Memory Joggers: Medication Information
Dosing Guidelines for Acetaminophen and Selected NSAIDs
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Dosing Guidelines for Acetaminophen and Selected NSAIDS
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| Generic (Brand) Name(s) |
Recommended Starting Oral Dose (mg)* |
Dosing Schedule |
Maximum Oral Dose (mg/day) Recommended** |
Comments |
| acetaminophen (Tylenol, many others) |
650 |
q4-6h |
4000-6000 |
No platelet or GI toxicity |
| aspirin (Bayer, many others) |
650 |
q4-6h |
4000-6000 |
May not be well tolerated |
| choline magnesium trisalicylate (Trilisate) |
500-1000 |
q12h |
4000 |
No effect on platelet aggregation. Available as liquid. |
| diclofenac [Cataflam(immediate-release), Voltaren Delayed Release, Voltaren-XR(extended-release)] |
25 |
q8h |
150 |
|
| diflunisal (Dolobid) |
500 |
q12h |
1500 |
|
| ibuprofen (Motrin, Advil, many others) |
400 |
q6h |
3200 |
Available as suspension |
| ketoprofen (Orudis, Oruvail Extended-Release) |
25 |
q6-8h |
300 |
Available rectally and as a topical gel |
| ketorolac (Toradol) |
10 |
q6h |
40 |
Use limited to 5 days |
| nabumetone (Relafen) |
1000 |
q24h |
2000 |
Minimal effect on platelet aggregation |
| naproxen (Naprosyn, Aleve) |
250 |
q12h |
1025-1375 |
|
| salsalate (Disalcid) |
500-1000 |
q12h |
4000 |
Minimal effect on bleeding time |
*Should be reduced by one-half to two-thirds in the elderly, those on multiple drugs, or those with renal insuffficiency.
**Data are lacking, but the dose listed is thought to be the maximum needed by most patients for analgesia and the dose beyond which side effects are more likely. Some patients require or tolerate less or more.
h = hour
q = every
INDICATIONS FOR NONOPIOID ANALGESICS:
- Mild Pain. Start with a nonopioid. Acetaminophen or a NSAID alone often provides adequate relief.
- Moderate to severe pain. Pain of any severity may be at least partially relieved by a nonopioid, but a SNAID alone usually does not relieve severe pain.
- Pain that requires an opioid. Consider adding a nonopioid for the opioid dose-sparing effect.
GASTROPROTECTIVE THERAPIES FOR PREVENTION OF ULCERS IN PATIENTS TAKING NSAIDs
- Misoprostol (Cytotec).
- Famotidine (Pepsid) 40 mg bid.
- Combination of H2 blocker, E.g., ranitidine (Zantac), sucralfate (Carafate), and antacid
PREVENTIVE STRATEGIES WHEN BLEEDING IS A CONCERN:
- Use NSAIDs that have minimal or no effect on bleeding time, such as choline magnesium trisaliscylate (Trilisate), salsalate (Disalcid), and nabumetone (Relafen).
- Use acetaminphen instead of a NSAID.
- To decrease bleeding associated with operative procedures, stop aspirin therapy one week before surgery, and stop most other NSAIDs 2 to 3 days before surgery
From McCaffery M, Pasero C: Pain: Clinical Manual, Copyright©, 1999, Mosby.
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