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Medicines (732)

Medicines > onset

: 30-60 minutes

or BP effect within 1-2 weeks

or ~1 hour

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Butalbital / Acetaminophen / Caffeine (1) · Butalbital / Aspirin / Caffeine (1) · Celecoxib (1) · Cetirizine (1) · Codeine / Acetaminophen (1) · Cyclobenzaprine (1) · Cyproheptadine (hydrochloride) (1) · Insulin degludec (1) · Irbesartan (1) · Levocetirizine (1) · Loperamide (1) · Meclizine (1) · Naproxen (sodium; free acid) (1) · Pseudoephedrine (hydrochloride; sulfate) (1) · Telmisartan (1) · Tizanidine (1) · Tramadol / Acetaminophen (1)

Aleve (OTC), Naprosyn (Rx), Anaprox (Rx), Naprelan (ER), EC-Naprosyn (enteric-coated), Vimovo (with esomeprazole) (1) · Antivert (Rx), Bonine (OTC), Dramamine Less Drowsy (OTC) (1) · Avapro (1) · Celebrex (oral capsules), Elyxyb (oral solution, for acute migraine) (1) · Fioricet, Esgic; with codeine as Fioricet with Codeine (Schedule III) (1) · Fiorinal; with codeine as Fiorinal with Codeine (Schedule III) (1) · Flexeril (IR; brand discontinued in US, generic widely available), Amrix (ER) (1) · Imodium, Imodium A-D (1) · Micardis (1) · Periactin (US brand discontinued; generic widely available) (1) · Sudafed (IR, 12-hour, 24-hour); many combination products including Claritin-D, Allegra-D, Zyrtec-D, Mucinex-D (1) · Tresiba (1) · Tylenol with Codeine #3 (30 mg codeine), Tylenol #4 (60 mg codeine), Capital with Codeine, Phenaphen with Codeine (1) · Ultracet, Tramacet (1) · Xyzal, Xyzal Allergy 24HR (OTC) (1) · Zanaflex (1) · Zyrtec, Zyrtec-D (1)

None (9) · '"`UNIQ--vote-00000013-QINU`"' Anticholinergic burden (dry mouth, blurred vision, urinary retention, cognitive effects) is the principal adverse-event concern and the basis for Beers-list cautions in elderly patients'"`UNIQ--ref-00000014-QINU`"'. (1) · '"`UNIQ--vote-00000017-QINU`"' Anticholinergic and sedating, with the standard first-generation antihistamine Beers-list concerns in elderly patients'"`UNIQ--ref-00000018-QINU`"'. (1) · '"`UNIQ--vote-00000391-QINU`"' Minimal CYP metabolism; mostly renally cleared unchanged. Cetirizine is the active racemate; levocetirizine is the active R-enantiomer marketed separately'"`UNIQ--ref-00000392-QINU`"'. (1) · '"`UNIQ--vote-0000083E-QINU`"' CYP2C9 substrate; no clinically active metabolites. The IDNT trial established renoprotection in diabetic nephropathy independent of BP lowering, contributing to the ARB class indication in T2DM with proteinuria'"`UNIQ--ref-0000083F-QINU`"'. (1) · '"`UNIQ--vote-00000950-QINU`"' Mostly renally cleared unchanged; dose-reduce in renal impairment. Like cetirizine, retains slightly more sedation than fexofenadine in some users'"`UNIQ--ref-00000951-QINU`"'. (1) · '"`UNIQ--vote-00000AEA-QINU`"' The 24-hour half-life supports once-daily dosing with consistent overnight BP control. Largely hepatically cleared (~98% biliary); no significant renal clearance dependence'"`UNIQ--ref-00000AEB-QINU`"'. (1) · '"`UNIQ--vote-00001356-QINU`"' Binds the same insulin receptor as endogenous insulin with comparable mitogenic-to-metabolic ratio'"`UNIQ--ref-00001357-QINU`"'. (1) · '"`UNIQ--vote-00001513-QINU`"' The combination with acetaminophen provides additive non-opioid analgesia and lowers required codeine dose. CYP2D6 PGx is one of the most clinically actionable in current pharmacology; CPIC supports genotype-guided opioid selection'"`UNIQ--ref-00001514-QINU`"'. (1)

