Analgesics

Non-opioid analgesics

ASPIRIN:

Indications: mild to moderate pain, pyrexia; antiplatelet.

Contraindications: children under 16 years and in breast-feeding (Reye’s syndrome); previous or active peptic ulceration, haemophilia; not for treatment

of gout.

Dose and Administration: By mouth, 300–900 mg every 4–6 hours when necessary; max. 4 g daily; child under 16 years not recommended.

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PARACETAMOL (Acetaminophen):

Indications: Arthritic Pain, Back Pain, Dysmenorrhea, Fever, Headache Disorder, Myalgia, Pain, and Toothache.

Contraindications: Acetaminophen Toxicity, Alcoholism, and Disease of Liver.

Dose and Administration: By mouth, 0.5–1 g every 4–6 hours to a max. of 4 g daily; child 2 months 60 mg for post-immunisation pyrexia, repeated once after 6 hours if necessary; 3 months–1 year 60–120 mg, 1–5 years 120–250 mg, 6–12 years 250–500 mg; these doses may be repeated every 4–6 hours when necessary (max. of 4 doses in 24 hours). By intravenous infusion over 15 minutes, adult and child over 50 kg, 1 g every 4–6 hours, max. 4 g daily; adult and child 10–50 kg, 15 mg/kg every 4–6 hours, max. 60 mg/kg daily; neonate and child less than 10 kg, 7.5 mg/kg every 4–6 hours, max. 30 mg/kg daily. By rectum adult and children over 12 years 0.5-1gm every 4-6 hours to a max. of 4gm daily. Children 3 months to 1 year 60-125mg. 1-5 years 125-250mg. 5-12 years 250-500mg. These doses may be repeated every 4-6 hours as necessary ( max. 4 doses in 24 hours).

PARACETAMOL-CAFFEINE:

Indications: Fever, Mild Arthritic Pain, Pain.

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Contraindications: Acetaminophen Toxicity, Recovery Phase Following Myocardial Infarct, Alcoholism, Conduction Disorder of the Heart, Disease of Liver, Insomnia, Myocardial Ischemia, Necrotizing Enterocolitis, Peptic Ulcer.

Dose and Administration: Adults and children over 12 years of age 2 tablets (each tablet contain 500mg paracetamol & 65mg caffeine) up to 4 times daily not exceeding 8 tablets per 24 hours.

PARACETAMOL-CAFFEINE-CODEINE:

Indications: relief mild to moderate pain and fever.

Contraindications: Acetaminophen Toxicity, Recovery Phase Following Myocardial Infarct, Alcoholism, Conduction Disorder of the Heart, Disease of Liver, Insomnia, Myocardial Ischemia, Necrotizing Enterocolitis, Peptic Ulcer and in those patients with G6PD deficiency.

Dose and Administration: Adults and children over 12 years of age 2 tablets/capsules (each tablet contain 500mg paracetamol, 30mg caffeine & 8mg codeine phosphate) up to 4 times daily not exceeding 8 tablets per 24 hours.

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Opioid analgesics

Opioid analgesics are usually used to relieve moderate to severe pain particularly of visceral origin. Repeated administration may cause dependence and tolerance, but this is no deterrent in the control of pain in terminal illness. Regular use of a potent opioid may be appropriate for certain cases of chronic non-malignant pain; treatment should be supervised by a specialist and the patient should be assessed at regular intervals. Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, shock, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders.

MORPHINE SULPHATE:

Indications: General Anesthesia Adjunct, Local Anesthesia Adjunct, Neonatal Abstinence Syndrome, Pain.

Contraindications: Acute Asthma Attack, Head Injury, Intracranial Hypertension, Paralytic Ileus, Status Epilepticus, Chronic Disease of Respiratory System, CNS Depression, Cor Pulmonale, Gastrointestinal Obstruction, Hypotension, Pancreatitis, Respiratory Depression.

