Page 81 - Radiology Book

analgesics: non-oPioids
79
non-oPioids
Drug
Usual/Max Daily Dose
Notes
Acetaminophen
325-1000 mg PO q4-6hrs, max 3 g
↓ dose in liver disease - 2 g ok in cirrhosis,
interacts with Warfarin
Slower onset and longer duration, increased CV and GI risk, caution with CKD
Salsalate
750-1000 mg PO q8-12hrs; max 3 g
Ibuprofen
200-800 mg q6hrs PO; max 3200 mg acute, 2400 mg chronic
250 mg PO q8hrs or 500 mg q12hrs; max 1250 mg acute, 1000 mg chronic
Increased CV and GI risk, caution with CKD
Naproxen Diclofenac Ketorolac
50 mg PO q8hrs; max 150 mg
15-30 mg IV/IM once; max 60 mg >65 yo
Best safety pro le of non-selective
COX-2 inhibitors, caution in CKD
Available in patch or gel applied to painful joints Good for short term IV treatment, do not use
>5 days
Selective COX-2 inhibitor, however at lower
doses more like typical NSAID
Use for chronic NSAID use in patients with history of gastropathy, >200 mg associated with ↑ CV risk Titrate the elderly more slowly
Anticholenergic side effects
Meloxicam Celecoxib Nortriptyline Gabapentin Pregabalin
7.5-15 mg PO daily; max 15 mg
Baclofen Duloxetine
5 mg PO daily → 10 mg tid
30 mg PO daily → 60 mg daily, >60 rarely
Antispasmodic
200 mg PO daily, 100 mg bid; max 400 mg
25 mg PO qhs → max 150 mg/day
300 mg PO daily → 300 mg bid → 300 mg
For neuropathic pain, can take 2 months to see effect, anticholinergic side effects, commonly causes dizziness, sedation
tid, titrate to pain relief; max 3600 mg/day
75 mg PO bid → 150 mg bid → 300 mg bid, 1 week titrations, >300 rarely effective
effective
Good for diabetic neuropathy, bromyalgia, lower back pain and osteoarthritis, titrate to decrease side effects, anticholinergic side effects common
EquivalEnts