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Medicines > classes : Dissociative or Sedative-hypnotic or [[:Category:Analgesics|Analgesic]]

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generic:
brand:
None (26) · (none, never marketed) (1) · Advil, Motrin, IBU, Caldolor (IV), NeoProfen (neonatal IV) (1) · Aleve (OTC), Naprosyn (Rx), Anaprox (Rx), Naprelan (ER), EC-Naprosyn (enteric-coated), Vimovo (with esomeprazole) (1) · Bayer, Ecotrin, Bufferin, St. Joseph (low-dose 81 mg), Excedrin (with acetaminophen and caffeine) (1) · Celebrex (oral capsules), Elyxyb (oral solution, for acute migraine) (1) · Dalmane (1) · Doral (1) · Doriden (1) · DXM (1) · DXO (1) · Halcion (1) · Hetlioz (1) · Imitrex (oral, injectable, nasal), Tosymra (nasal spray), Onzetra Xsail (nasal powder), Zembrace SymTouch (low-dose autoinjector), Sumavel DosePro (needle-free SC) (1) · Imovane (1) · Indocin (oral, IV, suppository), Tivorbex (low-dose), Indo-Lemmon (1) · Lunesta (1) · Maxalt (tablet), Maxalt-MLT (orally disintegrating tablet) (1) · Mobic, Vivlodex (lower-dose capsules), Anjeso (IV) (1) · Mogadon (1) · MS Contin (ER), Kadian (ER), Avinza (ER), Roxanol (IR oral solution), Duramorph (epidural / IT), Astramorph (IV), Infumorph (intrathecal pump), MorphaBond (IR abuse-deterrent) (1) · Nembutal (1) · Nurtec ODT (1) · OxyContin (ER), Roxicodone (IR), Oxaydo (IR abuse-deterrent), Xtampza ER (abuse-deterrent ER) (1) · Placidyl (1) · ProSom (1) · Quaalude (1) · Restoril (1) · Rohypnol (1) · Rozerem (1) · Seconal (1) · Sonata (1) · Spravato (1) · THIP (1) · Ultram (IR), Ultram ER, ConZip ER (1) · Versed (1) · Voltaren (IR oral, topical gel), Cataflam (potassium IR), Cambia (oral powder, migraine), Zorvolex (low-dose), Pennsaid (topical 2% solution), Flector (transdermal patch), Solaraze (3% gel for actinic keratosis) (1) · Xyrem (1)
classes: (Click arrow to add another value)
mechanism:
None (15) · Active metabolite of DXM; NMDA antagonist (1) · Contains salvinorin A (1) · Extremely potent GABAA positive allosteric modulator (1) · GABAA positive allosteric modulator (15) · GABAA positive allosteric modulator (non-benzodiazepine) (3) · GABAA positive allosteric modulator; very long half-life (1) · GABAA potentiator (1) · GABAA potentiator and direct activator (2) · GABAB agonist; GHB receptor agonist (1) · Kappa-opioid agonist; NMDA antagonist; SERT/DAT/NET inhibitor (1) · Kappa-opioid receptor agonist (1) · Melatonin receptor agonist (2) · NMDA antagonist (3) · NMDA antagonist; endogenous opioid releaser (1) · NMDA antagonist; fluorinated ketamine analogue (1) · NMDA antagonist; kappa-opioid agonist (1) · NMDA antagonist; ketamine analogue (1) · NMDA antagonist; more stimulating than PCP (1) · NMDA antagonist; opioid agonist (1) · NMDA antagonist; potent opioid agonist (1) · NMDA antagonist; SERT inhibitor; sigma-1 agonist (1) · NMDA antagonist; sigma receptor agonist (2) · NMDA antagonist; sigma receptor agonist; dopaminergic (1) · NMDA antagonist; sigma-1 agonist; serotonin reuptake inhibitor (1) · Positive allosteric modulator of the GABA<sub>A</sub> receptor at the benzodiazepine binding site; increases frequency of Cl<sup>−</sup> channel opening, producing anxiolytic, sedative, hypnotic, anticonvulsant, and skeletal-muscle relaxant effects. (1) · Selective GABAA agonist (extrasynaptic delta subunit) (1) · '"`UNIQ--vote-00000019-QINU`"' Once-daily dosing is a clinical advantage over short-half-life NSAIDs'"`UNIQ--ref-0000001A-QINU`"'. (1)
uses:
