Table 5.
Adjuvant analgesics used in pediatric pain management (Pain Medicine and Palliative Care, Children’s Hospitals and Clinics of Minnesota) [79].
| Class | Medication | Dose | Route of Administration | Comments/Side Effects (See Text for Further Details) |
|---|---|---|---|---|
| Tricyclic Antidepressants (TCA) | Amitriptyline | Starting dose 0.1 mg/kg QHS, usually slowly titrated up to 0.5 mg/kg (max. 20-25 mg) | PO | Tertiary amine TCA; stronger anticholinergic side effects (including sedation) than nortriptyline |
| Nortriptyline | Starting dose 0.1 mg/kg QHS, usually titrated up to 0.5 mg/kg (max. 20-25 mg) | PO | Secondary amine TCA; anticholinergic side effects | |
| Gabapentenoids | Gabapentin | Starting dose 2 mg/kg QHS, usually slowly titrated up to initial target dose of 6 mg/kg/dose TID (max. 300 mg/dose TID). Max. dose escalation to 24 mg/kg/dose TID (max. 1200 mg/dose TID) | PO | Slow dose increase required; side effects: ataxia, nystagmus, myalgia, hallucination, dizziness, somnolence, aggressive behaviors, hyperactivity, thought disorder, peripheral edema |
| Pregabaline | Starting dose 0.3 mg/kg QHS, usually slowly titrated up to initial target dose of 1.5 mg/kg/dose BID (max. 75 mg/dose BID). Max. dose escalation to 6 mg/kg/dose BID (max. 300 mg/dose BID) | PO | Switch from gabapentin, if distressing side effects or inadequate analgesia. Side effects: ataxia, nystagmus, myalgia, hallucination, dizziness, somnolence, aggressive behaviors, hyperactivity, thought disorder, peripheral edema; Associated with weight gain | |
| Sodium Channel Blocker/Local anesthetic | Lidocaine 5% | Max. of 4 patches (in patients > 50 kg) 12 h on/12 h off | Transdermal patch | Not for severe hepatic dysfunction |
| Alpha-Agonist | Clonidine | 1–3 mcg/kg QHS to Q6h | PO/transdermal | |
| Dexmedetomidine | Infusion: 0.3 mcg/kg/h; titrate to max. 2 mcg/kg/h | IV | ||
| Hormone | Melatonin | 0.06–0.2 mg/kg (max. 3–10 mg) QHS | PO | Sleep induction, use extended-release, if interrupted sleep, possible analgesic effect |
QHS: every night at bedtime; PO: per os, oral administration; IV: intravenous administration; BID: bis in die, twice a day; TID: ter in die, three times a day; Q6h: every 6h.