Dose and Administration: Acute pain, by subcutaneous injection (not suitable for oedematous patients) or by intramuscular injection, initially 10 mg (elderly or frail 5 mg) every 4 hours (or more frequently during titration), adjusted according to response; neonate initially 100 micrograms/kg every 6 hours, adjusted according to response; child 1–6 months initially 100– 200 micrograms/kg every 6 hours, adjusted according to response; child 6 months–2 years initially 100–200 micrograms/kg every 4 hours, adjusted according to response; child 2–12 years initially 200 micrograms/kg every 4 hours, adjusted according to response; child 12–18 years initially 2.5–10 mg every 4 hours, adjusted according to response. By slow intravenous injection, initially 2.5 mg (reduce dose in elderly or frail) every 4 hours (or more frequently during titration), adjusted according to response; neonate initially 40– 100 micrograms/kg every 6 hours, adjusted according to response; child 1–6 months initially 100–200 micrograms/kg every 6 hours, adjusted according to response; child 6 months–12 years initially 100–200 micrograms/kg every 4 hours, adjusted according to response.

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PETHIDINE HYDROCHLORIDE:

Indications: moderate to severe pain, obstetric analgesia; peri-operative analgesia.

Contraindications: Acute Asthma Attack, Head Injury, Intracranial Hypertension, Paralytic Ileus, Status Epilepticus, Chronic Disease of Respiratory System, CNS Depression, Cor Pulmonale, Gastrointestinal Obstruction, Hypotension, Pancreatitis, Respiratory Depression.

Dose and Administration: Acute pain, by subcutaneous or intramuscular injection, 25–100 mg, repeated after 4 hours; child, by intramuscular injection, 0.5–2 mg/kg. By slow intravenous injection, 25–50 mg, repeated after 4 hours. Premedication, by intramuscular injection, 25–100 mg 1 hour before operation; child 0.5–2 mg/kg. Postoperative pain, by subcutaneous or intramuscular injection, 25–100 mg, every 2–3 hours if necessary; child, by intramuscular injection, 0.5–2 mg/kg.

FENTANYL CITRATE:

Indications: Administration of General Anesthesia, General Anesthesia Adjunct, Postoperative Pain, Regional Anesthesia for Postoperative Pain, Regional Anesthesia for Surgery.

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Contraindications: Acute Asthma Attack, Paralytic Ileus, Toxin-Mediated Diarrhea, Chronic Disease of Respiratory System, Cor Pulmonale, Inflammatory Bowel Disease, Respiratory Depression.

Dose and Administration: By slow intravenous injection, with spontaneous respiration, 50–100 micrograms (max. 200 micrograms on specialist advice), then 50 micrograms as required; child 1–5 micrograms/kg, then 1 microgram/kg as required. With assisted ventilation, 0.3–3.5 mg, then 100–200 micrograms as required; child 5–10 micrograms/kg, then 1–3 micrograms/kg as required. By intravenous infusion, with spontaneous respiration, adult and child, 50– 80 nanograms/kg/minute adjusted according to response. With assisted ventilation, adult and child, initially 10 micrograms/kg over 10 minutes then 100 nanograms/kg/minute adjusted according to response; adults may require up to 3 micrograms/kg/minute during cardiac surgery.

TRAMADOL HYDROCHLORIDE:

Indications: moderate to severe pain.

Contraindications: Alcohol Intoxication, Benzodiazepine Toxicity, Opioid Toxicity, Pregnancy, Respiratory Depression, Alcohol Withdrawal Syndrome, Central Nervous System Infection, CNS Depression, Epilepsy, Head Injury, Hypoglycemic Disorder, Hyponatremia, Intracranial Hypertension, Lower Seizure Threshold, Serotonin Syndrome, Severe Renal Disease, Substance Abuse, Suicidal.

Dose and Administration: adult and child over 12 years, by mouth, 50– 100 mg not more often than every 4 hours; total of more than 400 mg daily not usually required. adult and child over 12 years, by intramuscular injection or by intravenous injection (over 2–3 minutes) or by intravenous infusion, 50–100 mg every 4–6 hours. Postoperative pain, 100 mg initially then 50 mg every 10–20 minutes if necessary during first hour to total max. 250 mg (including initial dose) in first hour, then 50–100 mg every 4–6 hours; max. 600 mg daily.

SUFENTANYL CITRATE:

Indications: Administration of General Anesthesia, General Anesthesia Adjunct.

