Generic Name

Brand Name

Dosage

Side-effects

Comments

acetaminophen

Tylenol

aspirin-free Anacin

aspirin-free Excedrin

325 mg or 500 mg one or two qid, Extra Strength or Arthritis Strength Tylenol are 500 mg tabs.  There is also an Extended Release form of Tylenol which may be taken at night and is supposed to last 8 hours

Only a rare patient has GI problems with acetaminophen.  It is generally tolerated well if kept under 4,000 mg per day.  Those patients who are taking significantly more than this on a regular basis may encounter liver or kidney toxicity especially in patients consuming a great deal of alcohol

acetaminophen with codeine

Tylenol with codeine

Tylenol #2 contains 15 mg of codeine, Tylenol #3 contains 30 mg of codeine,

Tylenol #4 contains 60 mg of codeine.  This may be given q4-6h

GI upset in some patients secondary to codeine, central nervous system side effects with dizziness, sedation, headache secondary to codeine.  Codeine may be constipating.  GI side-effects may occur with nausea and vomiting

If a patient requires Tylenol with codeine which may be constipating, then patients may need to increase fluid intake including fruit juice and particularly prune juice with the use of a stool softener such as Surfak or Colace and increased fiber in the diet or Metamucil. Since this medication is a narcotic (opioid), it may lead to physical dependence. It should be used in caution with anybody who will be operating a motor vehicle or heavy machinery

propoxyphene hydrochloride

Darvon Darvocet Wygesic

Darvon comes as a 65 mg or 100 mg tab (Darvon-N 100).  Propoxyphene also comes as a tab combined with acetaminophen which is called Darvocet or Wygesic and is a 100 mg tab. Patients may take 100 mg q4-6h as needed for pain

May have central nervous system side effects including sedation, dizziness, light-headedness.  Some patients have GI upset with nausea or vomiting

This is a milder narcotic and is often the next step utilized after patients are not controlled with acetaminophen alone.  Since it is a narcotic, it may be constipating and precautions such as are mentioned with Tylenol with codeine may be required with propoxyphene. Since this medication is a narcotic (opioid), it may lead to physical dependence, if used in excess. It should be used in caution with anybody who will be operating a motor vehicle or heavy machinery.

tramadol

Ultram

50 mg one or two up to four times per day. For moderate to severe pain, start 25 mg per day and then increase by 25 mg every three days until a dosage of 25 mg QID is acheived. Then, if necessary, increase by 50 mg every three days, up to 200 mg per day dose. Then, if needed, may go up to a maximum of 400 mg per day, except in patients over 75 years of age where maximum is 300 mg per day.

Central nervous system side-effect with some sedation, dizziness, headache.  Also may have GI side-effects with nausea.  There is an increased incidence of seizures especially in patients with a history of prior seizure disorder.  It may affect kidney function or liver function which requires monitoring

Tramadol offers another way to control pain in a less potentially addicting manner, but the patient needs to be monitored for all the various side-effects mentioned. Since this medication is a narcotic (opioid), it may lead to physical dependence if used in excess. It should be used in caution with anybody who will be operating a motor vehicle or heavy machinery

Usual dosage is 5 to 10 mg q4h for pain.  Some patients may need higher doses with 15 to 20 mg every four to six hours for the most severe degrees of pain

Central nervous system side-effects with headaches, dizziness, sedation, constipation (secondary to decreased motility), difficulty with emptying bladder, depression of the respiratory center with higher doses, rash with itching of the skin. The ibuprofen component of Vicoprofen may cause gastrointestinal irritation in addition to the side-effects of hydrocodone.  All of these various types of hydrocodone may cause dependence

This medication may be used to control the pain in the most severe forms of arthritis or with intractable neck or back pain. Since this medication is a narcotic (opioid), it may lead to physical dependence. It should be used in caution with anybody who will be operating a motor vehicle or heavy machinery

Percocet

Usually one tablet qid, up to two tablets qid for the most severe type of pain

Central nervous system effects with sedation, dizziness, light-headedness, GI upset with nausea and vomiting or constipation, skin rash, itching of the skin

Patients may become dependent on this medication.  Need to use carefully in elderly patients or patients with pulmonary disease as it may depress the respiratory center.  This is one of the stronger pain medications available and should be used with caution. It should be used in caution with anybody who will be operating a motor vehicle or heavy machinery

oxycodone hydrochloride 4.5 mg plus oxycodone terephthalate 0.38 mg plus aspirin 325 mg

Percodan

Usually one tablet qid up to two tablets at a time for more severe pain

Central nervous system effects with light-headedness, sedation, dizziness, also GI effects with nausea, vomiting, constipation, also itching of the skin

Patients who have allergy to aspirin would have a problem with Percodan because of the fact that it does contain the equivalent of one regular aspirin in it.  It may cause drug dependence.  It should be used in caution with anybody who will be operating a motor vehicle or heavy machinery

One every four hours as needed for pain

Constipation related to codeine, sedation, light-headedness, dizziness related to butalbital, GI upset or hypersensitivity secondary to aspirin

  It should be used in caution with anybody who will be operating a motor vehicle or heavy machinery

fentanyl patch

Duragesic patch

25, 50, 75 or 100 mcg/hour

GI symptoms with nausea, vomiting, constipation, dry mouth, central nervous system side-effects with sedation, weakness, confusion.  May depress the respiratory center, increased sweating, problems with urinary retention, headache