None (48) · No approved medical problem. Encountered as a designer/research benzodiazepine and, increasingly, as an adulterant in illicit opioid supplies. (1) · Treatment-resistant depression (TRD) in adults, as adjunct to oral antidepressant (FDA-approved March 2019). Depressive symptoms in adults with MDD with acute suicidal ideation or behavior (FDA-approved Aug 2020). (1) · '"`UNIQ--vote-00000011-QINU`"' (1) · '"`UNIQ--vote-00000013-QINU`"', '"`UNIQ--vote-00000014-QINU`"' (2) · '"`UNIQ--vote-00000019-QINU`"', '"`UNIQ--vote-0000001A-QINU`"', '"`UNIQ--vote-0000001B-QINU`"', '"`UNIQ--vote-0000001C-QINU`"' (2) · '"`UNIQ--vote-0000001B-QINU`"', '"`UNIQ--vote-0000001C-QINU`"', '"`UNIQ--vote-0000001D-QINU`"', '"`UNIQ--vote-0000001E-QINU`"', '"`UNIQ--vote-0000001F-QINU`"' (2) · '"`UNIQ--vote-0000001F-QINU`"', '"`UNIQ--vote-00000020-QINU`"', '"`UNIQ--vote-00000021-QINU`"', '"`UNIQ--vote-00000022-QINU`"', '"`UNIQ--vote-00000023-QINU`"', '"`UNIQ--vote-00000024-QINU`"', '"`UNIQ--vote-00000025-QINU`"' (2) · '"`UNIQ--vote-0000001F-QINU`"', '"`UNIQ--vote-00000020-QINU`"', '"`UNIQ--vote-00000021-QINU`"', '"`UNIQ--vote-00000022-QINU`"', '"`UNIQ--vote-00000023-QINU`"', '"`UNIQ--vote-00000024-QINU`"', '"`UNIQ--vote-00000025-QINU`"', '"`UNIQ--vote-00000026-QINU`"' (1) · '"`UNIQ--vote-00000021-QINU`"', '"`UNIQ--vote-00000022-QINU`"', '"`UNIQ--vote-00000023-QINU`"', '"`UNIQ--vote-00000024-QINU`"', '"`UNIQ--vote-00000025-QINU`"', '"`UNIQ--vote-00000026-QINU`"', '"`UNIQ--vote-00000027-QINU`"', '"`UNIQ--vote-00000028-QINU`"' (3)
starting dose:
None (48) · 200-400 mg PO every 4-6 hours as needed. OTC max 1200 mg/day without provider direction; prescription max 3200 mg/day divided (1) · 5-10 mg PO at migraine onset; may repeat after 2 hours, maximum 30 mg/24 hours (1) · 7.5 mg PO once daily; titrate to 15 mg daily if needed. Vivlodex 5 mg PO once daily, max 10 mg (1) · Acute gout: 50 mg PO TID until symptom relief, then taper; maximum 200 mg/day for 3-5 days. Rheumatoid arthritis / osteoarthritis: 25-50 mg PO BID-TID. Patent ductus arteriosus: 0.2 mg/kg IV, then 0.1-0.2 mg/kg every 12-24 hours for 2 doses (1) · Acute migraine: 75 mg PO at onset, maximum one dose per 24 hours. Preventive: 75 mg PO every other day (1) · Antiplatelet: 81 mg PO once daily. Acute MI/stroke: 162-325 mg chewed. Analgesic: 325-650 mg PO every 4-6 hours as needed (1) · Induction (TRD): 56 mg intranasal twice weekly × 4 weeks. Maintenance: 56-84 mg once weekly × 4 weeks, then 56-84 mg every 1-2 weeks. For acute suicidality: 84 mg twice weekly × 4 weeks. Administered under medical supervision in REMS-certified site. (1) · IR opioid-naive: 5-10 mg PO every 4-6 hours as needed. ER opioid-naive: '''10 mg PO every 12 hours (lowest available)'''; titrate slowly to clinical effect (1) · IR oral 50 mg PO TID or 75 mg BID. Voltaren 1% gel: apply 2-4 g to affected area QID. Pennsaid 2%: 40 drops to knee BID. Flector patch: every 12 hours (1) · IR oral: 15-30 mg every 4 hours as needed. ER opioid-naive: 15-30 mg every 12 hours. IV/IM/SC: 2-10 mg every 3-4 hours. Epidural / intrathecal: see surgical or palliative-care protocols (1) · IR: 25-50 mg PO every 4-6 hours as needed, titrate as tolerated. ER: 100 mg PO once daily, titrate by 100 mg every 5 days (1) · No medical dose. Active recreational doses reported in the 0.5–1.5 mg range (similar potency to alprazolam). (1) · Oral: 50-100 mg at migraine onset, may repeat in 2 hours if needed. SC: 6 mg, may repeat in 1 hour. Nasal: 5-20 mg per nostril, may repeat in 2 hours (1) · Osteoarthritis: 200 mg PO once daily or 100 mg BID. Rheumatoid arthritis: 100-200 mg PO BID. Acute pain: 400 mg loading, then 200 mg every 12 hours (1) · OTC: 220 mg PO every 8-12 hours, max 660 mg/24h. Rx: 250-500 mg PO BID. Acute gout: 750 mg loading then 250 mg every 8 hours (1)
preparations:
