Drug (Prescriber Category)

Dose

Side Effects

Remarks

Paracetamol 500mg (C+)

500-1000mg

4-6 hourly as needed. Max: 4000mg daily.

Potential liver damage if overdosage.

Can be given orally, rectally

Good for mild pain and moderate to severe pain (in combination with other drugs).

Precautions in patient with G6PD deficiency; chronic alcoholism or malnutrition. Contraindicated in severe hepatic impairment.

Drug

Dose

Side Effects

Remarks

Diclofenac Sodium 50mg (B)

50-150mg, in 2-3 divided doses.�Max 200mg/day

Peptic ulcer, GI bleed, Platelet Dysfunction,

Renal failure, Hypertension, Allergic reaction in susceptible individuals, increase in CV thrombotic events, bronchospasm, increase risk of hyperkalemia.

Avoid use in women at ≥ 30 weeks gestation and in patients with severe renal disease unless benefits outweigh the risk. Initiate dosing at the lower end of the dosing range for the elderly.

Mefenamic acid 250mg (C)

500mg tds

Ibuprofen 200mg (B)

200-400mgtds,�Max:2400mg/day

Naproxen 250mg (A/KK)

500-550 bd, �Max: 1gm/day.

Indomethacin

25mg (B)

25-50mg tds,

Max: 200mg/day.

Meloxicam 7.5mg (A/KK)

7.5-15mg od,�Max: 15mg/day

Drug

Dose

Side effects

Remarks

Celecoxib 200mg (A/KK)

200mg bd, �Max 600mg/day

Renal impairment, Allergic reaction, increase in CVS events, Hypertension, renal papillary necrosis (prolonged use), fluid retention, GI perforations, CV thrombotic events

Avoid use in women at ≥ 30 weeks gestation. Contraindicated in children and adolescent <16 years, patients with CrCl <30 mL/min and severe hepatic impairment (Child-Pugh ≥10).

Etoricoxib 90mg (A/KK); 60mg and 120mg (A*)

60mg, 90mg, 120mg daily.�Max 120mg/day

Indigestion, GI upset, abdominal pain, fatigue, constipation, diarrhea, mucosal ulcer, palpitation, headache, flu-like symptoms.

Drug

Dose

Side effects

Remarks

Pregabalin 50mg, 75mg, 150mg (A*)

150 mg/day as 75mg bid.

Increase to 300mg daily after 3-7d, then by 150mg/d every 3-7d as tolerated.

Max: 600mg/day

Dizziness. �Somnolence. �Weight gain. �Blurred vision. �Dry mouth. Constipation. �Peripheral oedema. Euphoric mood. Disturbed attention. Increased appetite. Unsteady gait.

Initiate at the lowest dose and monitor for symptoms of respiratory depression and sedation in the elderly. Use not recommended if CrCl < 30 mL/min.

PHN (1^st line)

DPN (1^st line)

TN (2^nd line)

Drug

Dose

Side effects

Remarks

Gabapentin 300mg (A/KK);

100mg and 600mg (A*)

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Day 1, 300 mg at bedtime�Day 2, 300 mg bd�Day 3, 300 mg tds�Increase by 300mg tds every 1-7d as tolerated�Max 3600mg daily (1200mg tds)�

Dizziness, somnolence, weight gain, blurred vision, dry mouth, constipation, peripheral oedema, euphoric mood, disturbed attention, increased appetite, unsteady gait.

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Avoid abrupt withdrawal; reduce dose gradually over at least 7 days.

For patients wth eGFR less than 15 mL/min, MAX 300 mg once daily. In conservatively-managed stage 5 chronic kidney disease, consider starting as low as 100 mg every other night.

PHN (1st line)

DPN (1st line)

TN (2nd line)

Drug

Dose

Side effects

Remarks

Carbamazepine 200mg (B)

100 mg bd

100mg every 3-7 d.

Max: 1200mg/day (for TN & PHN)

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Sedation, dizziness, gait abnormalities, nausea, vomiting, �Serious AE: hyponatraemia, agranulocytosis, aplastic anaemia, Steven-Johnson syndrome, toxic epidermal necrolysis.

May cause ECG abnormalities, AV heart block. Avoid in first trimester: risk of fetal carbamazepine syndrome.

TN (1^st line)

PHN (2^nd line)

Sodium Valproate 200mg (B)

600-2500mg daily in two divided doses�Max 2500mg daily�

Hepatic dysfunction, acute pancreatitis, GI upsets, hair loss, oedema, weight gain, platelet dysfunction and coagulation disturbances.

Elderly require dosage reduction and slower titration due to a greater sensitivity to somnolence.

