Comorbid conditions may impact opioid selection and scheduling.
|
Comorbid Condition
|
Avoid
|
Consider
|
|
pregnant
|
high doses
|
minimize impact on fetus
|
|
breastfeeding
|
codeine or tramadol
|
|
|
pediatric patient
|
codeine or tramadol if under 12
|
obtain informed consent; parents or guardian should supervise doses
|
|
geriatric patient
|
|
reduce initial dose and titrate slowly; assess fall risk
|
|
sleep disordered breath (OSA)
|
any opioid if moderate or severe
|
|
|
cardiopulmonary disease
|
any opioid if severe or evidence of OSA
|
carefully titrate and monitor
|
|
renal disease
|
morphine, codeine, tapentadol, extended-release tramadol
|
adjust dose and schedule for renal function; tramadol; oxycodone; hydromorphone; methadone, fentanyl; buprenorphine
|
|
liver disease
|
codeine; hydrocodone, tramadol, buprenorphine
|
reduce initial dose and titrate slowly if advanced; oxycodone, hydromorphone, methadone, fentanyl
|
|
neurologic disease
|
any opioid if severe
|
reduce initial dose and titrate slowly; monitor for fall risk and OSA
|
