● Consider using other tools to improve patient, household, and community safety, such as patient–prescriber agreements that reinforce patient–prescriber responsibilities. Give special safety instructions to patients with young children, especially toddlers, and those who live with a child or adult who is cognitively impaired. For example, prescribing a controlled substance to a patient with Alzheimer’s disease or other
cognitive impairments must involve instructions to a responsible adult in the home. Family members should also have a plan for accidental overdoses, including poison control (1-800-222-1222) for unintentional ingestion of a known or unknown substance. Family members should call 911 and initiate emergency services if the individual is in respiratory distress.
Table 5: Oral Opioids for Acute Pain in Opioid-Naïve Adults
Available Oral Strengths Tablets: • 15 mg/300 mg • 30 mg/300 mg • 60 mg/300 mg
Medication
Moderate Pain Severe Pain
Clinical Considerations
Codeine- acetaminophen • Tylenol with Codeine
1 to 2 tablets every four hours as needed for pain.
Incremental efficacy decreases and increases in adverse reactions with increasing doses. Limit codeine to no more than 60 mg/dose. Do not exceed codeine 360 mg/24 hours. The maximum dose of acetaminophen is 4,000 mg/day (from all sources). Metabolism of codeine to morphine (its active form) varies between patients; drug interactions may affect response. Dosage limited by acetaminophen maximum dose (4,000 mg/day [from all sources]).
Hydrocodone- acetaminophen
Tablets: • 2.5 mg/325 mg • 5 mg /300 mg • 5 mg/325 mg • 7.5 mg/300 mg • 7.5 mg /325 mg • 10 mg/300 mg • 10 mg/325 mg Oral solution: • 7.5 mg/325 mg per 15 mL • 10 mg/300 mg per 15 mL • 10 mg/325 mg per 15 mL Tablets: • 2.5 mg/325 mg • 5 mg/325 mg • 7.5 mg/325 mg • 10 mg/325 mg Oral solution: • 5 mg/325 mg per 5 mL Tablets: • 37.5 mg/325 mg
1 to 2 tablets PO every six hours as needed.
1 to 2 tablets PO every four to six hours as needed.
• Lorcet • Lortab • Norco • Vicodin
Oxycodone- acetaminophen*
1 to 2 tablets PO every six hours as needed.
1 to 2 tablets PO every four to six hours as needed.
Dosage limited by acetaminophen maximum dose (4,000 mg/day [from all sources]).
• Endocet • Percocet • Primlev • Roxicet • Xolox
Tramadol- acetaminophen • Ultracet
1 to 2 tablets PO every six hours needed.
1 to 2 tablets PO every four hours as needed. 1 tablet PO every four to six hours as needed.
Only FDA-approved for five days or less of treatment of acute pain. Maximum dose: Eight tablets/24 hours. FDA-approved for short-term, acute, severe pain (<10 days). Do not exceed five tablets/day. Do not exceed four tablets/24 hours. The duration of therapy should not exceed seven days A decrease in incremental efficacy and an increase in adverse reactions with increasing doses. Limit codeine to no more than 60 mg/dose. Do not exceed 360 mg codeine/24 hours. Metabolism of codeine to morphine (its active form) varies between patients; drug interactions may affect response.
Ibuprofen-hydrocodone • lbudone
Tablets: • 5 mg/200 mg • 7.5 mg/200 mg • 10 mg/200 mg
• Reprexain • Vicoprofen • Xylon
Ibuprofen-oxycodone (Only available as generic)
Tablets: • 5 mg/400 mg
1 tablet PO every six hours.
Codeine (Only available as generic)
Tablets: • 15 mg • 30 mg • 60 mg
15 to 60 mg PO every four hours as needed.
Page 134
Book Code: AUS3024
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