1-2 capsules (50 mg butalbital / 325 mg acetaminophen / 40 mg caffeine each) PO every 4 hours as needed; maximum 6 capsules/d (1) · 1-2 capsules (50 mg butalbital / 325 mg aspirin / 40 mg caffeine each) PO every 4 hours as needed; maximum 6 capsules/d (1) · 1-2 tablets (15-60 mg codeine, 300-600 mg acetaminophen) PO every 4-6 hours as needed (1) · 10 mg PO once daily (5 mg in older adults or if sedation occurs) (1) · 150 mg PO once daily; titrate to 300 mg if needed (1) · 2 mg PO every 6-8 hours; titrate by 2-4 mg per dose every 1-4 days; maximum single dose 16 mg, maximum daily dose 36 mg (1) · 2 tablets (75 mg tramadol / 650 mg acetaminophen) PO every 4-6 hours as needed; maximum 8 tablets/day for ≤5 days (1) · 4 mg PO initially, then 2 mg after each loose stool, '''not to exceed 16 mg/d''' (8 mg OTC); chronic-use lower (1) · 40 mg PO once daily; titrate to 80 mg (1) · 5 mg PO once daily in the evening (1) · Allergy: 4 mg PO TID. Serotonin syndrome: 12 mg loading dose PO or by nasogastric tube, then 2 mg every 2 hours until clinical improvement. Appetite stimulation: 2-4 mg PO TID-QID (1) · IR 5 mg PO TID; titrate to 10 mg TID if needed. Amrix ER 15 mg PO once daily. Off-label insomnia / fibromyalgia: 5-10 mg PO at bedtime (1) · IR: 60 mg PO every 4-6 hours. 12-hour ER: 120 mg PO every 12 hours. 24-hour ER: 240 mg PO once daily. Pediatric: weight-based (1) · Motion sickness: 25-50 mg PO 1 hour before travel, repeat every 24 hours as needed. Vertigo: 25-100 mg/day divided (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) · ~10 units SC at the same time daily, or 0.1-0.2 units/kg/d; titrate by fasting glucose (1)

100 U/mL (FlexTouch pen) and 200 U/mL (FlexTouch pen, higher-dose convenience) (1) · 2 mg capsules and tablets; 1 mg/5 mL oral solution; combined with simethicone (Imodium Multi-Symptom) (1) · 20, 40, 80 mg tablets (1) · 5 mg tablets; 2.5 mg/5 mL oral solution; OTC (1) · 5 mg, 10 mg tablets; 5 mg, 10 mg chewables; 1 mg/mL oral syrup; OTC (1) · 50/325/40 mg capsules (1) · 50/325/40 mg capsules and tablets; oral solution (1) · 75, 150, 300 mg tablets (1) · Capsules 50, 100, 200, 400 mg; Elyxyb oral solution 25 mg/mL (1) · Codeine/acetaminophen 15/300 (#2 historical), 30/300 (#3), 60/300 (#4) mg tablets; 12/120 mg/5 mL elixir (1) · IR tablets 30, 60 mg; 12-hour ER tablets 120 mg; 24-hour ER tablets 240 mg; oral liquid; multiple combination products with antihistamines, NSAIDs, or expectorants (1) · IR tablets 5, 7.5, 10 mg; Amrix ER capsules 15, 30 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 12.5, 25 mg; chewable tablets 25 mg (1) · Tablets 2, 4 mg; capsules 2, 4, 6 mg ('''capsules and tablets are not bioequivalent''': capsules slower with food; tablets faster on empty stomach) (1) · Tablets 4 mg; oral syrup 2 mg/5 mL (1) · Tramadol/acetaminophen 37.5/325 mg tablets (1)

10 mg/d (adults) (1) · 100 mg/day (vertigo) (1) · 1500 mg/day (Rx); 660 mg/24h (OTC, without provider direction) (1) · 16 mg/d (8 mg/d OTC) (1) · 240 mg/day (1) · 30 mg/day (IR or ER) (1) · 300 mg/d (1) · 32 mg/day adult; weight-based pediatric ceiling (1) · 36 mg/day in three divided doses; single dose maximum 16 mg (1) · 400 mg/day for chronic indications; higher for short-term acute pain (1) · 5 mg/d (adults) (1) · 6 capsules/d (300 mg butalbital, 1950 mg acetaminophen, 240 mg caffeine) (1) · 6 capsules/d (300 mg butalbital, 1950 mg aspirin, 240 mg caffeine) (1) · 8 tablets/d (300 mg tramadol / 2600 mg acetaminophen); 5-day duration limit per label (1) · 80 mg/d (1) · Acetaminophen 4 g/d absolute; codeine 240-360 mg/d typical practical limit (1) · Titrated to glucose; no fixed ceiling (1)

