Drugs for Relief of Pain
| Generic Name | Dose, mg | Interval | Comments | |||||
| Nonnarcotic analgesics: usual doses and intervals | ||||||||
| Acetylsalicylic acid | 650 PO | q4h | Enteric-coated preparations available | |||||
| Acetaminophen | 650 PO | q4h | Side effects uncommon | |||||
| Ibuprofen | 400 PO | q4-6h | Available without prescription | |||||
| Naproxen | 250-500 PO | q12h | Delayed effects may be due to long half-life | |||||
| Fenoprofen | 200 PO | q4-6h | Contraindicated in renal disease | |||||
| Indomethacin | 25-50 PO | q8h | Gastrointestinal side effects common | |||||
| Ketorolac | 15-60 IM/IV | q4-6h | Available for parenteral use | |||||
| Celecoxib | 100-200 PO | q12-24h | Useful for arthritis | |||||
| Valdecoxib | 10-20 PO | q12-24h | Removed from U.S. market in 2005 | |||||
| Generic Name | Parenteral Dose, mg | PO Dose, mg | Comments | |||||
| Narcotic analgesics: usual doses and intervals | ||||||||
| Codeine | 30-60 q4h | 30-60 q4h | Nausea common | |||||
| Oxycodone | — | 5-10 q4-6h | Usually available with acetaminophen or aspirin | |||||
| Morphine | 5 q4h | 30 q4h | ||||||
| Morphine sustained release | — | 15-60 bid to tid | Oral slow-release preparation | |||||
| Hydromorphone | 1-2 q4h | 2-4 q4h | Shorter acting than morphine sulfate | |||||
| Levorphanol | 2 q6-8h | 4 q6-8h | Longer acting than morphine sulfate; absorbed well PO | |||||
| Methadone | 5-10 q6-8h | 5-20 q6-8h | Delayed sedation due to long half-life; therapy should not be initiated with >40 mg/d, and dose escalation should be made no more frequently than every 3 days | |||||
| Meperidine | 50-100 q3-4h | 300 q4h | Poorly absorbed PO; normeperidine is a toxic metabolite; routine use of this agent is not recommended | |||||
| Butorphanol | — | 1-2 q4h | Intranasal spray | |||||
Buprenorphine | 25-100 µg/h 5-20 µg/h 0.3 q6-8h | — | 72-h transdermal patch 7-day transdermal patch Parenteral administration | |||||
| Tramadol | — | 50-100 q4-6h | Mixed opioid/adrenergic action | |||||
| Generic Name | Uptake Blockade | Sedative Potency | Anticholinergic Potency | Orthostatic Hypotension | Cardiac Arrhythmia | Average Dose, mg/d | Range, mg/d | |
| 5-HT | NE | |||||||
| Antidepressantsa | ||||||||
| Doxepin | ++ | + | High | Moderate | Moderate | Less | 200 | 75-400 |
| Amitriptyline | ++++ | ++ | High | Highest | Moderate | Yes | 150 | 25-300 |
| Imipramine | ++++ | ++ | Moderate | Moderate | High | Yes | 200 | 75-400 |
| Nortriptyline | +++ | ++ | Moderate | Moderate | Low | Yes | 100 | 40-150 |
| Desipramine | +++ | ++++ | Low | Low | Low | Yes | 150 | 50-300 |
| Venlafaxine | +++ | ++ | Low | None | None | No | 150 | 75-400 |
| Duloxetine | +++ | +++ | Low | None | None | No | 40 | 30-60 |
| Generic Name | PO Dose, mg | Interval | Generic Name | PO Dose, mg | Interval | |||
| Anticonvulsants and antiarrhythmicsa | ||||||||
| Phenytoin | 300 | daily/qhs | Clonazepam | 1 | q6h | |||
| Carbamazepine | 200-300 | q6h | Gabapentinb | 600-1200 | q8h | |||
| Oxcarbazepine | 300 | bid | Pregabalin | 150-600 | bid | |||
aAntidepressants, anticonvulsants, and antiarrhythmics have not been approved by the U.S. Food and Drug Administration (FDA) for the treatment of pain.
bGabapentin in doses up to 1800 mg/d is FDA approved for postherpetic neuralgia.
Abbreviations: 5-HT, serotonin; NE, norepinephrine.