When initiating opioid therapy for opioid-naive adults, the best policy is to begin with a low dose of an immediate-release oral medication such as 5mg of hydrocodone or morphine, 3mg of oxycodone, or 1mg of hydromorphone. Care should be taken with children, frail elderly, and others with low body weight (see Special Populations). The dose can be rapidly titrated upward, although slow-release tablets or patches should not be used for rapid dosage titration.
Immediate release oral opioids can be prescribed regularly every four hours. The dose can be increased by 25% to 100% or more each day as needed until pain is relieved. This may require additional dosing as often as every hour if needed.