solution containing 10-milligrams per 5-milliliters. Morphine in all forms is a Note R
b. Codeine. Codeine is the second naturally occurring narcotic. Its use is very
widespread; in some states it can be sold without prescription in combination products if
its concentration is weak enough (ETH & codeine, Robitussin AC). For our purposes,
however, when codeine is dispensed as a single agent, it is Note R, when in
combination, it is Note Q. Codeine is used as an antitussive, 5-15 mg every 4-6 hours,
and as an analgesic in mild to moderate pain, 30-60mg every 4-6 hours. Its most
common side effects include drowsiness, nausea/vomiting, and constipation; patients
must be cautioned about the drowsiness and the additive effect seen with concurrent
use of alcohol. Codeine is available as an injection of 15, 30, and 60 mg/ml, and in 15
and 30 mg tablets. A powder form for compounding is also available.
c. Hydromorphone (Dilaudid). Hydromorphone (Dilaudid) is a drug that was
obtained by chemical modification of morphine, used as an analgesic in moderate to
severe pain. It is frequently used in pain associated with cancer. Its usual dose is 2 mg
every 4 to 6 hours. Its major side effects are nausea and vomiting, dizziness, and
constipation. Although the manufacturer states that drowsiness occurs infrequently,
patients should be made aware of this possibility; also alcohol may intensify its effects.
Dilaudid is a Note R drug and is supplied in tablet or injectable form, both in 1, 2, 3,
and 4 mg strengths.
d. Meperidine (Demerol). Meperidine was the first synthetically produced
narcotic. It is one of the first widely used agents for moderate to severe pain. Usual
doses of this agent (50-150 mg every 3-4 hours) produce some drowsiness, nausea,
and vomiting. Patients who are prescribed meperidine should be cautioned that
drowsiness might occur. Further, they should be advised that alcohol might intensify
this drowsiness. Meperidine is a Note R drug, which is available as an injection (25, 50,
75, and 100 mg/ml), a tablet (50 or 100 mg tablets), and in a syrup (50 mg/5ml).
e. Fentanyl (Sublimaze, Duragesic, Oralet, Actiq). Fentanyl is a
synthetic agent with actions similar to morphine, but on a weight basis, Sublimaze is
80-100 times more potent. It is used as an analgesic component in general anesthesia
or conscious sedation and given intramuscularly (IM) or intravenously (IV). The dosage
is dependent upon its intended role during anesthesia, and ranges from 0.025 to 0.1
mg. Respiratory depression is the side effect of concern for this agent. Fentanyl is
unique in that it is available as an injection (Sublimaze), in a topical patch formulation
(Duragesic), a lozenge (Fentanyl Oralet) and a lozenge on a stick ("lollipop") (Actiq)
formulation. The latter three formulations are prescribed primarily for severe pain
conditions. Fentanyl is handled as a Note R product.
f. Methadone (Dolophine). Methadone (Dolophine) is a synthetic agent that
has been used as an analgesic for moderate to severe pain, and to treat withdrawal
symptoms of narcotics in a dose-tapering fashion. The usual dose for analgesia is 2.5-
10 mg every 4 hours, and common side effects include drowsiness and