Pain (Top Drugs)

Brand, Generic, Dosing, MOA, BBW

Diclofenac (brand)

Voltaren (XR)

Voltaren (generic)

Diclofenac

Diclofenac (dosing)

50mg po TID

Voltaren (dosing)

50mg po TID

Diclofenac / Voltaren (MOA)

inhibits prostaglandin synthesis through non-specific inhibition of cyclooxygenase

Diclofenac / Voltaren (BBW)

May cause increased risk of serious and fatal cardiovascular thrombotic events. Have been associated with GIB, ulceration, and perforation

Hydro/APAP (brand)

Vicodin, Lortab, Norco

Vicodin, Norco, Lortab (generic)

Hydro/APAP

Hydro/APAP (dosing)

1-2 tablets (5/300mg/tab) po q4-6h prn

Lortab, Vicodin, Norco (dosing)

1-2 tablets (5/300mg/tab) po q4-6h prn

Hydro/APAP // Lortab, Vicodin, Norco (MOA)

opioid receptor agonist/inhibition of prostaglandin synthesis in the CNS

Hydro/APAP // Lortab, Vicodin, Norco (BBW)

Opioids can be addictive, abused, and misused which can lead to overdose and death. REMS. Serious life- threatening respiratory depression may occur. Accidental exposure can be fatal, especially in children. Use in pregnancy can cause neonatal withdrawal. 3A4 interactions. Acetaminophen can cause hepatotoxicity. Concomitant use with benzodiazepines, alcohol, or other CNS depressants.

Ibuprofen (brand)

Motrin, Advil

Advil, Motrin (generic)

Ibuprofen

Ibuprofen (dosing)

400-800mg po 3-4x/d

Advil, Motrin (dosing)

400-800mg po 3-4x/d

Ibuprofen / Advil, Motrin (MOA)

inhibits prostaglandin synthesis through non-specific COX-1 and COX-2 inhibition

Ibuprofen / Advil, Motrin (BBW)

May increase the risk of serious cardiovascular thrombotic events, MI, stroke, GIB, ulcerations, and perforation

Ketorolac (brand)

Toradol

Toradol (generic)

Ketorolac

Ketorolac (dosing)

30mg IV q6h for max of 5 days

Toradol (dosing)

30mg IV q6h for max of 5 days

Ketorolac / Toradol (MOA)

inhibits prostaglandin synthesis through non-specific COX-1 and COX-2 inhibition

Ketorolac / Toradol (BBW)

-only indicated short-term, up to 5 days.

-Serious cardiovascular events, thrombotic events, serious GIB, ulceration and perforation, renal risk, risk of bleeding.

-Contraindicated for intrathecal or epidural administration.

-Severe hypersensitivity reactions may occur.

-Contraindicated in pts with advanced renal impairment.

-contraindicated in patients currently receiving aspirin or NSAIDs.

-Contraindicated in labor and delivery.

-Adjust dose for pts over 65yo and patients weighing less than 50kg

Meloxicam (brand)

Mobic

Mobic (generic)

Meloxicam

Meloxicam (dosing)

7.5mg po qd

Mobic (dosing)

7.5mg po qd

Meloxicam / Mobic (MOA)

inhibits prostaglandin synthesis through non-specific inhibition of cyclooxygenase

Meloxicam / Mobic (BBW)

May cause an increased risk of serious cardiovascular thrombotic events, MI, and stroke. NSAIDs have been involved in rare cases of GIB accidents

Methadone (brand)

Methadose, Dolophine

Methadose, Dolphin (generic)

Methadone

Methadone / Dolphin, Methadose (control)

CII

Methadone (dosing)

2.5-10mg q8-12h prn

Methadose, Dolphin (dosing)

2.5-10mg po q8-12h prn

Methadone / Methadose, Dolphin (MOA)

Mu-opioid receptor agonist

Methadone / Methadose, Dolophine (BBW)

Addiction, abuse, and misuse. REMS compliant education encouraged. Life-threatening respiratory depression. Life-threatening QT prolongation. Accidental exposure, Neonatal withdrawal syndrome. Many interactions with cytochrome P450 inhibitors. Risks from concomitant use with benzodiazepines or other CNS depressants.

Morphine (brand)

MS Contin, Roxanol, Kadian

MS Contin, Roxanol, Kadian (generic)

Morphine

Morphine (dosing)

ER formulation- 15mg po qd, dosing is individualized

MS Contin, Roxanol, Kadian (dosing)

ER formulation- 15mg po qd

Morphine / MS Contin, Roxanol, Kadian (MOA)

Opioids receptor agonist

Morphine / MS Contin, Roxanol, Kadian (BBW)

-Monitor for at least 24hrs after first dose if given intrathecal or epidural route.

-Do NOT consume alcohol with ER capsules. Addiction, abuse, misuse.

