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Tylenol
Acetaminophen
use: mild pain (headache, arthritis pain, fever)
- dosing: 500-650 mg PO every 4-6 hours PRN (max 4 g/day)
- children: 10-15 mg/kg per dose q 4-6 hours PRN
- hepatic impairment: 2 g/day
AE: hepatotoxicity (rare) - >3 drink/day increases risk, concomitant use with isoniazid
Concomitant warfarin use increases anticoagulant effect
counseling pt: report unresolved pain/fever; do not use > 4g/day
caution in G6PD deficiency, other OTC contain APAP, preferred in pregnancy and breastfeeding
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Fioricet, Zebutal, Dolgic Plus
Butalbital, acetaminophen, caffeine
use: relief of tension or muscle contraction headache
- dosing: 1-2 tablets q 4 hours not to exceed 6/day
- renal and hepatic impairment - reduce dose
common AE: drowsiness, depression, nervousness, insomnia, nightmares, nausea
rare AE: hallucinations, hypotension, respiratory and CNS depression, tachycardia, hepatotoxicity (>3 drink/day increases risk), concomitant use with isoniazid
concomitant use with other CNS depressant enhances effects
- CCB, OC, corticosteroid, cyclosporine, disopyramide, doxycycline, TCA, voriconazole, warfarin >> increases metabolism of these agents
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Ultram, Ultram ER, Ultracet
Tramadol
use: moderate to severe pain, neuropathic pain
- initial use: 50 mg PO q 4-6 hours PRN
- maintenance: 50-100 mg PO q 4-6 hours PRN
- max: 400 mg/day, 300 mg/day ER product
- renal/hepatic impairment: 50 mg PO q 12 hours (max 200 mg/day)
common AE: sedation, dizziness, constipation, NV, somnolence, euphoria/dysphoria
rare AE: hypotension, seizures > 500 mg/day, abstinence syndrome with abrupt d/c
- carbamazepine: decrease tramadol levels
- MAO-I, TCA, SSRI, increase risk of seizures and serotonin syndrome
- naloxone may induce seizure
CNS depressant: additive respiratory and CNS depressant
Counseling pt: may cause drowiness, abrupt d/c may result in withdrawal symptoms
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Actiq, Duragesic, Fentora, Sublimaze, Onsolis
Fentanyl
use: severe pain
- initial dose: 12.5-25 ug/hour every 72 hour
- maintenance dose: titrate to response
- max: 4 patches
common AE: constipation, NV, sedation, dizziness, xerostomia, pruritis (histamine release), skin rash (transdermal)
rare AE: hallucinations, hypotension, respiratory and CNS depression
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