Oral opioids for biliary colic

If an oral opioid is appropriate (see Choosing an analgesic regimen for biliary colic), the patient has severe pain and is being treated in hospital, use the regimens outlined in Severe, acute nociceptive pain.

If an oral opioid is appropriate, the patient has severe pain and is being treated in the community, use the doses for moderate pain below and arrange transfer to hospital.

If an oral opioid is appropriate and the patient has moderate pain (see Features of mild, moderate and severe acute pain for the features of moderate pain), use:

1 tapentadol immediate-release 50 mg orally, as a single dose¹. If repeat doses are required, see Moderate, acute nociceptive pain for regimens biliary colic tapentadol

OR

1 tramadol immediate-release biliary colic, oral dosing tramadol

adults 75 years or younger: 50 mg to 100 mg orally, as a single dose. If repeat doses are required, see Moderate, acute nociceptive pain for regimens

adults older than 75 years: 50 mg orally, as a single dose. If repeat doses are required, see Moderate, acute nociceptive pain for regimens

OR

2 morphine immediate-release² biliary colic, oral dosing morphine

adults 49 years or younger: 7.5 to 20 mg orally, as a single dose. Use the lower end of the dose range for patients treated in the community, and for cachectic or frail patients

adults 50 to 75 years: 7.5 to 15 mg orally, as a single dose. Use the lower end of the dose range for patients treated in the community, and for cachectic or frail patients

adults older than 75 years: 3.5 to 7.5 mg orally, as a single dose. Use the lower end of the dose range for patients treated in the community, and for cachectic or frail patients

wait 1 hour, then assess the patient for signs of opioid-induced ventilatory impairment (using sedation score and respiratory rate) and determine whether pain relief is adequate. If repeat doses are required, see Moderate, acute nociceptive pain for regimens

OR

2 oxycodone immediate-release biliary colic, oral dosing oxycodone

adults 49 years or younger: 5 to 15 mg orally, as a single dose. Use the lower end of the dose range for patients treated in the community, and for cachectic or frail patients

adults 50 to 75 years: 5 to 10 mg orally, as a single dose. Use the lower end of the dose range for patients treated in the community, and for cachectic or frail patients

adults older than 75 years: 2.5 to 5 mg orally, as a single dose. Use the lower end of the dose range for patients treated in the community, and for cachectic or frail patients

wait 1 hour, then assess the patient for signs of opioid-induced ventilatory impairment (using sedation score and respiratory rate) and determine whether pain relief is adequate. If repeat doses are required, see Moderate, acute nociceptive pain for regimens.

¹ At the time of writing, immediate-release tapentadol tablets are not available on the Pharmaceutical Benefits Scheme (PBS) for the treatment of biliary colic. See the PBS website for current information.Return

² At the time of writing, immediate-release morphine tablets are not available on the Pharmaceutical Benefits Scheme (PBS) for the treatment of biliary colic. See the PBS website for current information. Avoid using immediate-release morphine liquid in patients treated in the community because dose errors are common. If cost is a barrier, consider oxycodone instead.Return