Drugs for Relief of Pain

GENERIC NAME	DOSE, mg	INTERVAL	COMMENTS
Drugs for Relief of Pain
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	Naproxen is the common NSAID that poses the least cardiovascular risk; but it has a somewhat higher incidence of gastrointestinal bleeding
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
Oxycodone extended-release	-	10-40 q12h	Oral extended-release tablet; high potential for misuse
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	Due to long half-life, respiratory depression and sedation may persist after analgesic effect subsides; 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
Fentanyl	25-100 µg/h	-	72-h transdermal patch
Buprenorphine	5-20 µg/h		7-day transdermal patch
Buprenorphine	0.3 q6-8h		Parenteral administration
Tramadol	-	50-100 q4-6h	Mixed opioid/adrenergic action
GENERIC NAME	UPTAKE BLOCKADE		SEDATIVE POTENCY	ANTICHOLINERGIC POTENCY	ORTHOSTATIC HYPOTENSION	CARDIAC ARRHYTHMIA	AVE. DOSE, mg/d	RANGE, mg/d
GENERIC NAME	5-HT	NE	SEDATIVE POTENCY	ANTICHOLINERGIC POTENCY	ORTHOSTATIC HYPOTENSION	CARDIAC ARRHYTHMIA	AVE. DOSE, mg/d	RANGE, mg/d
Antidepressants ^a
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 antiarrhythmics^a
Phenytoin		300	daily/qhs	Clonazepam		1		q6h
Carbamazepine		200-300	q6h	Gabapentin ^b		600-1200		q8h
Oxcarbazepine		300	bid	Pregabalin		150-600		bid

^a Antidepressants, anticonvulsants, and antiarrhythmics have not been approved by the U.S. Food and Drug Administration (FDA) for the treatment of pain.^b Gabapentin in doses up to 1800 mg/d is FDA approved for postherpetic neuralgia.

Abbreviations: 5-HT, serotonin; NE, norepinephrine; NSAID, nonsteroidal anti-inflammatory drug.

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Table 6-2