Module 4: Therapeutics

Lesson 2

Choose the correct opioid formulation

• Immediate release (IR) formulations are indicated for short-term, acute pain; for breakthrough pain when combined with CR formulation; or for when determining total daily dose required to achieve pain relief/functional improvement goal.
• Controlled release (CR) formulations (including transdermal) are indicated for long-term use only. Choose when the daily dose of IR has been established. Safety issues must be explained to the patient as crushing or chewing a CR preparation converts it to IR.
• Opioid and non-opioid combinations, such as acetaminophen 325 mg + oxycodone 5 mg (Percocet), acetaminophen 300 mg + caffeine 15 mg + codeine 30 mg (Tylenol #3) are indicated for short-term acute pain when a synergistic effect is desired.

Refer to the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain tables B-8.2 and B-8.3, which consider safety issues for when selecting opioids and other formulations/preparations.