Table 2.
Commonly Used Nonopioid Analgesics |
| Drug |
Average Dose |
Dosing Interval |
Maximum Dose
in 24h |
Side Effects |
Comments |
Acetaminophen
(Tylenol) |
500-1000 mg |
4-6h |
4 Gm
(‹ 3 Gm in patients with liver dysfunction and in frail elderly) |
Minimal, if any, side effects. |
Toxic to the liver in overdose |
| Aspirin |
500-1000 mg |
4-6h |
4000 mg. |
* see below |
Caution with hepatic/renal disease |
Choline Magnesium Trisalicylate
(Trilisate) |
500-1000 mg |
8-12h |
3000 mg |
Lower incidence of GI bleeding, minimal anti-platelet
activity |
Caution with hepatic/renal disease |
Ibuprofen
(Motrin & others) |
200-400 mg |
4-6h |
2400 mg |
* see below |
Caution with hepatic/renal disease |
Naproxen
(Naprosyn) |
500 mg initial,
250 mg subsequent |
6-8h |
1500 mg |
* see below |
Caution with hepatic/renal disease |
Nabumetone
(Relafen) |
500-750 mg |
8-12h |
2000 mg |
* see below |
Caution with hepatic/renal disease |
Ketorolac
(Toradol) |
30 mg IV initial,
15-30 mg subsequent |
6h |
150 mg first day,
120 mg thereafter (in elderly, 30 mg starting dose, 15 mg thereafter) |
* see below |
Use restricted to 5 days max. Caution with hepatic/renal disease.
Oral dose is lower than equivalent parenteral dose |
Celecoxib
(Celebrex) |
100-200 mg |
12h |
200-400 mg |
Lower incidence of adverse GI effects |
Contraindicated in sulfonamide allergy. No platelet effects
*Increases the risk of cardiac problems; patients should be
carefully selected after a risk-benefit analysis |
Valdecoxib
(Bextra) |
10-20 mg |
12-24h |
40 mg |
Lower incidence of adverse GI effects |
Contraindicated in sulfonamide allergy. No platelet
effects |
| Tramadol
(Ultram, Ultracet)
Often listed with opioids |
25-50 mg |
4-6h |
400 mg
(300 mg in the elderly) |
Headache, confusion, sedation, nausea |
Has nonopioid and opioid effects. Lowers seizure threshold.
Sometimes classified as an opioid |
* Monitor for common adverse effects:
GI ulceration and bleeding, decreased platelet aggregation, and
renal toxicity.
Source: Massachusetts Pain Initiative Pain Management Pocket Tool,
2004. Used with pemission. |