to be measured by a special dropper instead of a teaspoon.
• For long-acting oral dosage form (extended-release tablets):
  • For pain (continuous and lasts a long time):
    • Adults-Your doctor will determine the dose according to your individual needs. To be helpful, these medicines need to be taken two times a day at regularly scheduled times.
    • Children-Use and dose must be determined by your doctor.
• For rectal suppository dosage form:
  • For pain:
    • Adults-10 to 40 mg three or four times a day.
    • Children-Dose must be determined by your doctor.

For oxymorphone
• For injection dosage form:
  • For pain:
    • Adults-1 to 1.5 milligrams (mg), injected into a muscle or under the skin every three to six hours as needed. Some patients may receive 0.5 mg, injected into a vein.
    • Children-Dose must be determined by your doctor.
• For rectal suppository dosage form:
  • For pain:
    • Adults-5 mg every four to six hours as needed.
    • Children-Dose must be determined by your doctor.

For pentazocine
• For oral dosage form (tablets):
  • For pain:
    • Adults-50 mg every three to four hours as needed. Some patients may need 100 mg every three to four hours. The usual maximum dose is 600 mg a day.
    • Children-Dose must be determined by your doctor.
• For injection dosage form:
  • For pain:
    • Adults-30 mg, injected into a muscle or a vein or under the skin every three to four hours as needed.
    • Children-Dose must be determined by your doctor.

For propoxyphene
• For oral dosage form (capsules, oral suspension, or tablets):
  • For pain:
    • Adults-Propoxyphene comes in two different forms, propoxyphene hydrochloride and propoxyphene napsylate. 100 mg of propoxyphene napsylate provides the same amount of pain relief as 65 mg of propoxyphene hydrochloride. The dose of propoxyphene hydrochloride is 65 milligrams (mg) every four hours as needed, up to a maximum of 390 mg a day. The dose of propoxyphene napsylate is 100 mg every four hours as needed, up to a maximum of 600 mg a day.
    • Children-Dose must be determined by your doctor.

Missed dose-

If your medical doctor or dentist has ordered you to take this medicine according to a regular schedule and you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage-

To store this medicine:

• Keep out of the reach of children. Overdose is very dangerous in young children.
• Store away from heat and direct light.
• Do not store tablets or capsules in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Store hydromorphone, oxycodone, or oxymorphone suppositories in the refrigerator.
• Keep liquid (including injections) and suppository forms of the medicine from freezing.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Last Revised: 12/02/2004

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