Table 3.

Non-opioid analgesic options used in the emergency setting. The medications, doses, and durations listed are estimates based on average responses in the general population; a full consideration of the individual patient's presentation and comorbidities should be given prior to initiating an analgesic regimen.

Medication	Average Dose	Duration	Max Dose	Side effects
Ibuprofen	400 mg PO	8 h	1200 mg per day	GI irritation, bleeding, renal dysfunction, bronchospasm, delayed wound healing
Diclofenac	50 mg PO	8 h	150 mg per day	GI irritation, bleeding, renal dysfunction, bronchospasm, delayed wound healing
Naproxen	250 mg PO (every 8 h) 500 mg PO (every 12 h)	8–12 h	1000 mg per day	GI irritation, bleeding, renal dysfunction, bronchospasm, delayed wound healing
Ketorolac	10–15 mg IV	6 h	60 mg per day	GI irritation, bleeding, renal dysfunction, bronchospasm, delayed wound healing
Capsaicin	thin film to effected area	6–8 h	Varies	Localized pain, erythema (rare - transient hypertension, pruritus, swelling, papules)
Acetaminophen	325-1000 mg PO	4–6 h	4 g per day	Nausea, vomiting, liver toxicity
Lidocaine	1.5 mg/kg  (admin over 10 min)	Varies	200 mg per administration	Confusion, anxiety, sense of impending doom, headache, drowsiness, cardiac dysrhythmias
Metoclopramide	10 mg IV	1–2 h	40 mg per day	Akathisia, dystonia, drowsiness, QT prolongation, torsade de pointes
Prochlorperazine	10 mg IV, PO	3–4 h	40 mg per day	Akathisia, dystonia, drowsiness, QT prolongation, torsade de pointes
Chlorpromazine	10 mg IV, PO	4–6 h	25 mg per day	Akathisia, dystonia, drowsiness, QT prolongation, torsade de pointes
Haloperidol	2–10 mg PO, IV, IM	2–4 h	20 mg (based on side effect profile, ECG findings)	Akathisia, dystonia, drowsiness, QT prolongation, torsade de pointes
Droperidol	2.5 mg IV	2–4 h	Unknown (based on side effect profile, ECG findings)	Akathisia, dystonia, drowsiness, QT prolongation, torsade de pointes
Ketamine	0.15–0.3 mg/kg IV	Varies	Dependent on infusion	Dizziness, agitation, emergence reaction, nystagmus, sensation of unreality, nausea, vomiting
Nitrous Oxide	50/50 (%NO/%Oxygen mixture)	3–5 min	Varies	Nausea, vomiting, headache, euphoria, dizziness, tingling, oral distaste mild increase in intracranial pressure
Propofol	30–40 mg IV	Varies (repeat 10 mg every 3–5 min as needed)	120 mg per day	Respiratory depression, hypotension, sedation, hypertriglyceridemia, pain at injection Propofol Infusion Syndrome
Sumatriptan	6 mg SQ 25–100 mg PO	Varies	12 mg SQ per day 200 mg PO per day	Tingling sensation, dizziness, hot flashes, palpitations, drowsiness, dysrhythmia
Gabapentin	300 mg PO (titrated up to 1200 mg three times per day)	24 h (requires titration to effect)	3600 mg per day	Fatigue, dizziness, weight gain, ataxia, nystagmus, leukopenia, rhabdomyolysis
Pregabalin	50–75 mg PO (titrate up to 150–300 mg)	12 h	600 mg per day (following slow titration)	Fatigue, dizziness, weight gain, ataxia, nystagmus, thrombocytopenia, angioedema
Dexmedetomidine	0.5–1 μg/kg IV	Varies	Dependent on infusion	Hypotension, bradycardia