Oral (16) · Subcutaneous (never IV; not for use in insulin pumps) (1)

12-24 hours (1) · 12-24 hours (IR); 24 hours (Amrix ER) (1) · 12-24 hours (long for an antihistamine) (1) · 24 hours (4) · 3-6 hours per dose (1) · 4-6 hours (4) · 4-6 hours (IR); 12-24 hours (ER) (1) · 6-8 hours (1) · 8-12 hours (1) · 8-12 hours (the long-duration feature relative to ibuprofen) (1) · >42 hours per dose (effectively flat once at steady state) (1)

42-58% (oral; dose-dependent)'"`UNIQ--ref-00000AEF-QINU`"' (1) · 60-80% (oral; not significantly affected by food)'"`UNIQ--ref-00000843-QINU`"' (1) · Butalbital well-absorbed; aspirin 50-75%; caffeine ~100%'"`UNIQ--ref-000015B8-QINU`"' (1) · Butalbital well-absorbed; caffeine ~100%; acetaminophen 85-98%'"`UNIQ--ref-000015A0-QINU`"' (1) · Codeine ~60% (oral); acetaminophen 85-98%'"`UNIQ--ref-00001518-QINU`"' (1) · High (oral); not significantly affected by food'"`UNIQ--ref-00000397-QINU`"' (1) · Tramadol ~75% (oral); acetaminophen 85-98%'"`UNIQ--ref-00001531-QINU`"' (1) · ~0.3% (oral; extensive first-pass via CYP3A4 and P-glycoprotein-mediated efflux at the intestinal and blood-brain barriers limit systemic and CNS exposure at therapeutic doses)'"`UNIQ--ref-00000FD3-QINU`"' (1) · ~100% from subcutaneous depot (1) · ~25% (oral)'"`UNIQ--ref-00000019-QINU`"' (1) · ~33-55% (IR); reduced by food'"`UNIQ--ref-0000001B-QINU`"' (1) · ~40% (oral); food and formulation substantially alter the absorption profile'"`UNIQ--ref-0000001E-QINU`"' (1) · ~85-90% (oral; not significantly affected by food)'"`UNIQ--ref-00000955-QINU`"' (1) · ~90% (oral, low first-pass)'"`UNIQ--ref-0000001C-QINU`"' (1) · ~95% (oral)'"`UNIQ--ref-0000001F-QINU`"' (1) · ~95% (oral)'"`UNIQ--ref-0000002A-QINU`"' (1) · ~99% (oral)'"`UNIQ--ref-0000002A-QINU`"' (1)

None (1) · '''[[USLegal:Behind-the-counter|Behind-the-counter]] in US''' under the Combat Methamphetamine Epidemic Act 2005: purchase restricted to ≤3.6 g/day and ≤9 g/30 days, with photo ID, logbook signature, and quantity logging required. Several states schedule higher than federal (1) · OTC in US (3) · [[USLegal:Over-the-counter|OTC]] as Bonine and Dramamine Less Drowsy; [[USLegal:Prescription only|Rx-only]] as Antivert (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]] in US (5) · [[USLegal:Prescription only|Rx-only]] in US. Not a controlled substance, distinguishing it from carisoprodol among muscle-spasm options'"`UNIQ--ref-0000001F-QINU`"' (1) · [[USLegal:Prescription only|Rx-only]] in US. Not a controlled substance, distinguishing it from the carisoprodol alternative for muscle spasm'"`UNIQ--ref-0000001C-QINU`"' (1) · [[USLegal:Schedule III|Schedule III controlled substance]] in US (Fiorinal is scheduled federally; Fioricet with acetaminophen is unscheduled federally despite identical butalbital content, a regulatory quirk) (1) · [[USLegal:Schedule III|Schedule III controlled substance]] in US. '''Contraindicated in children <12''' for any indication and in any age post-tonsillectomy/adenoidectomy (FDA 2017 black-box advisory)'"`UNIQ--ref-00001519-QINU`"' (1) · [[USLegal:Schedule IV|Schedule IV controlled substance]] in US (tramadol was reclassified from non-controlled to Schedule IV in 2014 after recognition of dependence risk) (1)