Non-opioid analgesics

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PARACETAMOL

Important: Therapy notes

MHRA advice: Intravenous paracetamol (Perfalgan ▼): risk of accidental overdose (December 2014) (www.gov.uk)

Risk Minimisation Materials: paracetamol 10mg/mL solution for infusion training poster 

  • Paracetamol caplets may be easier to swallow than standard tablets and are preferred by many patients. Caplets may be supplied on a prescription for paracetamol tablets.
  • The salt content of dispersible formulations of paracetamol and co-codamol may be unsuitable for some patients.

Important: Formulation and dosage details

Formulation:

TabletsOTC 500mg

Dosage:

Adults 50kg and over: 1 gram up to 4 times daily.
Consider dose reduction in patients with low body weight (less than 50kg), renal/hepatic impairment, chronic malnutrition, or chronic alcoholism to 15mg/kg/dose up to 4 times daily (to a maximum of 3 grams/day)

Important: Formulation and dosage details

Formulation:

Soluble tabletsOTC 500mg

Dosage:

Adults 50kg and over: 1 gram up to 4 times daily.
Consider dose reduction in patients with low body weight (less than 50kg), renal/hepatic impairment, chronic malnutrition, or chronic alcoholism to 15mg/kg/dose up to 4 times daily (to a maximum of 3 grams/day)

Important: Formulation and dosage details

Formulation:

Oral suspensionOTC 120mg/5mL, 250mg/5mL

Dosage:

Adults 50kg and over: 1 gram up to 4 times daily.
Consider dose reduction in patients with low body weight (less than 50kg), renal/hepatic impairment, chronic malnutrition, or chronic alcoholism to 15mg/kg/dose up to 4 times daily (to a maximum of 3 grams/day)

Important: Formulation and dosage details

Formulation:

SuppositoriesOTC 60mg, 120mg, 240mg, 500mg

Dosage:

Adults 50kg and over: 1 gram up to 4 times daily.
Consider dose reduction in patients with low body weight (less than 50kg), renal/hepatic impairment, chronic malnutrition, or chronic alcoholism to 15mg/kg/dose up to 4 times daily (to a maximum of 3 grams/day)

Important: Formulation and dosage details

Formulation:

Intravenous infusion 500mg/50mL, 1 gram/100mL

Dosage:

Adults 50kg and over: 1 gram up to 4 times daily.
Consider dose reduction in patients with low body weight (less than 50kg), renal/hepatic impairment, chronic malnutrition, or chronic alcoholism to 15mg/kg/dose up to 4 times daily (to a maximum of 3 grams/day)

Notes:

Note: Paracetamol infusion:

  • Is 100% bioavailable and there is a greater risk of toxicity so should only be prescribed where clinically indicated. Review the prescription regularly.
  • Should only be used when the patient is ‘nil by mouth’, or has swallowing difficulty which is not overcome by the use of suspension.
  • Must be given in lower doses to patients under 50kg.
  • Maximum daily dose must not exceed 3 grams in patient with renal/hepatic impairment, chronic malnutrition, chronic alcoholism.
  • Increase the minimum interval between each dose to 6 hours if creatinine clearance is less than 30mL/min.
  • Is more effective than paracetamol suppositories.

NEFOPAM

Important: Therapy notes

Can cause sympathomimetic and anticholinergic side-effects and is increasingly expensive.

Important: Formulation and dosage details

Formulation:

Tablets 30mg (s)

Dosage:

By mouth, in patients with renal impairment as an alternative to opioids and NSAIDs, start at 30mg up to 3 times daily.