Musculoskeletal Final Dosing

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1

Celecoxib (Celebrex)

initial dose

100 mg daily

2

Celecoxib (Celebrex)

maintenance dose

100 mg BID or 200 mg daily

3

Diclofenac (Cataflam)

initial dose

50 mg BID

4

Diclofenac (Cataflam)

maintenance dose

50-75 mg BID

5

Diclofenac XR (Voltaren XR)

initial dose

100 mg daily

6

Diclofenac XR (Voltaren XR)

maintenance dose

100-200 mg daily

7

Etodolac (Lodine)

initial dose

300 mg BID

8

Etodolac (Lodine)

maintenance dose

400-500 mg BID

9

Meloxicam (Mobic)

initial dose

7.5 mg daily

10

Meloxicam (Mobic)

maintenance dose

15 mg daily

11

Ibuprofen (Motrin, Advil) for arthritis

initial dose

200 mg TID

12

Ibuprofen (Motrin, Advil) for arthritis

maintenance dose

1200-3200 mg daily in 3-4 divided doses

13

Indomethacin (Indocin)

initial dose

25 mg BID

14

Indomethacin (Indocin)

maintenance dose

Titrate 25-50 mg per day if needed

15

Indomethacin (Indocin)

max dose

50 mg TID

16

Indomethacin SR (Indocin SR)

initial dose

75 mg daily

17

Indomethacin SR (Indocin SR)

maintenance/max dose

75 mg BID if needed

18

Nabumetone (Relafen)

initial dose

500 mg daily

19

Nabumetone (Relafen)

maintenance dose

500-1000 mg QD-BID

20

Naproxen (Naprosyn)

initial dose

250 mg BID

21

Naproxen (Naprosyn)

maintenance dose

500 mg BID

22

Naproxen Sodium (Anaprox, Aleve)

initial dose

[same as XR version]

220 mg BID

23

Naproxen Sodium (Anaprox, Aleve)

maintenance dose

220-550 mg BID

24

Naproxen Sodium DR (Naprelan)

maintenance dose

375-750 mg BID

25

Oxaprozin (Daypro)

initial dose

600 mg daily

26

Oxaprozin (Daypro)

maintenance dose

600-1200 mg daily

27

Piroxicam (Feldene)

initial dose

10 mg daily

28

Piroxicam (Feldene)

initial dose

20 mg daily

29

Acetaminophen (Tylenol) 325 mg tabs

usual dose

2 tabs (650 mg) every 4-6 hours

30

Acetaminophen (Tylenol) 325 mg tabs

max dose(s)

3.25 g daily (OTC)

4 g (Rx)

31

Acetaminophen (Tylenol) 500 mg tab

usual dose

2 tabs (1 g) TID

32

Acetaminophen (Tylenol) 500 mg tab

max dose(s)

3 g daily (OTC)

4 g (Rx)

33

Acetaminophen ER (Tylenol Arthritis) 650 mg tab

usual dose

2 tabs (1300 mg) TID

34

Acetaminophen ER (Tylenol Arthritis) 650 mg tab

max dose

3.9 g (OTC)

35

Tramadol (Ultram)

initial dose for arthritis

25 mg qAM

36

Tramadol (Ultram)

maintenance dose for arthritis

50-100 mg TID

37

Tramadol (Ultram)

for pt. with CrCl < 30 mL/min

max dose for arthritis

200 mg daily

38

Tramadol ER

initial dose for arthritis

100 mg daily

39

Tramadol ER

maintenance dose for arthritis

200-300 mg daily

40

Diclofenac solution (Pennsaid) 1.5%

10 drops QID

41

Diclofenac solution (Pennsaid) 2 %

2 pumps BID

42

Diclofenac gel (Voltaren Arthritis Pain) 1%

dose for: elbow, wrist or hand

2 g = 2.25 inches

for no more than 21 days, or 2 body areas/day

43

Diclofenac gel (Voltaren Arthritis Pain) 1%

dose for: ankle, knee, foot

4 g = 4.5 inches

for no more than 21 days, or 2 body areas/day

44

Duloxetine (Cymbalta)

usual dose for Osteoarthritis

30 mg daily

45

Osteoarthritis drugs to avoid if pt. CrCl < 30 mL/min

  • Tramadol
  • Duloxetine
46

Topical Capsaicin (Capzasin-HP)

Apply 3-4 times daily everyday

(will see benefit after a few weeks)

47

Acute Attack of Gout

Indomethacin

50 mg TID, taper to 25 mg TID

48

Acute Attack of Gout

Naproxen

750 mg x 1, then 250 mg q8h

49

Acute Attack of Gout

Sulindac

200 mg BID

50

Acute Attack of Gout

Ibuprofen

400-800 mg TID-QID

51

Acute Attack of Gout

Piroxicam

20 mg QD or 10 mg BID

52

Anti-Inflammation Prophylaxis with ULT for Gout

Naprosyn

250 mg BID

53

Acute Attack of Gout

Prednisone

20-50 mg daily for 3-5 days, then taper in 5 mg decrements each day over 10-14 days until d/c

