Intravenous opioids for renal colic

If an intravenous opioid is appropriate (see Choosing an analgesic regimen for renal colic), the initial dose depends on whether the patient has already received an opioid (eg before hospital admission) and the treatment setting:

  • loading doses should not be used for patients if they have already received an opioid or if they are being treated outside of a monitored acute care setting because the risk of opioid toxicity is increased
  • loading doses are used for patients if they have not already received an opioid and they are being treated in a monitored acute care setting.

Local protocols for critical care areas may set out an alternative approach to intravenous opioid dosing for renal colic. Always refer to local protocols when they are available.

Note: Always refer to local intravenous opioid administration protocols when they are available.

If a patient has already received an opioid (eg before hospital admission) or is not being treated in a monitored acute care setting, use:

1 morphine   renal colic, intravenous dosing morphine    

adults 69 years or younger who are not frail or cachectic: 1 to 2 mg intravenously, as a single dose

adults who are frail or cachectic, or older than 69 years: 0.5 to 1 mg intravenously, as a single dose

wait 5 minutes, then assess the patient for signs of opioid-induced ventilatory impairment (using sedation score and respiratory rate) and determine whether pain relief is adequate. See Example of intravenous opioid dose titration in hospital for severe, acute nociceptive pain in adults and children for subsequent doses, including maximum doses

OR

1 oxycodone   renal colic, intravenous dosing oxycodone    

adults 69 years or younger who are not frail or cachectic: 1 to 2 mg intravenously, as a single dose

adults who are frail or cachectic, or older than 69 years: 0.5 to 1 mg intravenously, as a single dose

wait 5 minutes, then assess the patient for signs of opioid-induced ventilatory impairment (using sedation score and respiratory rate) and determine whether pain relief is adequate. See Example of intravenous opioid dose titration in hospital for severe, acute nociceptive pain in adults and children for subsequent doses, including maximum doses.

If a patient has not already received an opioid (eg before hospital admission) and is being treated in a monitored acute care setting, use:

1 morphine morphine    

adults 69 years or younger who are not frail or cachectic: 2 to 5 mg intravenously, as a single dose

adults who are frail or cachectic, or older than 69 years: 1 to 2 mg intravenously, as a single dose

wait 5 minutes, then assess the patient for signs of opioid-induced ventilatory impairment (using sedation score and respiratory rate) and determine whether pain relief is adequate. See Example of intravenous opioid dose titration in hospital for severe, acute nociceptive pain in adults and children for subsequent doses, including maximum doses

OR

1 oxycodone oxycodone    

adults 69 years or younger who are not frail or cachectic: 2 to 5 mg intravenously, as a single dose

adults who are frail or cachectic, or older than 69 years: 1 to 2 mg intravenously, as a single dose

wait 5 minutes, then assess the patient for signs of opioid-induced ventilatory impairment (using sedation score and respiratory rate) and determine whether pain relief is adequate. See Example of intravenous opioid dose titration in hospital for severe, acute nociceptive pain in adults and children for subsequent doses, including maximum doses.