Analgesics

Narcotics

• Side effects: hypotension, respiratory depression, nausea, urinary retention, and constipation.
• Contraindication: Head trauma
• Fentanyl (Sublimaze) CII
  • Titrated IV increments of 2-3μg/kg up to 50μ
  • Transdermal(duragesic) one 2.5mg patch q3 days.
  • Preoperative analgesia
  • 50-100 mcg IV/IM – given 30-60 min prior to surgery
  • Renal dose adjust
• Hydromorphone (Dilaudid) CII
  • Mod-severe pain
  • 1-4mg IM/SC/IV q4-6h
  • 2-8mg PO q4-6hr
• Meperidine (Demerol) CII
  • Mod-severe pain
  • 50-150 mg PO/SC/IM q3-4h
    • PO route least effective
  • Preoperative sedation
    • 5-100 mg SC/IM x1
  • Renal dose adjust
• Methadone (Dolophine) CII
  • Severe pain.
  • 2.5-10mg PO q8-12h prn
  • Primarily used for detoxification of heroin addicts
  • Renal dose adjust
  • Tabs: 5, 10
• Morphine Sulfate CII
  • Mod-severe chronic pain
  • 10-30 mg PO q3-4h prn;
    • Alt: 15-30 mg ER PO q8-12h for chronic pain
    • <50 kg or elderly may need lower dose, longer interval
  • 2.5-10 mg SC/IM/IV q2-6h prn
    • Alt: 0.05-0.1 mg/kg IV load, then 0.8-10 mg/h IV.
  • Renal dose adjust
• Oxycodone (Roxicodone) CII
  • 5mg PO q6h
  • Tabs: 5mg
  • Controlled release - OxyContin
    • 10-40mg PO q12h
    • Tabs: 10, 20, 40, 80mg
• Propoxyphene HCl (Darvon) CIV
  • Mild-moderate pain
  • 65mg PO q4h prn

 

Narcotic Combinations

• Proxyphene/Acetaminophen (Darvocet N-50 or N-100) CIV
  • Mild-moderate pain
  • 2 tabs PO q4h prn
  • N-50: 50/325, N-100: 100/650
  • CI: CYP450 3A4 inhibitors, suicidal patient
  • Darvon Compound CIV
    • Propoxyphenel/ASN/Caffeine
    • 65/389/32.4mg
    • 1 PO q4h
• Hydrocodone/Acetaminophen (Vicodin, Lortab) CIII
  • Moderate –moderate severe pain
  • 1-2 tabs PO q4-6 prn
  • Lortab: 5/500, 7.5/500, 10/500
  • Vicodin: 5/500, ES-7.5/750, HP-10/660
  • Vicoprofen (hydrocodone/Ibuprofen)
  • 7.5/200
  • 1 tab PO q4-6hr
• Oxycodone/Acetaminophen (Percocet) CII
  • Moderate –moderate severe pain
  • 1-2 tabs PO q6h prn
  • 2.5/325, 5/325, 7.5/325, 7.5/500, 10/325, 10/650
  • Percodan (Oxycodone/ASA)
  • 5/325mg
• Damason-P (Hydrocodone/ASA/Caffeine)
  • 1 tab PO q4-6h
  • 5/224/32
• Panlor DC (Acetaminophen 356.4mg + Caffeine 30mg + Dihydrocodeine Bitartrate 16mg) CIII
  • 1 tab q4-6h PRN pain,
  • no more than 10/day
  • Panlor SS (Acetaminophen 712.8mg + Caffeine 60mg + Dihydrocodeine Bitartrate 32mg)
  • 1 tab q4-6h PRN pain
  • no more than 5/day
• Soma Compounds with Codeine (Carisoprodol 200mg + ASA 325mg + Codeine 16mg) CIII
  • 1-2 tabs PO qid
• Tylenol with Codeine CV
  • Tylenol #1 (Acetaminophen 300mg + Codeine 7.5mg) -1-2 tabs PO q4h.
  • Tylenol #2 (Acetaminophen 300mg + Codeine 15mg) -1-2 tabs PO q4h.
  • Tylenol #3 (Acetaminophen 300mg + Codeine 30mg) -1-2 tabs PO q4h,
  • Tylenol #4 (Acetaminophen 300mg + Codeine 60mg) -1-2 tabs PO q4h.
  • Peds Elixir (Acetaminophen 120mg + Codeine 12mg/5ml)-3-5yrs: 5ml(1 tsp) q3-4 day; 7-12yrs: 10ml(2 tsp) q3-4 day
• Tylox (Oxycodone 5mg + Acetaminophen 500mg) CII
  • 1 tab PO q6h
• Ultracet (Tramadol + Acetaminophen)
  • 2 tabs PO q4-6h
• Wygesic (Propoxyphene/Acetaminophen) CIV
  • 65/650mg
  • 1 tab PO q4h
• Zydone (Hydrocodone/Acetaminophen) CIII
  • 5/400, 7.5/400, 10/400
  • 1 tab PO q4-6h

 

Controlled Substance

• Schedule I
  • High potential for abuse
  • No currently accepted medical use
  • Lack of accepted safety for use under medical supervision
• Schedule II
  • High potential for abuse
  • Has a accepted medical use
  • Abuse may lead to severe psychological or physical dependence
• Schedule III
  • Potential for abuse less than schedules I and II
  • Abuse may lead to moderate or low physical dependence or high psychological dependence
• Schedule IV
  • Low potential for abuse relative to schedule III
  • Abuse may lead to limited physical or psychological dependence relative to schedule III
• Schedule V
  • Low potential for abuse relative to schedule IV
  • Abuse may lead to limited physical or psychological dependence relative to schedule IV

• Reference: US Drug Enforcement Agency, 21 USC Sec. 812, 01/22/02

 

Non-Narcotics

• Acetaminophen (Tylenol)
  • 650mg PO q4h
  • Peds 15mg/kg/dose
  • Has analgesic and antipyretic properties but no anti-inflammatory action
• Tramadol (Ultram)
  • Moderate – moderate severe
  • 50-100mg PO q4-6h prn
  • Taper dose to d/c
  • Renal dose adjust

 

Narcotic Reversal

• Narcan