None (48) · 28 mg/device (each dose uses 2 devices) (1) · Capsules 25, 50 mg; ER capsules 75 mg; oral suspension 25 mg/5 mL; suppositories 50 mg; injection 1 mg/vial (PDA closure) (1) · Capsules 50, 100, 200, 400 mg; Elyxyb oral solution 25 mg/mL (1) · Illicit tablets ("bars"), powders, blotter, occasionally solutions. No pharmaceutical product exists. (1) · IR tablets 15, 30 mg; oral solution 10 mg/5 mL, 20 mg/mL, 100 mg/5 mL (concentrated); suppositories; ER tablets and capsules in multiple strengths; injectable 0.5-50 mg/mL (1) · IR tablets 25, 50 mg; ER tablets 100 mg; Cataflam IR 50 mg; Zorvolex 18, 35 mg; Voltaren gel 1%; Pennsaid 2% topical solution; Flector transdermal patch; Solaraze 3% gel; Cambia oral powder 50 mg (1) · IR tablets 5, 7.5, 10, 15, 20, 30 mg; IR oral solution 5 mg/5 mL; concentrated solution 20 mg/mL; OxyContin ER tablets 10, 15, 20, 30, 40, 60, 80 mg; Xtampza ER capsules (1) · IR tablets 50 mg; ER tablets 100, 200, 300 mg (Ultram ER, ConZip); oral solution 5 mg/mL; combination products with acetaminophen (Ultracet) (1) · Oral tablets 25, 50, 100 mg; SC injection 4, 6 mg autoinjector; needle-free SC 6 mg (Sumavel); nasal spray 5, 20 mg; nasal powder 22 mg (Onzetra Xsail); low-dose autoinjector 3 mg (Zembrace SymTouch) (1) · Orally disintegrating tablet 75 mg (1) · OTC tablets 220 mg; Rx tablets 250, 375, 500 mg; ER tablets 375, 500, 750 mg (Naprelan); oral suspension 125 mg/5 mL; enteric-coated tablets (EC-Naprosyn) (1) · Tablets 200, 400, 600, 800 mg; capsules 200 mg; oral suspension 100 mg/5 mL; chewable tablets 100 mg; injection 100 mg/mL (Caldolor) (1) · Tablets 5, 10 mg; ODT (Maxalt-MLT) 5, 10 mg (1) · Tablets 7.5, 15 mg (Mobic); capsules 5, 10 mg (Vivlodex); oral suspension 7.5 mg/5 mL; injection 30 mg/mL (Anjeso) (1) · Tablets 81 (low-dose), 325, 500, 650 mg; chewable 81 mg; enteric-coated tablets; effervescent tablets; suppositories (1)
pregnancy:
None (48) · Avoid from 20 weeks gestation onward per FDA's 2020 expanded NSAID warning (fetal renal dysfunction, oligohydramnios); contraindicated from 30 weeks (risk of premature ductus arteriosus closure)'"`UNIQ--ref-00000022-QINU`"' (1) · Avoid from 20 weeks gestation onward per FDA's 2020 expanded NSAID warning (fetal renal dysfunction, oligohydramnios); contraindicated from 30 weeks (risk of premature ductus arteriosus closure)'"`UNIQ--ref-00000028-QINU`"' (1) · Avoid from 20 weeks gestation onward per FDA's 2020 expanded NSAID warning (fetal renal dysfunction, oligohydramnios); contraindicated from 30 weeks (risk of premature ductus arteriosus closure)'"`UNIQ--ref-0000002B-QINU`"' (3) · Avoid from 20 weeks gestation onward per FDA's 2020 expanded NSAID warning; contraindicated from 30 weeks (risk of premature ductus arteriosus closure, which is paradoxically the basis of the neonatal PDA-closure indication)'"`UNIQ--ref-00000028-QINU`"' (1) · Avoid. Benzodiazepines are associated with neonatal sedation, floppy-infant syndrome, and withdrawal; teratogenic signal weak but non-zero. Designer benzo with no safety data, assume worst-case. (1) · Avoid; may cause fetal harm (1) · Chronic third-trimester exposure produces neonatal opioid withdrawal syndrome and respiratory depression at delivery.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (3) · Limited human data.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited human data; pregnancy registry data have been broadly reassuring across the triptan class.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited human data; pregnancy registry data have been broadly reassuring relative to baseline malformation rates.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Low-dose (81 mg) safe and indicated for preeclampsia prophylaxis after 12 weeks in high-risk patients per USPSTF; high-dose aspirin avoid third trimester due to premature ductus arteriosus closure and bleeding risk (1)

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