54

Acute Attack of Gout

Methylprednisolone

24 mg x 1, then daily decreasing by 4 mg each day for 6 days total (dose pack)

55

Anti-Inflammation Prophylaxis with ULT for Gout (2nd line)

Prednisone

≤10 mg daily

56

Anti-Inflammation Prophylaxis with ULT for Gout

Colchicine

  • 0.6 mg QD or BID
  • 0.3 mg QD or BID (w/moderate)
  • 0.3 mg QOD or QD (w/strong)
57

Acute Attack for Gout

Colchicine (FDA approved)

Two 0.6 mg tabs, then one 0.6 mg tab 1 hour later

58

Acute Attack for Gout

Colchicine (Off label; ACR recommended)

0.6 mg QD or BID beginning 12 hrs after FDA approved regimen, then continue until resolved (usually 7-10 days)

59

Allopurinol (Zyloprim)

dose regimen

100 mg daily initially, then titrate up to 300 mg, increasing every 2-5 weeks based on response and serum urate levels

60

Allopurinol (Zyloprim)

max dose

800 mg daily

61

Allopurinol (Zyloprim)

dose for pt. with CrCl 30-60 mL/min

75 mg daily

62

Allopurinol (Zyloprim)

dose for pt. with CrCl <30 mL/min

50 mg daily

63

Probenecid

initial dose

250 mg BID x 1-2 wks, then 500 mg BID x 1-2 weeks

64

Probenecid

usual dose

500 mg BID (can increase increments of 500 mg), can decrease once controlled for 6 months

65

Probenecid

max dose

2000 mg daily

66

Pregabalin (Lyrica) for fibromyalgia

initial dose

75 mg BID

67

Pregabalin (Lyrica) for fibromyalgia

maintenance dose

titrate to 150 mg BID after 1 week, up to 225 mg BID

68

Pregabalin (Lyrica) for fibromyalgia

max dose

450 mg daily

69

Duloxetine (Cymbalta)

initial dose for fibromyalgia

30 mg daily

70

Duloxetine (Cymbalta)

maintenance/max dose for fibromyalgia

60 mg daily

71

Milnacipran (Savella)

initial dose

12.5 mg daily

72

Milnacipran (Savella)

maintenance dose

titrate to 50 mg BID

73

Milnacipran (Savella)

max dose

100 mg BID

74

Cyclobenzaprine (Flexeril) and Amitriptyline (Elavil)

initial dosing range for fibromyalgia

5-10 mg 1-2 hours before bedtime

75

Cyclobenzaprine (Flexeril)

max dose

40 mg daily

76

Amitriptyline (Elavil)

max dose

75 mg daily

77

Tramadol (Ultram)

dosing ranges for fibromyalgia

37.5-50 mg daily, may titrate to QID if needed

78

Methotrexate (Rasuvo, Trexall, Otrexup-SubQ)

7.5-20 mg weekly

79

Hydrochloroquine (Plaquenil)

  • 200 mg BID OR
  • 400 mg QD
80

Sulfasalazine (Azulfidine) enteric-coated

500-100 mg BID; increase to 3 g daily in divided doses after 12 wks of 2 g QD

81

Leflunomide (Arava)

loading dose

100 mg QD x 3 days

82

Leflunomide (Arava)

maintenance dose

10-20 mg QD

*if diarrhea or abdominal cramping occur, decrease from 20 mg to 10 mg QD

83

Tofacitinib (Xeljanz) IR

5 mg BID

84

Tofacitinib (Xeljanz) ER

11 mg QD

85

Baricitinib (Olumiant)

2 mg QD; 1 mg QD in moderate renal impairment (CrCl 40-60 mL/min)

86

Upadacitinib (Rinvoq)

15 mg daily extended release

87

Entanercept (Enbrel)

  • 50 mg SubQ once weekly OR
  • 25 mg SubQ twice weekly

in thigh (preferred), abdomen, or upper arm

88

Adalimumbab (Humira)

  • 40 mg SubQ every other week if also taking Methotrexate or another cs-DMARD
  • 40 mg SubQ every other week to 40 mg SubQ every week if not taking MTX or another cs-DMARD
89

Golimumab (Simponi)

50 mg SubQ monthly in thigh, abdomen, or upper arm

90

Certolizumab pegol (Cimzia)

  • 200 mg SubQ every other week OR
  • 400 mg SubQ every 4 week

in abdomen or thigh

91

Sarilumab (Kevzara)

