Subcutaneous opioids for renal colic

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

If a subcutaneous 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 a subcutaneous 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 tramadol   renal colic, subcutaneous dosing tramadol    

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

adults older than 75 years: 25 to 50 mg subcutaneously, as a single dose; use the lower end of the dose range for cachectic or frail patients. If repeat doses are required, see Moderate, acute nociceptive pain for regimens

OR

2 morphine   renal colic, subcutaneous dosing morphine    

adults 39 years or younger: 5 to 10 mg subcutaneously, as a single dose. Use the lower end of the dose range for cachectic or frail patients

adults 40 to 59 years: 2.5 to 5 mg subcutaneously, as a single dose. Use the lower end of the dose range for cachectic or frail patients

adults 60 to 69 years: 1.25 to 4 mg subcutaneously, as a single dose. Use the lower end of the dose range for cachectic or frail patients

adults 70 to 85 years: 1.25 to 2.5 mg subcutaneously, as a single dose. Use the lower end of the dose range for cachectic or frail patients

adults older than 85 years: 1 to 1.5 mg subcutaneously, as a single dose. Use the lower end of the dose range 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   renal colic, subcutaneous dosing oxycodone    

adults 39 years or younger: 5 to 10 mg subcutaneously, as a single dose. Use the lower end of the dose range for cachectic or frail patients

adults 40 to 59 years: 2.5 to 5 mg subcutaneously, as a single dose. Use the lower end of the dose range for cachectic or frail patients

adults 60 to 69 years: 1.25 to 4 mg subcutaneously, as a single dose. Use the lower end of the dose range for cachectic or frail patients

adults 70 to 85 years: 1.25 to 2.5 mg subcutaneously, as a single dose. Use the lower end of the dose range for cachectic or frail patients

adults older than 85 years: 1 to 1.5 mg subcutaneously, as a single dose. Use the lower end of the dose range 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.