TOC   |  DRUGS  |   Arthritis/ Pain  |   ACP Drug Resource | Medline Drugs Info Site 

 

Headache & Pain Med     |   Pain Med  
REF: Pain Management in Elderly Patients 2009 |  Clinical Approach to Patients with Neuropathic Pain 2006  
For Migraine
  • Midrin (isometheptene) 1-2cap onset, repeat 3-4x/d (Max 6/24 hours)
  • Fioricet or Fiorinal 1-2 tab tid prn headache (Use no more than 4 days/week to avoid rebounce)
  • Caferfot 1 mg 1 tab q30min prn (Max 6/24 hours) - avoid in CAD & pregnant pts.
  • DHE 0.5 - 1 mg IM tid prn (Max 3 mg/day or 10 mg/wks - avoid in CAD & pregnant pts.
  • Imitrex /Sumatriptan - * Never use within 24 hrs of Cafergot, DHE or other ergots.
        6 mg sc, max 2x/d for migraine - avoid in CAD & pregnant pts.
        25 or 50mg tab PO  1 2 hours (9 tab pack)    Max 200 mg/24 hours.
        5 or 20mg nasal spray
  • Maxalt-MLT/ Rizatriptan 5 - 10 mg tab dissolve in mouth, q 2 hours. (9 tab pak) Max 30 mg/24 hours.
  • Amerge/Naratriptan  2.5 mg tab, may repeat in 4 hours.  Max 5 mg/24 hours. 
  • Zomig/Zolmitriptan 2.5 - 5 mg tab q 2 hours. Max 10 mg/24 hours.

* Marijuana grass or Marinol (Dronabinol) 2.5 - 5 - 10 mg capsule ?

 
Preventive Rx for Migraine:
  • Inderal 20 - 120 mg bid
  • Verapamil 40-80 mg tid
  • Elavil 10 - 150 mg hs
  • Prozac 10 - 80 mg qd
  • Valproid Acid 250 mg bid to 500 mg tid - avoid in pregnant pts.

 
Oral Pain Medication
  • Darvocet N-100 (Tylenol 650mg + propoxyphene 100mg) q4h PO
  • Tylenol#3 (Tylenol 325mg+codeine 30mg)
  • Vicodin (Tylenol 500mg+Hydrocodone 5mg)
  • Lortab 7.5/500(Tylenol 500+Hydrocodone 7.5mg) q4-6h
  • Ultram/Tramadol 50 mg 1-2 tab q4-6h PO
  • Ultracet (Tramadol 37.5 mg + Acetaminophen 325 mg) tablet 2 tab q4-6h
  • Toradol (Ketorolac) NSAID class PO 10mg 1-2 tab initial, then 1 tab q4-6h (Max:40mg/d, <5d) 
          IM 30-60mg single dose, 15-30mg q6h multiple doses, IV 15-30mg.
  • Neurontin (Gabapentin )  Start 100 mg tid, may increase up to 600 mg tid usual dose (Max  up to 3,600 mg/day)
  • Lyrica (Pregabalin) 50 mg PO tid, may increase after 1 week to max 100 mg tid  
    - for painful neuropathy
  • Percocet (Tylenol 325mg+Oxycodone 5mg) 1-2 tab q4-6 hours prn pain
  • Percocet 2.5/325, 5/325, 7/500, 10/650 tablets
  • Tylox (Tylenol 500 mg+Oxycodone 5 mg) 1-2 cap q4-6hours prn pain
  • Dilaudid (Hydromorphone) 2-6mg q3-4h PO, subl, subc, or 1.5-3mg supp. (max=12mg q4h).
    Dilaudid 1mg=MS 2.5mg PO: 1,2,4 mg ampules, 2,4,8 mg tab.  Rectal supp: 3 mg supp
  • OxyIR (Oxycodone immediate-release) 5mg cap q6h
  • OxyContin (Oxycodone controlled -release) 10-20-40 mg tab q12h
  • Morphine sulfate 5-40mg q4h PO,subl, or rectal supp. (10-20mg/5ml soln) Tab 15,30 mg q3-4h. Elixir 2-20mg/mL Rectal supp 5,10,20,30 mg
  • MS-Contin 15-30-60-100mg tab, 200cap mg q12h (Morphine controlled-release)
  • Kadian (MS sustained release) 20-50-100 mg cap once daily.
  • Fentora (Fentanyl buccal tablet) 100 mcg initially
  • Lidoderm 5% patch apply to cover the most painful area, once up to 12 hours within a 24 hour period.
  • Transderm Patch Analgesics
    • Fentanyl/ Duragesic 25-50-75-100 mcg/hour transderm patch for 72 hours
    • Lidoderm/ Lidocaine 5% patch for postherpetic neuralgia for 12 hours/day

 
IV Patient-Controlled-analgesia
  • Morphine 0.5-3 mg q5-15 min intervalFentanyl 10-50 ug q5-10 min
  • Hydromorphine 0.1-0.5 mg q5-10 min
  • Meperidine 5-30 mg q5-15 min
  • Nalbuphine 1-5 mg q5-10 min
  • Toradol (Ketorolac) NSAID class IM 30-60mg single dose, 15-30mg q6h multiple doses, IV 15-30mg. PO 10mg 1-2 tab initial, then 1 tab q4-6h Max:40mg/d, <5d) 
  • Duragesic(Fentanyl Transderm) 25, 50,75,100 mcg/h patch q72h
  • *Ultram (Tramadol) 50mg 1-2 tab q4-6h prn pain. -a centrally acting agent, not an NSAID, not assoc. with ulcer
  • Metastron for metastatic bone pain

 
Muscle Relaxants:
  • Soma (Carisoprodol) 350mg qid
  • Soma compound (Soma 200mg+ ASA 325mg) 1-2tab qid
  • Soma Cmpd with codeine 16mg 1-2tab qid
  • Flexeril (Cyclobenzaprine) 10mg tid
  • Robaxin (Methocarbamol) 500-750mg 2 tab 2-3x/d
  • Robaxisal (Robaxin 400mg +ASA 325mg) 2-3tab qid
  • Parafon Forte DSC (Chlorzoxazone)500mg qid
  • Norgesic-Forte (Orphenadrine/ASA/ Caffeine)
  • Dantrium (Dantrolene) 25-50mg cap start 25mg/d, then gradually to qid for spasticity
  • Quinamm (Quinine sulfate) 260mg BID
  • Valium (Diazepam) 2-5-10mg tid

 

                                                                                                              

http://www.partnersagainstpain.com/  

           2009