Drug

Dose

Side effects

Remarks

Amitriptyline 25mg (B)

10-25 mg daily at bedtime�Increase by 10-25mg weekly.�Max 75mg daily

Dry mouth, sweating, sedation, disturbed vision, cardiotoxicity, palpitation, postural hypotension, urinary retention, constipation, drowsiness, SIADH, suicidal thoughts.

Avoid use in elderly due to highly anticholinergic and sedating effects, especially patients with a history of falls or fractures (unless safer alternatives are not available).

PHN (1^st line)

DPN (1^st line)

TN (2^nd line)

Nortriptyline 10mg, 25mg, 50mg (requires Import Permit, not registered with Drug Control Authority)

10-25 mg at bedtime�Increase by 25mg daily every 3-7d as tolerated.�Max 150mg daily.

Hypoglycemia and hyperglycemia have been reported.

PHN (1^st line)

DPN (1^st line)

TN (2^nd line)

Drug

Dose

Side effects

Remarks

Duloxetine 30mg, 60mg (A*)

30 mg/day�Increase to 60mg/d after 1 week.�Max: 60mg/d. There is no evidence that doses higher than 60mg confer additional benefit and higher doses are associated with

Nausea, vomiting, dry mouth, constipation, GI distress, GI bleeding, decreased appetite, insomnia, dizziness, somnolence, blurred vision, increased sweating fatigue, hypertensive crisis, suicidal thoughts.

Avoid in elderly and adults with CrCl < 30 mL/min due to increased risk of GI adverse effects. Hyponatremia or SIADH may occur or exacerbated.

DPN (1^st line)

Drug

Dose

Side effects

Remarks

Morphine Aqueous Morphine 10mg/5ml (B) Morphine Sulphate Tablet 10mg, 30mg (A)

10-15 mg morphine q4h�or as needed (equianalgesic dosages should be used for other opioid analgesics)�After 1-2 weeks convert total daily dosage to long acting opiod and continue short acting as needed.�No maximum dosage with careful titration.

Constipation, sedation, nausea, vomiting, dizziness, respiratory depression, pruritus, syncope.

Conditions with mixed�Nociceptive/neuropathic

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Tramadol 50mg

(Tablet/ Capsule:A/KK; IV/IM: A)

50 mg qid or bd.�Increase by 50-100mg daily in divided doses every 3-7 d as tolerated.�Max 400mg daily(100mg qid) . 300mg daily in patient >75 years

Dizziness, dry mouth, nausea, constipation, somnolence, risk of seizure/epilepsy, risk of seratogenic syndrome if combine with TCAs or SSRIs, flushing, pruritus.

PHN (2^nd line)

DPN (2^nd line)

*use with caution in patients on SSRIs, patients with renal or severe hepatic impairment.

CrCl< 10 : contraindicated

CrCl 10-30: max 100mg BD

Severe hepatic impairment: Increase dosing interval to BD

Drug

Dose

Side effects

Remarks

IV Lignocaine (B)

5mg/kg over 30-60 min

Nausea.�Hypotension.�Bradycardia. Hypertension.�Paraesthesia.�Dizziness.�Vomiting

Used by Pain specialist only

Drug

Dose

Side effects

Remarks

Capsaicin (not in MOH Formulary)

0.075% applied tds-qds

Local, transient pain and erythema

PHN (1^st line)

5% Lignocaine patch (A*)

Apply for maximum 12hr/day. Max 3 patches/day.

Mild localized skin reactions around application site

PHN (1^st line)

Prescribed by pain specialist only.

Drug

Dose

Side effects

Remarks

EMLA�Eutectic mixture of 2.5% lidocaine and 2.5% prilocaine (A)

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Surface anaesthesia for skin during needle insertion and superficial surgical procedures.

Apply 1-2g under occlusive dressing 1-5 hours before procedure (max two doses/24 hours)

Pale skin, redness, or swelling at application site, burning, change in hot or cold sensation.

Methaemoglobinaemia in high doses.

Not to be applied to open wounds other than leg ulcers, genital mucosa of children, impaired tympanic membrane. Precautions in G6PD deficiency congenital methaemoglobinaemia; atopic dermatitis.

PHN (1^st line)

Drug

Dose

Side effects

Remarks

Tetracaine (Ametop Gel 4%) (requires Import Permit, not registered with Drug Control Authority)

Apply only to intact skin under occlusive dressing, 1g over 30cm2 skin surface area. Remove after 45 minutes. Rapid absorption through mucosa.

Max cumulative dose in 24 hours should not exceed 7 tubes for adults and 2 tubes for children.

Ototoxic

Caution in patient with epilepsy.

Each tube expels 1g ( sufficient for area 6 x 5cm)

Drug

Dose

Side effect

Remarks

Sumatriptan50mg, 100mg (A/KK)

Initial: 50-100 mg taken as soon as signs of migraine headache appear. If the 1st dose was partially effective but headache recurs, may repeat dose after at least 2 hours. Max: 100 mg/dose; 200 mg/24 hours.

