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causes less GI aches, bursitis, CMT: QD, suppositories may involve irritation and antiplatelet backache, BID, multiple organs effects than aspirin sprains, arthritis, or TID pain due to fever, cold, flu Propionic acid Ibuprofen Mild to q 4-6 h Oral (tablets, NSAID class effects Commonly used NSAID derivatives moderate pain, caplets, Toxic amblyopia OTC formulations including pain geltabs, available associated with the suspension); Combinations with common cold, rectal codeine and headache, toothache, suppositories hydrocodone muscular aches, available backache, menstrual Fewer GI effects cramps, and arthritis; than other nonfever reduction selective NSAIDs Naproxen RA, OA, AS, JA, q 6-12 h Tablets, oral NSAID class effects OTC formulations tendonitis, bursitis, suspension, Other: available gout, primary delayed- pseudoporphyria Delayed-release tablets dysmenorrhea release tablets are NR for initial treatment of acute pain Ketoprofen Signs and symptoms q 6-8 h; Capsules, NSAID class effects OTC formulations of OA and RA, pain, ER capsules available and primary q 24 h ER capsules NR for dysmenorrhea for ER form treatment of acute pain Flurbiprofen OA, RA BID, TID, Tablets NSAID class effects or QID Oxaprozin Acute and long-term q 24 h Caplets NSAID class effects Long half-life management of Other: (55 hours), thus OA and RA photosensitivity, can be given rash once daily Indoleacetic acids Indomethacin Moderate to severe BID, TID, Oral (capsules, NSAID class effects Limited use due to OA, RA, AS; acute or QID suspension, Ocular effects side effects gouty arthritis; acute slow-release (corneal deposits, painful shoulder capsules) retinal (bursitis and/or rectal disturbances) tendonitis) suppositories Exacerbation of Parkinson’s disease, epilepsy, or psychiatric disorders Benzothiazine Piroxicam Acute and long-term q 24 h Capsules NSAID class effects Single daily dose derivatives management of Insomnia (oxicams) OA and RA Meloxicam OA q 24 h Tablets NSAID class effects Single daily dose National Pharmaceutical Council 35 Section III: Types of Treatments Table 19. Examples of Nonopioid Analgesics (continued) Usual Oral Dosage Dosing Forms and Chemical Generic Interval or Routes of Major Side Class Name Indications Frequency Administration Effects Comments Pyrroleacetic acid Diclofenac OA, RA, AS, BID, TID, Tablets, NSAID class effects Lower risk of GI effects derivatives primary or QID ER tablets Other: acute dysmenorrhea hemolytic anemia, ER form aseptic meningitis, q 24 h rash Avoid use in patients with porphyria Combination with misoprostol contraindicated in pregnant women Ketorolac Short term Varies for Oral (tablets), NSAID class effects Parenteral form useful (440, AV block paralytic ileus Contraindications: status-post acute MI, hypersensitivity, concomitant MOAI use Use with caution in patients with seizures, urinary retention, angle-closure glaucoma, hyperthyroidism, CV disease, advanced age Nortriptyline Depression PDN, mixed Capsules, Common SE: Better tolerated than neuropathic pains suspension insomnia, some amitriptyline due to sedation, less sedation and anticholinergic anticholinergic SE effects May cause insomnia, Other SE and so administer during contraindications: daytime see Amitriptyline Local Lidocaine Postherpetic PHN, PDN, stump Patch Most common SE: Only FDA-approved anesthetics Lidoderm neuralgia pain, reflex sympathetic localized reaction treatment for PHN (topical) dystrophy, painful that usually resolves Anecdotal data suggest HIV-related neuropathy Less common SE: may be effective for allergic and systemic other pain reactions Low blood levels due Use precautions to topical application in patients with Convenient and severe hepatic generally well damage and tolerated avoid eye exposure Contraindicated in patients with known sensitivity to LAs or for use on non-intact skin 44 Pain: Current Understanding of Assessment, Management, and Treatments Section III: Types of Treatments Table 25. Examples of Antiepileptic Drugs, Antidepressants, and Local Anestheticsa (continued) Doage Forms Uses in and Routes of Potential Class Generic Name Indications Painb Administration Side Effects Comments EMLA® Local Needle insertion, Cream, disc Toxicity with Placebo-controlled anesthesia on intravenous repeated dosing, trials support efficacy intact skin for cannulation, eye irritation, in relieving acute pain procedures spinal needle insertion, allergic reactions, associated with or superficial electrosurgery of methemoglobinemia multiple procedures surgery on cutaneous lesions, skin biopsies, PHN, other neuropathic pain Local Bupivacaine Local or Acute pain Parenteral, Most common Moderate to fast anesthetics regional management: local epidural SE: dose-related acting, with long (other routes) anesthesia or infiltration, nerve CNS (e.g., anxiety, duration of action analgesia for blocks, epidural dizziness) and CV Better able to surgery; oral blocks, arthroscopy (e.g., arrhythmias, selectively block surgical and myocardial nociceptive nerve obstetrical depression) effects fibers procedures; Use with caution Can be combined with and diagnostic in patients with liver opioids for epidural and or heart disease analgesia therapeutic due to risk of Only use 0.25% procedures hepatic toxicity and 0.5% and arrhythmias concentrations for
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