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: Opioid

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Codeine (2)

None (12) · (multiple, generic dominant) (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) · Alfenta (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) · Darvon (1) · Demerol (1) · Dilaudid (1) · Dolophine (1) · Duragesic (1) · Heroin (1) · Imitrex (oral, injectable, nasal), Tosymra (nasal spray), Onzetra Xsail (nasal powder), Zembrace SymTouch (low-dose autoinjector), Sumavel DosePro (needle-free SC) (1) · Indocin (oral, IV, suppository), Tivorbex (low-dose), Indo-Lemmon (1) · Krokodil (1) · Maxalt (tablet), Maxalt-MLT (orally disintegrating tablet) (1) · Mobic, Vivlodex (lower-dose capsules), Anjeso (IV) (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) · Nubain (1) · Nucynta (1) · Nurtec ODT (1) · O-DSMT (1) · Opana (1) · OxyContin (ER), Roxicodone (IR), Oxaydo (IR abuse-deterrent), Xtampza ER (abuse-deterrent ER) (1) · Stablon (1) · Stadol (1) · Suboxone (1) · Sufenta (1) · Talwin (1) · Ultiva (1) · Ultram (IR), Ultram ER, ConZip ER (1) · Vicodin (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)

None (31) · 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) · Adult: 15–60 mg every 4 hours as needed. (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) · 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) · 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)

None (31) · 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) · 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) · Tablet (15, 30, 60 mg); oral solution; combination products (with [[Acetaminophen|acetaminophen]] or ibuprofen). (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)

None (31) · 15 mg/day (oral); 30 mg IV once daily (Anjeso) (1) · 150 mg/day (oral); use lowest effective dose for shortest duration per FDA NSAID class guidance (1) · 1500 mg/day (Rx); 660 mg/24h (OTC, without provider direction) (1) · 200 mg/day (oral); 12 mg/day (SC); 40 mg/day (nasal spray); 44 mg/day (Onzetra) (1) · 200 mg/day (typical adult oral) (1) · 30 mg/24 hours (1) · 3200 mg/day (Rx); 1200 mg/day (OTC, without provider direction) (1) · 360 mg/day (1) · 400 mg/day (IR, adult); 300 mg/day (ER); 300 mg/day in elderly >75 years (1) · 400 mg/day for chronic indications; higher for short-term acute pain (1) · 4000 mg/day (analgesic) (1) · 75 mg per dose; one dose per 24 hours (acute); one dose every other day (preventive) (1) · No fixed ceiling; titrate to clinical effect and tolerability with CDC opioid prescribing guidance constraints on morphine-milligram-equivalent (MME) totals (2)

None (31) · epidural (1) · intramuscular (1) · intranasal (1) · intrathecal (1) · intravenous (2) · intravenous (Caldolor (1) · intravenous (PDA closure only) (1) · NeoProfen) (1) · Oral (12) · Oral (sublingual disintegration) (1) · oral powder (Cambia for migraine) (1) · PO (only formulation marketed in the US). (1) · rectal (3) · subcutaneous (2) · topical (1) · transdermal (1)

None (31) · 1-2 hours for migraine relief (1) · 10 minutes (SC); 15-30 minutes (nasal); 30-60 minutes (oral) (1) · 10-30 minutes (IR) (1) · 30 minutes for migraine relief (1) · 30-60 minutes (2) · 30-60 minutes (IR) (1) · 30-60 minutes (oral) (1) · 30-60 minutes (oral); rapid relief in acute gout (1) · 30-60 minutes (oral); slower for topical (1) · 30–60 min (PO) (1) · 5-10 minutes (IV); 30 minutes (oral IR); slower for ER and rectal (1) · Analgesic effect within hours; full anti-inflammatory effect over 1-2 weeks (1) · Antiplatelet effect within 30-60 minutes; analgesic effect 30-60 minutes (1)

None (31) · '''Antiplatelet effect lasts the platelet's lifetime (~7-10 days)''' due to irreversible COX-1 acetylation; analgesic 4-6 hours (1) · 12-24 hours (1) · 2-4 hours; headache recurrence rate ~20-30% within 24 hours (1) · 24 hours (once-daily dosing supported by long half-life) (1) · 3-5 hours (IR); 8-24 hours (ER); 12-24 hours (epidural / intrathecal) (1) · 4-6 hours (1) · 4-6 hours (IR); 12 hours (ER) (1) · 4-6 hours (IR); 24 hours (ER) (2) · 4-6 hours; headache recurrence is common (1) · 4–6 hours (1) · 6-8 hours (IR oral); 12-24 hours (ER) (1) · 8-12 hours (the long-duration feature relative to ibuprofen) (1) · ~48 hours of headache freedom (1)

None (31) · 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; risk of neonatal opioid withdrawal with chronic use; UM-mother breastfeeding contraindicated. (1) · Chronic third-trimester exposure produces neonatal opioid withdrawal syndrome and respiratory depression at delivery.[[[Pharmacopedia:Citation needed|citation needed]]] (3) · Limited human data.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Limited human data; pregnancy registry data have been broadly reassuring across the triptan class.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Limited human data; pregnancy registry data have been broadly reassuring relative to baseline malformation rates.[[[Pharmacopedia:Citation needed|citation needed]]] (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)

None (31) · US Schedule II (single-entity); Schedule III–V (combination products by content). (1) · [[USLegal:Over-the-counter|OTC]] in the US at ≤200 mg per tablet / ≤1200 mg/day; [[USLegal:Prescription only|Rx-only]] at higher strengths and indications (1) · [[USLegal:Over-the-counter|OTC]] in US at all standard strengths (1) · [[USLegal:Over-the-counter|OTC]] in US at ≤220 mg/tablet and ≤660 mg/day; [[USLegal:Prescription only|Rx-only]] at higher strengths (1) · [[USLegal:Prescription only|Rx-only]] for oral and most topical formulations in US; Voltaren Arthritis Pain 1% gel switched to [[USLegal:Over-the-counter|OTC]] in 2020 (1) · [[USLegal:Prescription only|Rx-only]] in US (6) · [[USLegal:Schedule II|Schedule II controlled substance]] in US; WHO essential medicine'"`UNIQ--ref-00000022-QINU`"' (1) · [[USLegal:Schedule II|Schedule II controlled substance]] in US'"`UNIQ--ref-0000001F-QINU`"' (1) · [[USLegal:Schedule IV|Schedule IV controlled substance]] in US (federally scheduled 2014); some states schedule higher'"`UNIQ--ref-0000001F-QINU`"' (1)