Dizziness.�Warm or hot sensation. Flushing. �Chest discomfort.

Precautions in patients with CV risk factors.

Ergotamine 1mg/ Caffeine 100mg (not in MOH Formulary)

Initial: 2 tabs at onset of attack, then 1 tab every 30 min, if necessary. Max: 6 tabs/day; 10 tab/week.

Angina�Tachycardia�Rebound headache�Pruritus

Precautions in patient with risk or predisposed vascular effects.

Drug

Dose

Side effect

Remarks

Pizotifen 0.5mg (B)

Prophylaxis: Initial: 0.5 mg, increase gradually as necessary. Maintenance: 1.5 mg/day in single or 3 divided doses. Max: 4.5 mg/day (max ≤3 mg/dose).

Oedema.�Hypotension�Weight gain�Epigastric distress

Precautions in patient with angle-closure glaucoma, urinary retention, epilepsy. Avoid abrupt withdrawal.

Propanolol 10mg, 40mg (B)

Prophylaxis: initial 80mg/d divided every 6-8hly. Increase by 20-40mg/dose every 3-4 weeks to max of 160-240mg/day in divided doses.

Hypotension�Vivid dreams�Vertigo�Hyperkalemia�Bronchospasm

If satisfactory response not achieved within 6/52of starting therapy, withdraw drug over several weeks.

Drug

Dose

Side effect

Remarks

Sulphasalazine 500mg (A/KK)

0.5-1 g /day.�Increase weekly to maintenance dose of �2 g /day in 2 divided doses.�Max 3 gm/day

Rashes�Cyanosis�Abnormal LFT.�Urine discoloration

Precautions in patient with severe allergies, bronchial asthma, G6PD deficiency, blood dyscrasias; history of recurring or chronic infections.

Drug

Dose

Side effect

Remarks

Methotrexate 2.5mg (A)

7.5mg once weekly�Increase by 5mg every 2-4 week to a maximum 20-30mg once weekly

Reddening of skin�Leukopenia�Thrombocytopenia�Renal dysfunction�Liver enzyme elevation

Precautions in patient with pleural effusion, ascites, folic acid deficiency; inactive and chronic infection (e.g. herpes zoster, TB, hepatitis B or C); risk factors for hepatotoxicity.

Drug

Dose

Side Effect

Remarks

Pamidronate 30mg, 90mg (A*)

60-90mg as a single infusion over 2-24hr,s may repeat if necessary after at least 7 days

Hypocalcemia, hypophosphataemia, hypomagnaesemia, flu like symptoms,mild fever, malaise, rigors and local injection site reaction

Rehydrate patient with normal saline before or during treatment. Not to be given as bolus injection. Caution in renal impairment patients ,reduce dose and increase infusion duration. In poor oral hygiene patients there is risk of osteonecrosis of the jaw.

Zoledronate 4mg (A*)

4mg infusion over 15 min, may repeat if necessary after at least 7 days

Rise in body temperature �Flu like symptom�Headache�Hypersensitivity reaction Osteonecrosis of the jaw

Drug

Dose

Side Effect

Remarks

Clodronate (A*)- (requires Import Permit, not registered with Drug Control Authority)

Oral, Initial: 1,600 mg/day, increase as needed. Max: 3200m/day

Gastrointestinal irritation.�Cautiion in renal dysfunction

Should not be taken 1 hour before and 2 hour after meals.

Drug

Dose

Side effect

Remarks

Dexamethasone 0.5mg, 4mg (A)

8-16mg daily or divided doses,then to reduce to lowest possible dose(usually 2mg/d)��Elderly patients: 5 mg daily and taper as soon as feasible.

Increase or decrease appetite, insomnia, indigestion, nervousness, myopathy, oral candidiasis,�adrenal suppression, Cushing’s syndrome, pancreatitis.

Should be given before 6pm to reduce risk of insomnia. Use lowest possible dose to prevent side effect. Anticipate fluid retention, glycemic effect (short term) and bone demineralization (long term). Caution in PUD, concomitant NSAIDs use, liver or cardiac impairment

Drug

Dose

Side effect

Remarks

Magnesium Trisilicate Mixture 5% (C)

Prepared as 250mg/ml mixture of equal parts Magnesium Carbonate Light, Magnesium Trisilicate and Sodium Hydrogen Carbonate.

Recommended dose: �10 - 20ml TDS or as required.

Diarrhoea, intestinal colic, flatulence.

Possible delayed onset allergic reaction (some preparations contain PABA).

Risk of metabolic alkalosis when given with polystyrene sulphonate resins (eg. Kalimate).

Contraindicated in severe renal impairment, hypophosphataemia, GI obstruction.

Used with caution in pregnancy (insufficient data).

