Opioids + Muscle Relaxants Medications

hydrocodone/acetaminophen

oxycodone immediate/extended release

oxycodone/acetaminophen

morphine immediate/controlled release

fentanyl patches

tramadol

cyclobenzaprine

methocarbamol

tizanidine

carisoprodol

Vicodin, Norco

OxyIR

Oxycontin

Percocet

MS Contin, Kadian

Duragesic

Roxanol

Ultram

Flexeril

Robaxin

Zanaflex

Soma

severe pain

moderate to severe chronic pain

moderate to severe chronic pain

acute severe non-cancer-related pain

moderate to severe chronic pain

moderate to severe chronic pain

chronic pain (with no other solution)

moderate to severe chronic pain, restless leg syndrome

skeletal muscle spasm, temporo-mandibular joint disorder, fibromyalgia

musculoskeletal pain or spasm

muscle spasticity and spasms

disorder of musculoskeletal system

10mg q12h prn
(titrate to response)

5-15mg po q4-6h prn

10mg po q12 prn
(titrate to response)

2.5010mg q4-6h prn
(max 4g/day)

moderate to 10-20mg po q4 (acute)/q12h (chronic) pain prn
(titrate to response)

7.5-15mg po q3-4h prn

1 12.5-100 mcg/h patch q72h
(dosage based on pt’s current 24h oral morphine requirement)

50mg po q4-6h prn
(titrate to response)

5-15mg po TID

1500mg po QID

2-6mg po up to TID

250-350 mg po TID and HS

Constipation, GI distress, somnolence, rash, respiratory depression, euphoria, pruritus

Counseling Points:
• May cause constipation with chronic use, stool softeners can help
• May cause drowsiness, avoid activity requiring alertness
• Avoid alcohol and CNS depressants

Constipation, GI distress, sedation, sweating, pruritus, asthenia, dyspnea, hypotension, euphoria, nausea, vomiting

Counseling Points:
• May cause constipation with chronic use, stool softeners can help
• May cause drowsiness, avoid activity requiring alertness
• Avoid alcohol and CNS depressants

Constipation, GI distress, sedation, sweating, pruritus, asthenia, dyspnea, hypotension, euphoria, nausea, vomiting

Counseling Points:
• May cause constipation with chronic use, stool softeners can help
• May cause drowsiness, avoid activity requiring alertness
• Avoid alcohol and CNS depressants
• Do not crush or chew tablets

Constipation, stomach pain, feeling dizzy, sleepy, tired, or weak, headache, upset stomach or throwing up

Counseling Points:
• Naloxone/nalmefene prescription recommended for pt’s with increased risk of overdose

Constipation, nausea, vomiting, hypotension, dizziness, sedation, diaphoresis, headaches, depression, xerostomia, Dyspnea, urinary retention, edema, pruritic

Counseling Points:
• May cause constipation with chronic use, stool softeners can help
• May cause drowsiness, avoid activity requiring alertness
• Avoid alcohol and CNS depressants
• Do not crush or chew tablets
• Capsule contents can be sprinkled on soft foods but must be swallowed whole (not chewed)

Dizziness, sleepiness, tiredness, or weak, dry mouth, constipation, diarrhea, stomach pain, upset stomach, throwing up, or decreased appetite, headache, anxiety, sweating a lot

Counseling Points:
• Only use when treatment is needed for daily pain for long periods
• Not intended for opioid naïve pt’s

Application site reactions, sweating, constipation, GI distress, confusion, headache, anxiety, urinary retention, fatigue, arrhythmias, chest pain, dyspnea, respiratory depression, upper respiratory tract infection

Counseling Points:
• Monitor carefully, patches are very concentrated/potent
• May cause constipation with chronic use, stool softeners can help
• May cause drowsiness, avoid activity requiring alertness
• Avoid alcohol and CNS depressants
• Skin breaks and febrile patients may have increased absorption

Constipation, GI distress, dizziness, sedation, edema, sweating, pruritus, headaches, flushing, dyspnea, xerostomia, depression, orthostatic hypotension

Counseling Points:
• May cause constipation with chronic use, stool softeners can help
• May cause drowsiness, avoid activity requiring alertness
• Avoid alcohol and CNS depressants
• Do not crush or chew
• Can take with or without food, but stick to one way to avoid variability in absorption

Xerostomia, headache, dizziness, drowsiness, constipation, indigestion, nausea, pharyngeal dryness, asthenia, confusion, blurred vision

Counseling Points:
• May cause drowsiness, avoid activity requiring alertness
• Take capsule same time each day

Somnolence, flushing, pruritus, rash, urticaria, nausea, vomiting, dizziness, headache, nystagmus, vertigo, blurred vision, conjunctivitis

Counseling Points:
• May cause drowsiness, avoid activity requiring alertness
• Should only use for short periods (up to 2-3 wks)
• Avoid using with other opioids

Hypotension, xerostomia, asthenia, dizziness, somnolence, muscle weakness, constipation, vomiting, dyskinesia, amblyopia, feeling nervous, syncope, depression

Counseling Points:
• May cause dizziness and somnolence, avoid driving until effects are known
• May cause hypotension, rise slowly from lying/sitting
• Take drug same way (with/without food) each time to avoid inconsistent absorption

Drowsiness, dizziness, headache

Counseling Points:
• May cause drowsiness, avoid activity requiring alertness
• Avoid alcohol
• Monitor for withdrawl symptoms and seizures for pt’s stopping prolonged therapy