. 2021 Jul 1;2(3):e072. doi: 10.1097/AS9.0000000000000072

TABLE 2.

Perioperative Medications, Timing, Dosages, and Potential Side Effects in Older Adults

Phase of Care	Medication	Timing	Example Dosing²⁸	Maximum Dose	Side Effects	Special Considerations
Preoperative	Acetaminophen	Within 30–90 min of surgery	500 to 1000 mg IV or PO × 1 mg daily	3000 mg daily	Hepatotoxicity	Reduce maximum dose (2000 mg) if malnourished (<50 kg) or hepatic insufficiency²⁸
	NSAIDs (eg, celecoxib)		200 mg PO celecoxib × 1 mg daily	Celecoxib: 400 mg daily	GI bleeding, renal dysfunction	Nonselective potentially inappropriate: risk of GI bleed, PUD, and AKI²⁹
	GABA analogs (eg, gabapentin, pregabalin)		600 mg PO gabapentin OR 150 mg PO of pregabalin x 1 mg daily	Gabapentin: 2400 mg/d	Respiratory depression, sedation, dizziness	Potential drug-drug interaction with opioids²⁹
	GABA analogs (eg, gabapentin, pregabalin)			Pregabalin: 300 mg/d	Respiratory depression, sedation, dizziness	Potential drug-drug interaction with opioids²⁹
Intraoperative Peri-induction	Neuraxial/local	At time of induction or incision	Variable dose and route	Variable	Cardiotoxicity	Route specific to surgery
	Dexamethasone		0.11–0.2 mg/kg	8–25 mg per day	Blood glucose alterations	Anesthesia to dose
	Magnesium		30–50 mg/kg bolus followed by infusion	30–40 g per day	Hypotension	Anesthesia to dose
Postoperative	Acetaminophen	Initiate <24 h of surgery completion	500–1000 mg PO or IV q6h	3000 mg daily	Hepatotoxicity	Reduce maximum dose (2000 mg) if malnourished (<50 kg) or hepatic insufficiency
	NSAIDs		200 mg BID celecoxib OR 15 mg IV q6h ketorolac	Celecoxib: 400 mg daily	GI bleeding, renal dysfunction	Nonselective potentially inappropriate: risk of GI bleed, PUD, and AKI
	NSAIDs		200 mg BID celecoxib OR 15 mg IV q6h ketorolac	Ketorolac: 60 mg/d	GI bleeding, renal dysfunction
	GABA analogs		600 mg gabapentin OR 150 mg pregabalin q12h	See above	Respiratory depression, sedation, dizziness	Potential drug-drug interaction with opioids
	Topical patches		5% lidocaine patch (lidoderm) 12 h/d	NA	Local skin reaction
	Opioids		Reduce by 25%–50% (eg, 2.5 mg oxycodone q6h)	Variable	Respiratory depression, sedation, tolerance, and addiction risks	Use equianalgesic table when converting³⁰
	Opioids		PCA when IV required (eg, morphine 1 mg q10min or hydromorphone 0.1 mg q10min)	Variable		Use equianalgesic table when converting³⁰

AKI indicates acute kidney injury; BID, twice daily; GABA, gamma-aminobutyric acid; GI, gastrointestinal; IV, intravenous; NSAIDs, nonsteroidal anti-inflammatory drugs; PCA, patient-controlled analgesia; PO, per oral; PUD, peptic ulcer disease; q10min, every 10 minutes; q12h, every 12 hours; q6h, every 6 hours.