Drug

Dose

Side effect

Remarks

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Omeprazole 20mg (A/KK)

Recommended dose:�20 - 40mg OD (given for 4 weeks for duodenal ulcer or 8 weeks for gastric ulcer treatment)

10 - 40mg OD maintenance dose following treatment dose (titrated depending on response).

 20mg OD for NSAID-associated ulceration (given for up to 8 weeks)

Nausea, vomiting, diarrhoea, constipation, flatulence, abdominal pain.

Hepatic transaminitis.

Rare: Systemic Lupus Erythematosus, hypomagnesaemia, osteoporosis-related fractures.

Dose reduction in patients with hepatic impairment (half-dose; given as 10-20mg OD for treatment followed by 10mg OD for maintenance)

Used with caution in pregnancy, lactating mothers and paediatric age group

Drug

Dose

Side effect

Remarks

Pantoprazole 40mg (B)

Recommended dose:

40mg OD for 2-4 weeks (Peptic ulcer disease)

Headache , abdominal pain, facial oedema, generalized oedema, chest pain, diarrhea, constipation, pruritus, rash, flatulence.

Severe cutaneous adverse reactions, including Stevens-Johnson Syndrome(SJS) and Toxic Epidermal Necrolysis(TEN).

Not recommended in paediatric age group

Avoid using longer than medically indicated.

May be associated with increased risk for osteoporosis-related fracture, severe hepatic impairment, Cutaneous lupus erythematosus(CLE) and systemic lupus erythematosus(SLE)

Drug

Dose

Side effect

Remarks

Hyoscine Butylbromide (Buscopan) (C)

Prepared as sugar coated tablets, each containing 10mg of Hyoscine-N-Butylbromide.

Recommended dose:

10-20mg 3-4 times/day.

Max: 50mg/day.

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Anticholinergic effects (dry mucous membranes, transient tachycardia).

 Anaphylaxis / anaphylactic shock, hypersensitivity, urticarial, pruritus.

Contraindicated in patients with myasthenia gravis or mechanical GIT obstruction.

 May cause unexplained sudden, severe abdominal pain associated with nausea, vomiting, fever, hypotension, syncope or melaena / haematochezia

Drug

Dose

Side effect

Remarks

Eperisone Hydrochloride 50mg (Myonal) (A)

Prepared as sugar coated tablets, each containing 50mg of Eperisone Hydrochloride.

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Recommended dose: 1 tablet (50mg) TDS

Anaphylaxis / anaphylactic shock, anaphylactoid reaction, Steven-Johnson’s Syndrome, Toxic Epidermal Necrolysis.

Contraindicated in lactating mothers or in patients with prior history of allergic reaction.

Used with caution in patients with hepatic dysfunction, elderly patients (dose reduction due to physiological reduction in hepatic function).

Drug

Dose

Side effect

Remarks

Baclofen 10mg (B)

Prepared as 5mg tablets

 Recommended dose:

Oral:

5mg TDS for 3/7, then 10mg TDS for 3/7, then 15mg TDS for 3/7, then 20mg TDS for 3/7.

Max dose: 60mg/day. To reassess treatment if therapeutic effect is not seen after 6 weeks on max dose.

Respiratory depression, acute urinary retention, CNS depression, bradycardia.

 Nausea, vomiting, dry mouth, constipation, diarrhoea, increased salivation, dehydration, decreased appetite.

 Muscle weakness, myalgia, hypotonia.

 Sedation, somnolence, headache, dizziness, tremor.

 Eye disorders: accommodation disorder, blurred vision, nystagmus, diplopia.

 Drug withdrawal upon cessation of therapy (i.e. autonomic dysreflexia, hyperthermia, rapid uncontrollable muscle spasms)

Increased risk of adverse reactions when given along with levodopa / carbidopa.

Enhanced CNS depression when taken with alcohol.

Oral preparation contraindicated in patients with peptic ulcer disease

Drug

Dose

Side effect

Remarks

Clonazepam 0.5mg, 2mg (B)

Recommended dose:�Oral:

0.25 - 1mg BD,

Max dose 4mg/day

Drowsiness or sedation, fatigue, muscular hypotonia.

Behavioural disturbances including aggressiveness, agitation, hyperkinesis and irritability.

Coordination disturbances, dizziness, vertigo, visual disturbances.

Skin rash, hair loss, hirsutism, and ankle and facial oedema.

Diarrhoea, constipation, weight gain or loss, abnormal thirst, gastritis, increased or decreased appetite, dyspepsia, nausea, coated tongue, dry mouth, sore gums.

Can result in profound sedation and respiratory depression if given together with opioids.

Contraindicated in patients with acute closed angle glaucoma, myasthenia gravis, obstructive sleep apnoea, severe respiratory insufficiency.