Medication classSafetyTolerabilityEffectiveness*Price of generic (brand)†SimplicityComments
Acetaminophen

  • Hepatotoxicity

  • Renal toxicity

  • Excellent

+

  • $0.04 ($0.18), 1,000 mg

  • 325 to 650 mg orally every 4 to 6 hours

  • or

  • 1,000 mg orally 3 to 4 times daily

  • Maximum: 4,000 mg per day

  • Avoid concurrent use of more than one acetaminophen-containing product

  • Toxicity unlikely if single dose is less than 10 g in an adult

  • FDA boxed warning: hepatic injury

Aspirin

  • Bronchospasm

  • GI irritation

  • Platelet inhibition

  • Good: short-term

  • Fair: long-term

++

  • $0.05 ($0.16), 650 mg

  • 325 to 650 mg orally every 4 to 6 hours

  • or

  • 1,000 mg orally every 6 hours

  • Maximum: 4,000 mg per day

  • Can cause allergic reaction in sensitive patients, especially those with chronic urticaria or asthma

Nonselective NSAIDs (e.g., ibuprofen)

  • GI irritation

  • GI ulceration and bleeding

  • Platelet inhibition

  • Renal dysfunction

  • Renal failure

  • Good

++

  • $0.21 ($0.60), 600 mg

  • Cost varies by drug

  • 200 to 400 mg orally every 4 to 6 hours

  • Maximum: 1,200 mg per day (over-the-counter)

  • 400 to 800 mg orally 3 to 4 times daily

  • Maximum: 3,200 mg per day (prescription)

  • Dosing varies by drug

  • FDA boxed warning: cardiovascular thrombotic events

  • Eradicating Helicobacter pylori before starting NSAIDs may reduce the risk of ulcers

  • NSAID-associated upper GI bleeding increases with concurrent use of low-dose aspirin

Cyclooxygenase-2 selective NSAIDs (e.g., celecoxib [Celebrex])

  • Hepatic dysfunction

  • Renal dysfunction

  • Good

++

  • NA ($5.72), 200 mg

  • 100 to 200 mg orally twice daily

  • FDA boxed warning: cardiovascular thrombotic events

  • Similar analgesia with less GI toxicity compared with nonselective NSAIDs

  • Can cause acute renal failure

Opioid combinations (e.g., hydrocodone/acetaminophen)

  • Same as individual components

  • Good

+++

  • $0.20 ($1.83), 7.5 mg/500 mg

  • Cost varies by drug

  • 2.5 to 10 mg hydrocodone orally every 4 to 6 hours

  • Maximum: 4,000 mg acetaminophen daily

  • Hydrocodone combinations are Schedule II to III controlled substances with addiction risk

Opioid (e.g., morphine)

  • Nausea/vomiting

  • Respiratory depression

  • Sedation

  • Good

+++

  • $0.25 (NA), 15 mg

  • Cost varies by drug and formulation

  • 10 to 30 mg orally every 3 to 4 hours

  • Dosing varies by drug and formulation

  • No ceiling to analgesia effect

  • Respiratory depression risk increases with concurrent use of benzodiazepines

  • Schedule II controlled substance with addiction risk

Dual-action opioids (e.g., tapentadol [Nucynta])

  • Similar to opioids

  • Serotonin syndrome (rare)

  • Good

+++

  • NA ($2.90), 50 mg

  • 50 to 100 mg orally every 4 to 6 hours

  • Structurally similar to tramadol (Ultram)

  • Opioid and noradrenergic properties

  • Avoid use with other serotonergic drugs