Contraindications: Bradycardia, Decreased Cardiac Function, Head Injury, Hypothyroidism, Intracranial Hypertension, Intracranial Lesion, Renal Disease.

Dose and Administration: Adult Dosage,In minor but painful general surgical procedures (anticipated duration of anesthesia of 1–2 hours) requiring endotracheal intubation and assisted or controlled respiration in adults, a total sufentanil dosage of 1–2 mcg/kg is administered IV in conjunction with nitrous oxide and oxygen; approximately 75% or more of the total dosage (titrated to patient response) may be administered by slow IV injection or infusion prior to intubation. Pediatric Dosage, The manufacturers state that when sufentanil is used to provide induction and maintenance of anesthesia without additional anesthetic agents in children younger than 12 years of age undergoing cardiovascular surgery, an initial anesthetic dose of 10–25 mcg/kg is administered IV in conjunction with 100% oxygen and a skeletal muscle relaxant; additional IV doses of up to 25–50 mcg each (or, alternatively, 1–2 mcg/kg each) are recommended as necessary based on response to the initial dose and as determined by changes in vital signs that indicate surgical stress or lightening of anesthesia.

TRAMADOL-PARACETAMOL:

Indications: moderate to severe pain.

Contraindications: Acetaminophen Toxicity, Alcohol Intoxication, Benzodiazepine Toxicity, Opioid Toxicity, Pregnancy, Respiratory Depression, Alcoholism, Alcohol Withdrawal Syndrome, Central Nervous System Infection, CNS Depression, Disease of Liver, Epilepsy, Head Injury, Hypoglycemic Disorder, Hyponatremia, Intracranial Hypertension, Lower Seizure Threshold, Serotonin Syndrome, Severe Renal Disease, Substance Abuse, Suicidal.

Dose and Administration: 2 tablets (tramadol hydrochloride 37.5 mg, paracetamol 325 mg) not more than every 6 hours; max. 8 tablets daily; child under 12 years not recommended.

Antimigraine Drugs

ERGOTAMINE TARTRATE:

Indications: treatment of acute migraine

Contraindications: Bacterial Septicemia, Buerger’s Disease, Coronary Angioplasty, Coronary Artery Disease, Disease of Liver, Induction of Labor, Intermittent Claudication, Lactating Mother, Nutritional Disorder, Occlusive Peripheral Vascular Disease, Phlebitis, Pregnancy, Premature Labor, Raynaud’s Phenomenon, Renal Disease, Severe Arteriosclerotic Vascular Disease, Severe Pruritus, Severe Uncontrolled Hypertension, Vascular Surgery.

Dose and Administration: adult and child over 12 years, 1–2 tablets (each contain ergotamine tartrate 1 mg, caffeine 100 mg) at onset; max. 4 tablets in 24 hours, not to be repeated at intervals of less than 4 days; max. 8 tablets in one week.

SUMATRIPTAN:

Indications: treatment of acute migraine.

Contraindications: Angina, Basilar Migraine, Cerebral Ischemia, Cerebrovascular Accident, Coronary Artery Disease, Hemiplegic Migraine, Ischemic Bowel Disease, Myocardial Infarction, Myocardial Ischemia, Ophthalmoplegic Migraine, Peripheral Vascular Disease, Prinzmetal Angina, Severe Hepatic Disease, Severe Uncontrolled Hypertension, Transient Cerebral Ischemia.

Dose and Administration: By mouth, 50 mg (some patients may require 100 mg); dose may be repeated after at least 2 hours if migraine recurs; max. 300 mg in 24 hours; Intranasally, 10–20 mg (adolescent 12–17 years 10 mg) into one nostril; dose may be repeated once after at least 2 hours if migraine recurs; max. 40 mg (adolescent 12–17 years 20 mg) in 24 hours.

RIZATRIPTAN:

Indications: treatment of acute migraine.

Contraindications: Angina, Basilar Migraine, Hemiplegic Migraine, Myocardial Infarction, Myocardial Ischemia, Prinzmetal Angina, Severe Uncontrolled Hypertension, Disease of Liver, Peripheral Vascular Disease, Renal Disease.

Dose and Administration: one tablet (5 mg) by oral route once, may repeat at 2-hour intervals; do not exceed 30 mg in 24 hours.