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Pain Management Medication Types (cont.)

Medical Editor:

What are the warnings/precautions with pain medications?

Acetaminophen can be toxic to the liver and should be used with caution, if at all, in people with liver disease. The maximum recommended dose of acetaminophen is 4 grams per 24 hours, but moderate-to-heavy alcohol drinkers need to have the dosage adjusted downward.

NSAIDs may cause bleeding in the stomach. To reduce this possibility, they should be taken with food. These drugs may cause kidney failure in those with kidney or liver disease. Also, some NSAIDs increase the risk of cardiovascular events.

Opioid analgesics may result in dependency. Operating a motor vehicle or machinery may be dangerous while using these pain medications because they can cause drowsiness. Opioids may slow down breathing. Mixing opioids with alcohol or certain other centrally-acting drugs could make this effect even worse.

Death and serious side effects have occurred with the use of fentanyl transdermal patches. Fentanyl patches are not recommended as starting therapy in inexperienced opiate users. Heat from the sun, hot baths, or heating pads can increase the speed of fentanyl release from patches.

Fentanyl buccal tablets have just one indication: treatment of breakthrough pain in cancer patients who are using and who have grown tolerant to opiates. Inappropriate use of fentanyl buccal tablets has resulted in death.

Methadone can affect the heart. Patients slated for methadone therapy should first have an EKG to check for abnormalities.

Most muscle relaxants cause drowsiness. Metaxalone and chlorzoxazone should be used with caution in people with liver disease. Dantrolene can be toxic to the liver. Carisoprodol use may result in dependence.

Anxiolytics or anti-anxiety medications -- especially the benzodiazepine class -- may cause drowsiness. Sudden withdrawal from these drugs can result in seizures and possibly death.

Some antidepressant medications may cause drowsiness. The older antidepressants (the tricyclics) interact with a wide array of drugs, sometimes with fatal results -- and they can affect the heart.

Patients using anticonvulsants as well as newer antidepressants should be monitored for signs and symptoms of suicidal thoughts.

Orally administered corticosteroids for acute inflammation should not, in general, be suddenly withdrawn. Doses are customarily tapered down over time and patients must follow instructions exactly.

Medically Reviewed by a Doctor on 4/27/2016

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