Therapeutic dose ranges for commonly used adjuvant analgesics

Category based on conventional use	Class	Drugs	Usual starting dose	Usual effective dose range*
Multipurpose analgesics	Glucocorticoids	Dexamethasone	Varies	1 to 2 mg twice daily, orally or IV
	Glucocorticoids	Prednisone	Varies	5 to 10 mg twice daily
	Antidepressants	Desipramine	10 to 25 mg at bedtime	50 to 150 mg at bedtime
		Duloxetine	20 to 30 mg daily	60 to 120 mg daily^¶
		Bupropion	75 mg twice daily	300 to 450 mg daily^Δ
		Venlafaxine, sustained release	75 mg once daily	150 to 225 mg daily
		Nortriptyline	10 to 25 mg at bedtime	50 to 150 mg at bedtime
	Alpha-2 adrenergic agonists	Tizanidine	1 to 2 mg at bedtime	2 to 8 mg twice daily
Used for neuropathic pain	Antiseizure medications	Gabapentin	100 to 300 mg twice daily	300 to 1200 mg three times daily
	Antiseizure medications	Pregabalin	50 to 75 mg twice daily^◊	150 to 300 mg twice daily
	GABA agonists	Clonazepam	0.5 mg at bedtime	0.5 to 3 mg daily
Used for bone pain	Osteoclast inhibitors	Pamidronate	–	60 to 90 mg monthly, IV
		Zoledronic acid	–	4 mg monthly, IV
		Denosumab	–	120 mg monthly, subcutaneously
Used for bowel obstruction	Anticholinergic drugs	Glycopyrrolate	0.1 mg daily	0.1 to 0.2 mg three times daily, subcutaneously
Used for bowel obstruction	Somatostatin analogue	Octreotide	Varies	0.1 to 0.3 mg twice daily, subcutaneously

IV: intravenous; GABA: gamma-aminobutyric acid.
* All doses shown are for adult patients, oral administration, unless otherwise noted.
¶ Randomized trials conducted in patients with diabetic peripheral neuropathy suggest no additional efficacy from 120 mg daily versus 60 mg daily.
Δ Bupropion doses ≥150 mg should be sustained release.
◊ Medically frail patients and those with significantly impaired kidney function are started at 25 mg once daily and titrated more gradually.

Graphic 82318 Version 7.0

خرید پکیج

Therapeutic dose ranges for commonly used adjuvant analgesics