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Prescribing Guidelines

NSAIDS and Acetaminophen Tolerated

Anticipated Pain Severity Analgesic Recommendation (typical dosing for a healthy adult)
Mild

Ibuprofen (400mg q4h, 600mg q6h, 800mg q8h) scheduled for 24 hours then PRN pain

OR

Acetaminophen (APAP) 500mg q4h or 1,000mg q8h scheduled for 24 hours then PRN pain
Moderate

Ibuprofen (400mg q4h, 600mg Q6h, 800mg q8h) scheduled for 24 hours then PRN pain

AND

Acetaminophen 500mg q4h or 1,000mg q8h scheduled for 24 hours then PRN pain 
High

Ibuprofen (400mg q4h, 600mg q6h, 800mg q8h) scheduled for 24 – 48 hours then PRN pain

AND

Acetaminophen 500mg q4h or 1,000mg q8h scheduled for 24 – 48 hours then PRN pain

AND

Oxycodone 2.5 – 10mg q4 – 6h scheduled for 24 hours then PRN pain

Typically, oxycodone 5mg q4 – 6h for 24 hours then PRN

NSAIDS Contraindicated

Anticipated Pain Severity Analgesic Recommendation (typical dosing for a healthy adult)
Mild Acetaminophen 500mg q4h scheduled for 24 hours then PRN pain
Moderate

Tramadol 50 – 100mg every four to six hours, not to exceed 400mg per day

OR

Hydrocodone-Acetaminophen 5/325mg q4 – 6h scheduled for 24 – 48 hours then PRN pain
High

Acetaminophen 500mg q4h scheduled for 24 hours then PRN pain

AND

Oxycodone 2.5 – 10mg q4-6h scheduled for 24 hours then PRN pain

APAP Contraindicated

Anticipated Pain Severity Analgesic Recommendation (typical dosing for a healthy adult)
Mild Ibuprofen (400mg q4h, 600mg q6h, 800mg q8h) scheduled for 24 hours then PRN pain
Moderate

Ibuprofen (400mg q4h, 600mg q6h, 800mg q8h) scheduled for 24 – 48 hours then PRN pain

OR

Tramadol 50 – 100mg every four – six hours, not to exceed 400mg per day
High

Ibuprofen (400mg q4h, 600mg q6h, 800mg q8h) scheduled for 24 hours then PRN pain

AND

Oxycodone 2.5 – 10mg q4 – 6h scheduled for 24 hours then PRN pain


OR


Tramadol 50 – 100mg every four to six hours, not to exceed 400mg per day

AND

Ibuprofen (400mg q4h, 600mg q6h, 800mg q8h) scheduled for 24 hours then PRN pain 

APAP/Ibuprofen Both Contraindicated

Anticipates Pain Severity Analgesic Recommendation (typical dosing for a healthy adult)
Mild - High Oxycodone 2.5 – 10mg q4 – 6h scheduled for 24 hours then PRN pain

Additional Considerations 

  • Patients should be warned to avoid acetaminophen (APAP), including combination formulations in prescription or in over-the-counter medications. 
  • Maximum daily dose of APAP is 3,000mg per day. To avoid potential APAP toxicity, consider prescribing an opioid rescue medication containing ibuprofen. 
  • A typical adult maximum dose of ibuprofen is 2,400mg per day. Higher maximal daily doses have been reported for osteoarthritis when under the direction of a physician. 
  • A decrease in post-operative pain severity has been demonstrated when a nonsteroidal anti-inflammatory drug is administered preemptively. 
  • A long-acting local anesthetic (i.e., bupivacaine) can delay onset andv severity of post-operative pain. 
  • Perioperative corticosteroid (i.e., dexamethasone) limits swelling and decreases post-operative discomfort after third molar extractions. 
  • Tramadol and codeine should be avoided in children due to Black Box Warning.
  • Acetaminophen in children: 15mg/kg/dose, q6 hours maximum 90mg/kg/24 hours. 
  • Ibuprofen in children: 5 – 10mg/kg/dose q6 hours maximum 40mg/kg/24 hours.