(See Original Feature Article on Duragesic Patch on our site).  Fentanyl is an opioid and can cause dependence on it.  Patients who have trouble tolerating oral medications may do well with a transdermal patch with this unique delivery system through the skin. It should be used in caution with anybody who will be operating a motor vehicle or heavy machinery

oxycodone hydrochloride controlled release tablets

Oxycontin

10 mg q12h up to as much as 240 mg per day

Constipation, nausea, vomiting, central nervous system side-effects with sedation, dizziness, headaches, also sweating, dry mouth, weakness, itching of the skin

Higher dosages are needed for severe cancer pain and the most severe forms of intractable neck and back pain, used in lower dosages with osteoarthritis with success especially in patients with pain from end-stage disease with bone on bone. Since this medication is a narcotic (opioid), it may lead to physical dependence. It should be used in caution with anybody who will be operating a motor vehicle or heavy machinery

oxycodone hydrochloride immediate release capsules

Oxy-IR

Similar to Oxycontin with central nervous system side-effects, nausea, vomiting, itching of the skin

The immediate release form of oxycodone may be used for "rescue" treatment for any breakthrough pain not controlled on OxyContin or other long acting narcotic pain medications. Since this medication is a narcotic (opioid), it may lead to physical dependence. It should be used in caution with anybody who will be operating a motor vehicle or heavy machinery

pentazocine hydrochloride 25 mg plus acetaminophen 650 mg

Talacen

One po q4h up to six per day

Central nervous system side-effects with dizziness, light-headedness, sedation, headache, confusion, visual blurring, also increased sweats, GI symptoms with nausea, vomiting

It does contain a sulfite that might create problems with patients who are allergic to it.  Occasionally patients will get hallucinations after taking Talacen. It should be used in caution with anybody who will be operating a motor vehicle or heavy machinery

pentazocine 12.5 mg plus aspirin 25 mg

Talwin

Two Caplets tid or qid

Central nervous system side-effects with headaches, sedation, light-headedness and dizziness, hallucinations, GI problems with nausea, vomiting, visual blurring, sweating

  It should be used in caution with anybody who will be operating a motor vehicle or heavy machinery

pentazocine 50 mg plus naloxone hydrochloride .5 mg

Talwin Nx

Central nervous system side-effects with headaches, dizziness, light-headedness, sedation, confusion, increased sweating, nausea, vomiting, constipation

The naloxone at this dosage is simply in this tablet in case this medicine is abused and taking intravenously instead of orally.  The naloxone decreases the potential for abuse as it has an antagonist type action to the pentazocine. It should be used in caution with anybody who will be operating a motor vehicle or heavy machinery

butorphanol tartrate nasal spray

Stadol NS

One spray in one nostril (equivalent to 1 mg q3-4h increasing to 2 mg with each dose if absolutely necessary)

Sedation, dizziness, nausea, vomiting, nasal congestion from the spray, insomnia, fatigue, constipation, dry mouth, nausea, vomiting, loss of appetite

  It should be used in caution with anybody who will be operating a motor vehicle or heavy machinery

meperidine hydrochloride

Demerol

50 to 150 mg q4h

Central nervous system side-effects with dizziness, light-headedness, sedation, also sweating, nausea, vomiting, constipation, decreased blood pressure, problems with emptying bladder, itching of skin

This is not commonly used in rheumatic diseases because of the drug dependence that may occur with abuse. It should be used in caution with anybody who will be operating a motor vehicle or heavy machinery

hydromorphone hydrochloride

Dilaudid

2 mg q4-6h orally up to 4 mg with more severe pain

Central nervous system side-effects, fatigue, drowsiness, dizziness, depression of the respiratory center

This medicine is only reserved for patients with most severe pain especially because of its risk of dependence and abuse. It should be used in caution with anybody who will be operating a motor vehicle or heavy machinery

morphine sulfate controlled release

MS Contin 15, 30, 60 and 100 mg tablets

MS IR oral capsules 15 or 30 mg capsules and tablets

Find proper dosage by starting with immediate release oral morphine q4-6h and then converting to MS Contin on a q12h dosage or q8h dosage.  May start with 15 mg of MS Contin q12h or tid or may use 30 mg MS Contin for patients with a higher total requirement taking it q12h or tid

5 to 30 mg q4h

Constipation, central nervous system side-effects, dizziness, light-headedness, sedation, GI symptoms with nausea, vomiting, increased sweating, depression of the respiratory center

Central nervous system side-effects with dizziness, light-headedness, sedation, also nausea, vomiting, increased sweating, constipation

Potential for dependence on morphine, also withdrawal symptoms may occur with abrupt discontinuation of this medicine. It should be used in caution with anybody who will be operating a motor vehicle or heavy machinery

oxycodone 5 mg plus acetaminophen 500 mg

Tylox

One q6h

Central nervous system side-effects with dizziness, sedation, light-headedness, also nausea, vomiting and constipation, also rash, itching of the skin, respiratory depression

This medicine does have a sulfite in it, so allergic reactions to this may occur.  Also patients may develop a drug dependence problem. It should be used in caution with anybody who will be operating a motor vehicle or heavy machinery

oxycodone 5 mg

Roxicodone

5 to 30 mg q4h

Central nervous system side-effects with dizziness, sedation, light-headedness, nausea, vomiting, itching of the skin, rash

Respiratory depression may occur with this medication. Since this medication is a narcotic (opioid), it may lead to physical dependence. It should be used in caution with anybody who will be operating a motor vehicle or heavy machinery