Prenteral form of opioids are more potent than the oral formulation, milligram for milligram

Always remember to convert to the correct dosage and double check before administration

Never give a sustained release oral Opioid more often than every eight hours.

Long acting formulations, when dosed more often than recommended by the manufacturer often accumulate in the body and can cause adverse side effects like respiratory depression etc.

Never crush a sustained release Opioid and give it through a gastrostomy or jejunostomy tube.

The time release properties of the pill are controlled by the membrane in which it is encapsulated. When the pill is crushed, the drug behaves like its rapid release form.

Never order a sustained release Opioid for breakthrough pain (as a prn).

Only short acting forms of the drug should be prescribed for break-through pain.

Avoid meperidine (Demerol) in a palliative care setting.

With chronic administration of meperidine (Demerol), its metabolite normeperidine accumulates in the body. Nor-meperedine is a CNS stimulant with a longer half-life than the parent compound and causes adverse reactions like tremors, muscle twitches, and even seizures especially in the elderly and in patients with renal failure (Inturrisi, Simopoulos).