-REMS

-Serious or life-threatening respiratory depression

-neonatal withdrawal syndrome

-Accidental exposure can be fatal, especially in children

-use in pregnancy can cause neonatal withdrawal syndrome

-concomitant use with benzodiazepines, alcohol or other CNS depressants can result in respiratory depression, coma, and death

Oxycodone (brand)

OxyContin, Roxicodone

OxyContin, Roxicodone (generic)

Oxycodone

Oxycodone (dosing)

• IR: 5mg po q4-6h prn

• ER: 10-20mg po BID

Roxicodone, OxyContin (dosing)

• IR: 5mg po q4-6h prn

• ER: 10-20mg po BID

Oxycodone/ Roxicodone, OxyContin (MOA)

opioid receptor agonist

Oxycodone / Roxicodone, Oxycontin (BBW)

-Opioids can be addictive, abused, and misused which can lead to overdose and death

-REMS

-serious life-threatening respiratory depression may occur

-accidental exposure can be fatal. especially in children

-Use in pregnancy can cause neonatal withdrawal syndrome

-Use with benzodiazepines, alcohol, or other CNS depressant can result in respiratory depression, coma, and death

Oxy/APAP (brand)

Percocet, Roxicet, Endocet

Percocet, Roxicet, Endocet (generic)

Oxy/APAP

Oxy/APAP (dosing)

1T po q6h prn

Percocet, Roxicet, Endocet (dosing)

1T po q6h prn

Oxy/APAP // Percocet, Endocet, Roxicet (MOA)

opioid receptor agonist and inhibition of prostaglandin synthesis in CNS

Oxy/APAP // Percocet, Roxicet, Endocet (BBW)

-Opioids can be addictive, abused, and misused which can lead to overdose and death

-REMS

-serious life-threatening respiratory depression may occur

-accidental exposure can be fatal. especially in children

-Use in pregnancy can cause neonatal withdrawal syndrome

-Use with benzodiazepines, alcohol, or other CNS depressant can result in respiratory depression, coma, and death

Tramadol (brand)

Ultram (ER)

Ultram (ER) (generic)

Tramadol

Tramadol (dosing)

50-100mg po q4-6h prn

Ultram (ER) (dosing)

50-100mg po q4-6h prn

Tramadol / Ultram ER (MOA)

opioids receptor agonist AND blocks reuptake of NE and 5HT

Tramadol / Ultram (ER) (BBW)

• addiction, abuse, and misuse

• REMS

• life-threatening respiratory depression

• accidental exposure

• ultra-rapid metabolism increases risk of respiratory depression in children

• neonatal opioid withdrawal syndrome

• Interactions with drugs affecting cytochrome P450 enzymes

• risks from concomitant use with benzodiazepines and other CNS depressants

Celecoxib (indication)

pain and osetoarthritis

Celebrex (indication)

pain and osteoarthritis

Celecoxib (brand)

Celebrex

Celebrex (generic)

celecoxib

Celebrex (dosing)

200mg po qd

Celecoxib (dosing)

200mg po qd

Celecoxib / Celebrex (MOA)

inhibits prostaglandin synthesis through selective inhibition of cyclooxygenase 2

Celecoxib / Celebrex (BBW)

• may cause increased risk of serious and fatal cardiovascular thrombotic events.

• Have been associated with GIB, ulceration, and perforation

Carisoprodol (brand)

Soma

Soma (generic)

Carisoprodol

Carisoprodol (indication)

pain relief of musculoskeletal conditions

Soma (indication)

pain relief of musculoskeletal conditions

Soma (dosing)

250-350mg po TID HS

Carisoprodol (dosing)

250-350mg po TID HS

Carisoprodol / Soma (MOA)

central depressant resulting in musculoskeletal relaxation

Fentanyl Transdermal (brand)

Duragesic

Duragesic (generic)

Fentanyl Transdermal

Fentanyl Transdermal (dosing)

1 patch applied topically q72h, remove and replace at the end of 72hr period

Duragesic (dosing)

1 patch applied topically q72h, remove and replace at the end of 72hr period

Fentanyl Transdermal / Duragesic (MOA)

opioid receptor agonist

Fentanyl Transdermal / Duragesic (BBW)

• Serious, life-threatening respiratory depression may occur.

• Can be addictive, abused, and misused which can lead to overdose and death.

• Accidental exposure can be fatal, especially in children.

• Concomitant use with CYP3A4 inhibitors, benzodiazepines, alcohol, or other CNS depressants can result in respiratory depression and coma.

• Use in pregnancy can cause neonatal withdrawal.

• Required REMS to ensure benefits outweigh risks.

• Exposure of application site to heat sources may increase absorption and result in overdose.

Baclofen (brand)

Lioresal

Lioresal (generic)

Baclofen

baclofen (dosing)

10mg po TID prn

Lioresal (dosing)

10mg po TID prn

Baclofen (indication)

musculoskeletal pain/spasm

Lioresal (indication)

musculoskeletal pain/spasm

10mg po TID

Baclofen / Lioresal (MOA)

MAY work through hyperpolarization of afferent terminals resulting in inhibition of monosynaptic and polysynaptic reflexes

Baclofen / Lioresal (BBW)

abrupt discontinuation of intrathecal baclofen can result in rhabdomyolysis, multiple organ-system failure, and death

Cyclobenzaprine (brand)

Amrix, Flexeril, Fexmid

Amrix, Flexeril, Fexmid (brand)

Cyclobenzaprine

Cyclobenzaprine (dosing)

10mg po TID

Amrix, Flexeril, Fexmid (dosing)

10mg po TID

Flexeril, Amrix, Fexmid (indication)

musculoskeletal pain/spasm

Cyclobenzaprine (indication)

musculoskeletal pain/spasm

Cyclobenzaprine / Flexeril, Amrix, Fexmid (MOA)

Acts in the brains stem to reduce tonic somatic motor activity

Methocarbamol (indication)

musculoskeletal pain/spasm

Robin (indication)

musculoskeletal pain/spasm