Legal Notices

Analgesia and Dyspnea Protocol
Legal Comments

(Please also read Legal Notices for a more comprehensive disclaimer)

The information provided on the Web site is for Health Care Practitioners and is for informational purposes only. It is not professional medical advice, diagnosis, treatment or care, nor is it intended to be a substitute therefor.

If you are a Health Care Professional this information is shared with you
on the express condition that you will use your own expertise and
professional judgment in applying any information to a specific
case. This is general information only the validity of which may be
affected by individual patient factors that are unknown to the

It is the responsibility of those using this information to ensure
appropriate interpretation and application is undertaken with
regards to any specific clinical situation.
The following protocol for the use of opioids in pain control and dyspnea has been in use in Winnipeg since 1997, and is a modification of an analgesic protocol used for many years previously at the St. Boniface General Hospital. It is the responsibility of those using the information provided here to ensure that appropriate interpretation and application of the material is undertaken with regards to the specific clinical situation at hand.

If questions please contact:

Mike Harlos MD, CCFP, FCFP
Professor and Section Head, Palliative Medicine, University of Manitoba
Medical Director, Palliative Care Program, Winnipeg Regional Health Authority
Rm.A8024, 409 Taché Ave,
Winnipeg, Manitoba, Canada R2H 2A6
Ph:1-204-235-3929; Fax:1-204-237-9162; Pager:1-204-932-6231

Opioid Dosage Chart
OPIOID ROUTE DOSAGE STEPS (# mg every 4 hours)
Morphine po/pr/SL 5 10 15 20 30 40 60 80 100 130 160 200 240 280
SQ 2.5 5 7.5 10 15 20 30 40 50 65 80 100 120 140
Hydromorphone po/pr/SL 1 2 3 4 6 8 12 16 20 26 32 40 48 56
SQ 0.5 1 1.5 2 3 4 6 8 10 13 16 20 24 28

NOTE: - Generally, in converting from one opioid to another, in order to address incomplete cross-tolerance divide the calculated equivalent dose by half and titrate up quickly if needed. However, under circumstances of poor pain control it may not be appropriate to reduce the converted dose in this manner.


 A registered nurse who has approval to use the protocol may, without contacting a physician:
Consider decreasing the opioid dose by one increment using the Opioid Dosage Chart if the pain control is adequate and:
A physician must be contacted when any of the following present:


Last Modified Feb. 21, 2003