Indications & Dose: PAIN Moderate-to-severe PO Adult 50-100mg q4-6h, ER 100mg OD Child 12–18 yr: 50–100mg not more often than q4h Elderly >75 yr: IR Max 300mg/day | Moderate-to-severe IV/IM Adult 50-100mg q4-6h over 2-3 min Child 12–18 yr: 50–100mg q4-6h | POST-OPERATIVE PAIN IV Adult Initially 100mg, then 50mg q10-20 min if needed, max 250mg in first hour (including initial dose). Thereafter, doses are 50-100mg q4-6h up to a total daily dose of 600 mg Child 12-18 yr: Initially 100mg, then 50mg q10-20min if necessary total max 250mg (including initial dose) in first hour, then 50-100mg q4–6h, max 600mg/day | RECTAL Adult Suppository: 100mg QID

Precautions: increased intracranial pressure/head injury, renal/hepatic impairment, anaphylactoid reactions, CNS depression, seizures, respiratory disease, acute abdominal conditions

ADR: Serious: Flushing, postural hypotension, chest pain, blurred vision, dyspnea, abnormal ECG, bradycardia, bronchospasm, seizure, respiratory depression, Others: sedation, diaphoresis, bronchitis, congestion, anxiety, depression, euphoria, malaise, dermatitis, xerostomia, UTI, arthralgia, dizziness, headache, somnolence, insomnia, pruritus, constipation, nausea, vomiting, dyspepsia, weakness

DDI: Serious CNS Depressants causes sedation & respiratory depression, Venlafaxine causes serotonin syndrome, Carbamazepine increases drug metabolism & reduces analgesic effect, Coumarins increases risk of bleeding, Alcohol leads to CNS depression, TCAs/SSRIs leads to seizures & serotonin syndrome, Ondansetron reduces drug efficacy

Diet: With/without food

Monitor: Pain relief, respiratory rate, BP & pulse, signs of tolerance, abuse, suicidal ideation