Harrison's Manual of Medicine: Table 6-2: Drugs for Relief of Pain

Table 6-2: Drugs for Relief of Pain

Table 6-2

Generic Name	Dose, mg	Interval	Comments
Nonnarcotic Analgesics: Usual Doses and Intervals
Acetylsalicylic acid	650 PO	q 4 h	Enteric-coated preparations available
Acetaminophen	650 PO	q 4 h	Side effects uncommon
Ibuprofen	400 PO	q 4–6 h	Available without prescription
Naproxen	250-500 PO	q 12 h	Delayed effects may be due to long half-life
Fenoprofen	200 PO	q 4–6 h	Contraindicated in renal disease
Indomethacin	25-50 PO	q 8 h	Gastrointestinal side effects common
Ketorolac	15-60 IM/IV	q 4–6 h	Available for parenteral use
Celecoxib	100-200 PO	q 12–24 h	Useful for arthritis
Valdecoxib	10-20 PO	q12–24 h	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 q 4 h	30–60 q 4 h	Nausea common
Oxycodone	—	5–10 q 4-6 h	Usually available with acetaminophen or aspirin
Morphine	10 q 4 h	60 q 4 h
Morphine sustained release	—	30–200 bid to tid	Oral slow-release preparation
Hydromorphone	1–2 q 4 h	2–4 q 4 h	Shorter acting than morphine sulfate
Levorphanol	2 q 6–8 h	4 q 6–8 h	Longer acting than morphine sulfate; absorbed well PO
Methadone	10 q 6–8 h	20 q 6–8 h	Delayed sedation due to long half-life
Meperidine	75–100 q 3-4 h	300 q 4 h	Poorly absorbed PO; normeperidine a toxic metabolite
Butorphanol	—	1–2 q 4 h	Intranasal spray
Fentanyl	25–100 μg/h	—	72 h Transdermal patch
Tramadol	—	50–100 q 4–6 h	Mixed opioid/adrenergic action

	Uptake Blockade
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	q 6 h
Carbamazepine	200–300	q 6 h	Gabapentin^b	600–1200	q 8 h
Oxcarbazine	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.

Note: 5-HT, serotonin; NE, norepinephrine.

Table 6-2: Drugs for Relief of Pain has been found in Harrison's Manual of Medicine 17/e

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Table 6-2: Drugs for Relief of Pain

Last updated: May 11, 2009

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