PAIN DRUGS HANDBOOK TABLE
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DRUGS (Alphabetical Order)
Appendix 1: World Health Organization
Appendix 2: Drug Tables
Appendix 3: Infusion Tables
Appendix 4: Relative Potencies of
Appendix 5: Relative Potencies of Steroids
Appendix 6: Intravenous PCA
Appendix 7: Patient Controlled Analgesia Flow Sheet
Appendix 8: Relative Potencies of Opioids
Appendix 9: Epidural Analgesia Monitoring Orders
Appendix 10: Pain Rating Scales
Appendix 11: Multiplication Factors for Converting the
Daily Dose of a Prior Opioid to the Daily Dose of Oxycontin
Appendix 12: CPR Algorithms
Appendix 13: Pediatric CPR Algorithms
Appendix 14: Trade Name Table
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Pain Drug Handbook
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Preparation, Pharmacology, Pharmacokinetics
Principal Adverse Reactions
supplemental relief (in combination with opioids) of pain and muscle spasm in fibromyalgia, back, chronic, cancer and neuropathic pain; treatment of hypertension, migraine prophylaxis, treatment of opioid/alcohol withdrawal states; epidural/spinal analgesia; prolongation of duration of action of local anesthetics.
Premedication: PO 0.1-0.3 mg (3-5 mcg/kg)
Antihypertensive: Initial PO 0.05-0.1 mg twice daily (morning and bedtime).
Maintenance PO 0.05-0.2 mg two to four times daily.
Use lower doses in geriatric patients.
Migraine Prophylaxis PO 0.025-0.1 mg 2 or 3 times daily (Children 0.5-2 mcg/kg/day)
Detoxification PO 0.1-0.3 mg 3 or 4 times daily. Titrate to patient response and tolerance.
Hypertensive crisis: IV 0.15-0.3 mg over 5 minutes
Supplementation of Analgesia
PO 0.025-0.1 mg two to four times daily (0.05-0.4 mg/day)
Transdermal 0.1-0.3 mg/24hr. Replace systems every 7 days. Dosage adjustments may be made at weekly intervals. The transdermal system provides reliable delivery of clonidine for 7 days. Therapeutic plasma levels are achieved after 2-3 days. Therapeutic levels persist for about 8 hours following removal of the systems, then decline over several days.
IV bolus 0.1-0.2 mg (2-4 mcg/kg) over 5 minutes
infusion 0.05-0.1 mg/hr (1-2 mcg/kg/hr)
Epidural Analgesia: bolus: 100 -200 mcg [2-4 mcg/kg] Dilute in 10 mls (preservative free) NS. or Local Anesthetic
infusion: 10-40 mcg/hr (0.2-0.8 mcg/kg/hr)
Start infusion (conc. 2 mcg/ml) at 5 mls/hour and titrate to effect.
Epidural Anesthesia: bolus: 200 -500 mcg [4-10 mcg/kg] Dilute in 10 mls (preservative free) NS. or Local Anesthetic
Spinal Analgesia: bolus 15-100 mcg (0.3-2 mcg/kg)
infusion: 2-8 mcg/hr (0.04-0.16 mcg/kg/hr)
or 3 X bolus dose/24 hours
Brachial Plexus Block: Add 25-150 mcg (0.5-3 mcg/kg) clonidine to 40 mls Local Anesthetic.
Peripheral Nerve Block: Dilute clonidine in Local Anesthetic to concentration of 5 mcg/ml. Max dose of 100-150 mcg (0.5-1 mcg/kg) clonidine.
Intravenous Regional: Upper Extremities: 0.5-1 mcg/kg clonidine (Max dose of 100-150 mcg) diluted in 40-50 mls of Lidocaine 0.5% solution.
Lower Extremities: 0.5-1 mcg/kg clonidine (Max dose of 100- 150 mcg) d iluted in 100-120 mls of Lidocaine 0.25% solution.) Do not add Epinephrine for intravenous r regional block. If desired, add fentanyl 50 mcg to enhance the block and/or muscle relaxant (pretreatment doses only) e.g. pancuronium 0.5 mg. This combination may enable the use of lower concentrations of the local anesthetic (e.g. lidocaine 50 mls of 0.25% for upper xtremity block)
Caution: Significant hypotension and sedation may occur at the high dose ranges of clonidine (100-150 mcg). Treat with intravenous fluids.
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Every effort has been made to ensure that the drug dosage schedules
herein are accurate and in accord with the standards accepted
at the time of publication. As new research and experience broaden
our knowledge, changes in treatment and drug therapy occur. The
medications described do not necessarily have specific approval
by the Food and Drug Administration for use in the situations
and the dosages for which they are recommended. This information
is advisory only. The package insert should be consulted for use
and dosage as approved by the FDA, for any changes in indications
and dosages and for added warnings and precautions. The ultimate
responsibility lies with the prescribing physician.
No part of this information may be reproduced or transmitted electronically
in any information storage or retrieval system, or within any
monitoring system without prior permission in writing from S.O.T.A.
Technologies (Electronic Publishers).
The Universal Drug Infusion Slide Ruler (patent pending) is now
available. It incorporates an infusion data guide and enables
infusion calculations for any drug at any dose and at any concentration.
It may be obtained by calling S.O.T.A Technologies (800 9-MEDIC-9)
TOPICAL MEDICATIONS MAY BE ORDERED (BY PRESCRIPTION ONLY) FROM L.A.
PAIN CLINIC. CALL 310 675-9121 or 1 800 9-MEDIC-9.
Copyright 2000. Sota Omoigui, M.D. All rights reserved.