Top 200

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 

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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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

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