Pain management

Question 1

1. Which analgesic should I prescribe for people 16 years of age and older?

A stepwise strategy for managing mild-to-moderate pain in adults is recommended:

Answer 1

Step 1 - paracetamol max dose of 1g/4x/day

Step 2 - substitute paracetamol with low-dose ibuprofen 400mg/3x/day. Max of 2.4g/day

NSAID max therapeutic dose (e.g. codeine 60mg every 4-6 hrs; max 240mg/day)

Step 3 - add paracetamol 1g/4xday to low-dose ibuprofen 400mg/3xdays (max 2.4g/day)

If the person is unable to tolerate an NSAID, add paracetamol to a weak opioid.

Step 4 - continue paracetamol 1g/4x/day. Replace the ibuprofen with an alternative NSAID (naproxen 250mg - 500mg 2x/day).

Step 5 - start a full therapeutic dose of a weak opioid (such as codeine 60 mg <= 4xday; max 240 mg daily) in addition to full-dose paracetamol (1g/4xday) and/or an NSAID.

Cytochrome P450 2D6