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By injection into a vein (intravenous) or muscle (intramuscular): About 3 to 4 hours
Immediate-release form by mouth: About 4 hours
Controlled- and sustained-release forms by mouth: 8 to 24 hours
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Morphine starts to work quickly. The oral form can be very effective for chronic pain. It is more likely to cause itching than other opioids.
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By injection into a vein, under the skin, or muscle: About 6 hours
By skin patch: Up to 1 week
Between the gums and cheek: 12 hours
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Buprenorphine has some of the effects of opioids but also blocks some of the effects of opioids. It is occasionally used to relieve chronic pain and may be substituted for a stronger opioid to help people who are addicted to opioids stop taking them. It may be the preferred opioid for older people because it has fewer side effects (such as constipation and respiratory depression) and can be used more safely in those with a kidney disorder. However, buprenorphine can cause withdrawal symptoms when given to people who have opioids in their system.
The skin (transdermal) patch is re-applied once a week.
For pain, the forms most commonly used are a skin (transdermal) patch or a film placed under the tongue.
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Codeine is less potent than morphine. It is usually taken with aspirin or acetaminophen.
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As lozenges or dissolvable tablets: 2 to 4 hours
By spray into the nose or under the tongue: 2 to 4 hours
By skin patch: up to 72 hours
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Fentanyl lozenges and dissolvable tablets can be used to treat breakthrough pain (a brief, often severe flare-up of pain that may occur during treatment for chronic pain).
Fentanyl lozenges can also be used to relieve pain and provide sedation (before painful procedures) in children.
A fentanyl patch is often used to treat chronic pain.
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Hydrocodone is similar to codeine in effectiveness.
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By intravenous or intramuscular injection: 4 to 6 hours
By rectal suppository: 6 to 8 hours
Extended-release form: 24 hours
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Hydromorphone begins to work quickly. It can be used instead of morphine and is useful for chronic pain.
The rectal suppository is used at bedtime.
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By intravenous or intramuscular injection: 6 to 8 hours
By mouth: About 6 to 8 hours
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The oral form is strong. It can be used instead of morphine.
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By intravenous or intramuscular injection: About 4 hours
By mouth: Not very effective
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Meperidine can be effective for short-term use. But long-term use is discouraged because meperidine has side effects, such as muscle spasms, tremors, seizures, and confusion or delirium (especially in older people). Some health care practitioners prefer not to use it.
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By mouth: 6 to 8 hours, sometimes much longer
By intravenous or intramuscular injection or injection under the skin (subcutaneous): 6 to 8 hours
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Methadone is used for treating addiction to heroin and other opioids. It can also be used to treat chronic pain.
Methadone can have serious side effects, especially when it is first started. For example, it can cause breathing to become dangerously slow or to stop within days after people start taking it, even without an increase in the dose taken. To prevent serious side effects, people must be careful to take the drug as directed.
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Short-acting form by mouth: About 4 to 6 hours
Long-acting, controlled-release form by mouth: About 12 hours
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Oxycodone can be used instead of morphine to treat chronic pain. The short-acting formulation is usually combined with aspirin or acetaminophen.
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Controlled-release form by mouth: 12 hours
By intravenous or intramuscular injection: About 6 hours
By rectal suppository: 4 to 6 hours
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Oxymorphone can be used instead of morphine to treat chronic pain.
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By intravenous or intramuscular injection: 3 to 4 hours
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Pentazocine can block the pain-relieving action of other opioids. It is about as strong as codeine. The usefulness of pentazocine is limited because higher doses do not provide more pain relief and because the drug can cause confusion and anxiety, especially in older people. It is not a good choice for older people.
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Short-acting form by mouth: 3 to 6 hours
Long-acting form by mouth: 12 hours
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Tapentadol is used to treat neuropathic pain due to diabetes, as well as moderate to severe acute pain and moderate to severe chronic pain.
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Short-acting form by mouth: 4 to 11 hours
Long-acting form by mouth: 12 to 24 hours
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With tramadol, the potential for abuse is less than that with other opioids. It is not as potent as other opioid analgesics.
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