200 mg SubQ every 2 weeks

92

Abatacept (Orencia)

125 mg SubQ once week

93

Diazepam

dosing range for treating back pain & spinal disorders

2-10 mg TID-QID

94

Cyclobenzaprine

dosing range for treating back pain & spinal disorders

5-10 mg TID-QID

95

Duloxetine

initial dosing regimen for treating back pain & spinal disorders

30 mg/day with food for one week (to reduce incidence of nausea)

96

Duloxetine

max dosing for treating back pain & spinal disorders

60 mg daily

97

Tramadol

dosing regimen for treating back pain & spinal disorders in non-elderly patients

400 mg daily

98

Tramadol

dosing regimen for treating back pain & spinal disorders in elderly patients

300 mg daily

99

Lidocaine 5% transdermal patch

Apply up to 3 patches in 12 hours

100

Alpha-lipoic acid

dosing regimen for treating back pain & spinal disorders

600-1200 mg daily

101

Acetyl-L-carnitine

dosing regimen for treating back pain & spinal disorders

1000 mg BID-TID

102

Tumeric

dosing for treating back pain & spinal disorders

500 mg BID

103

Glucosamine

dosing regimen for treating back pain & spinal disorders

1500 mg daily; may break up to 500 mg TID if dose is not tolerated

104

Pregabalin (Lyrica) for Neuropathic Pain

initial dose

25 mg at bedtime

105

Pregabalin (Lyrica) for Neuropathic Pain

maintenance dose

75-300 mg BID

106

Pregabalin (Lyrica) for Neuropathic Pain

max dose

600 mg daily

107

Gabapentin (Neurontin) for Neuropathic Pain

initial dose

100 mg at bedtime

108

Gabapentin (Neurontin) for Neuropathic Pain

maintenance dose

300 -1200 mg TID

109

Gabapentin (Neurontin) for Neuropathic Pain

max dose

3600 mg daily

110

Lidocaine patch OTC

max concentration

4%

111

Ibuprofen for strains/sprains

400-600 mg q6-8h

112

Naproxen for strains/sprains

440 mg q8-12h

113

Oxycodone PO equianalgesic dose per 30 mg Morphine PO

20 mg

114

Morphine

max dose in 24 hours

No max, body will adjust

115

Morphine IR

initial dose PO

5-30 mg q4h

116

Morphine IR

initial dose IM

5-10 mg q4h

117

Morphine IR

initial dose IV

2-5 mg q3-4h

118

Morphine Extended-Release (MS Contin)

initial dose PO

15 mg q 8-12h

119

Morphine Extended-Release (MS Contin)

maintenance dose PO

30-60 mg q8-12h

120

Oxycodone IR

initial dose PO

5-15 mg q4-6h

121

Oxycodone CR/ER

initial dose PO

*higher doses may be begun in opioid tolerant patients*

10 mg q12h

122

Oxycodone IR/APAP

initial dose PO

5/325 mg 1-2 tabs q6h

123

Docusate for constipation prevention

50-100 mg daily

124

Senna for constipation prevention

8.6 mg QD to BID/PRN

125

Bisacodyl for constipation prevention

5-15 mg daily/prn

126

PEG for constipation prevention

17g daily/prn

127

Methylnatrexone (Relistor) for constipation

12 mg daily SubQ

128

Hydrocodone bitartrate ER (Zohydro ER)

initial dose

10 mg q12 scheduled

129

Hydrocodone bitartrate ER (Zohydro ER)

titration dose schedule

titrate dose by 10 mg increments q3-7d as tolerated and PRN

130

Hydromorphone (Dilaudid)

initial dose

2-4 mg q4-6h PO PRN

131

Oxymorphone (Opana) PO

5 mg q12h

132

Tapentadol (Nucynta) IR

50-100 mg q4-6h

133

Tapentadol (Nucynta) E R

50 mg q12h

134

A pt. is opioid tolerant if they're taking AT LEAST how much:

Morphine (PO)?

60 mg daily

135

A pt. is opioid tolerant if they're taking AT LEAST how much:

Fentanyl (Transdermal)?

25 mcg/h

136

A pt. is opioid tolerant if they're taking AT LEAST how much:

Oxycodone (PO)?

30 mg daily

137

A pt. is opioid tolerant if they're taking AT LEAST how much:

Hydromorphone (PO)?

8 mg daily

138

A pt. is opioid tolerant if they're taking AT LEAST how much:

Oxymorphone (PO)?

25 mg daily

139

Methadone for pain

initial dose

2.5-5mg q8-12h

140

Methadone for detox

initial dose

30 mg

141

Morphine/Naltrexone (Embeda)

initial dose

20 mg/0.8 mg q24h

142

Hydromorphone ER

initial dose

8-12 mg q24h