Extended-release opioid preparations for chronic pain

Opioid preparation (US brand name)	Available preparations	Usual dosing interval
Buprenorphine transdermal patch (Butrans)	5, 7.5, 10, 15, 20 mcg/hour transdermal patches	Seven days
Buprenorphine buccal film (Belbuca)*	75, 150, 300, 450, 600, 750, 900 mcg buccal films	12 or 24 hours
Fentanyl transdermal patch (Duragesic)	12, 25, 50, 75, 87.5, 100 mcg/hour	Three days
Hydrocodone ER 12 hour (Zohydro ER)	10, 15, 20, 30, 40, 50 mg capsules	12 hours
Hydrocodone ER 24 hour (Hysingla ER)	20, 30, 40, 60, 80, 100, 120 mg tablets	24 hours
Hydromorphone ER 24 hour (Exalgo)	8, 12, 16, 32 mg tablets	24 hours
Methadone^¶	5, 10 mg tablets	8 to 12 hours
Morphine sulfate ER 24 hour (Kadian)	10, 20, 30, 45, 50, 60, 75, 80, 90, 120, 200 mg capsules	24 hours
Morphine sulfate ER (MS Contin)	15, 30, 60, 100, 200 mg tablets	8 to 12 hours
Oxycodone ER 12 hour^Δ (OxyContin)	10, 15, 20, 30, 40, 60, 80 mg tablets	12 hours
Oxycodone ER 12 hour^Δ (Xtampza ER)	9, 13.5, 18, 27, 36 mg capsules	12 hours
Oxymorphone ER 12 hour (Generic only)	5, 7.5, 10, 15, 20, 30, 40 mg tablets	12 hours
Tapentadol ER^◊ (Nucynta ER)	50, 100, 150, 200, 250 mg tablets	12 hours
Tramadol ER 24 hour (Ultram ER)	100, 150, 200, 300 mg tablets and capsules	24 hours

Refer to UpToDate for information on the role of opioids in the treatment of chronic pain.
The total daily dose requirement for use of a long-acting formulation should be established first with the use of an appropriate immediate-release opioid analgesic.
Brand (trade) names and strengths listed in the table are for products available in the US and some other countries.

US: United States; ER: extended-release; MS: morphine sulphate.
* Although buprenorphine buccal film is not an extended release preparation, it can be used as a long-acting opioid due to its prolonged half-life of approximately 28 hours.
¶ Due to challenges inherent in safe prescribing of methadone, it is not typically a first-line analgesic choice. Although methadone is not an ER preparation, it can be used as a long-acting opioid due to its prolonged half-life (0.5 to 7 days); guidelines for safe administration must be followed to reduce risk of unintentional overdose. Refer to UpToDate topic on cancer pain management with opioids, section on methadone.
Δ Dose of ER tablets is expressed as oxycodone hydrochloride and the dose of ER capsules is expressed as oxycodone base; 10 mg of oxycodone hydrochloride is equivalent to 9 mg oxycodone base.
◊ Patients should not consume alcoholic beverages or use prescription or nonprescription products that contain alcohol while taking tapentadol ER. The combination of alcohol with tapentadol ER may result in increased plasma tapentadol levels and a potentially fatal overdose of tapentadol.

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