Non-opioid analgesics (Formulary: CNS)

Important: Formulation and dosage details

Formulation:

• Paracetamol tablets 500mg^OTC

Paracetamol caplets may be easier to swallow than standard tablets and are preferred by many patients. Caplets may be supplied on a prescription for paracetamol tablets.

Important: Formulation and dosage details

Formulation:

• Paracetamol soluble tablets 500mg^(OTC)

The salt content of dispersible formulations of paracetamol and co-codamol may be unsuitable for some patients.

Important: Formulation and dosage details

Formulation:

• Paracetamol oral suspension 120mg/5mL^OTC, 250mg/5mL^OTC

Important: Formulation and dosage details

Formulation:

• Paracetamol suppositories 60mg^OTC, 120mg^OTC, 240mg^OTC, 500mg^OTC

Important: Formulation and dosage details

Formulation:

• Paracetamol intravenous infusion 500mg/50mL, 1 gram/100mL

Consider dose reduction in patients with low body weight (less than 51kg), renal / hepatic impairment, chronic malnutrition, or chronic alcoholism.

MHRA advice: Intravenous paracetamol (Perfalgan▼): risk of accidental overdose (December 2014) 

• Is 100% bioavailable and there is a greater risk of toxicity so should only be prescribed where clinically indicated. Review the prescription regularly.
• Should only be used when the patient is ‘nil by mouth’, or has swallowing difficulty that is not overcome by the use of suspension.
• Must be given in lower doses to patients under 51kg.
• Renal impairment: increase dose interval as per BNF.
• Hepatic impairment: reduce dose as per BNF.
• Increase the minimum interval between each dose to 6 hours if creatinine clearance is less than 30mL/min.
• Is more effective than paracetamol suppositories.

Important: Formulation and dosage details

Formulation:

• Nefopam ablets 30mg (Restriction: specialist initiation/recommendation only)

In patients with renal impairment, as an alternative to opioids and NSAIDs, start at 30mg up to 3 times daily.

Important: Formulation and dosage details

Formulation:

• Lidocaine plaster 700mg

Indications: 

• As per SMC 334/06: for the treatment of neuropathic pain associated with previous herpes zoster infection (post-herpetic neuralgia).
  SMC Restriction: There are only limited comparative data available for lidocaine plasters, the comparative clinical effectiveness remains unclear. It is restricted to use in patients who are intolerant of first-line systemic therapies for post-herpetic neuralgia or where these therapies have been ineffective.
• Off-label as per Palliative Care Guidelines for: 
  • localised neuropathic pain (particularly associated with allodynia) that is unresponsive to opioids and adjuvant analgesics
  • locally painful bone metastases unresponsive to standard treatments (paracetamol, opioids, adjuvant analgesics, radiotherapy) or when standard treatments are inappropriate, poorly tolerated or contra-indicated
  • short term treatment of localised, severe uncontrolled bone or neuropathic pain, while adjuvant analgesics are being titrated.

Lidocaine patches are NOT recommended to be prescribed for other indications.

Dosage:

• The painful area should be covered with the plaster once daily for up to 12 hours, followed by a 12 hour plaster-free period.
• In total, not more than three plasters should be used at the same time.
• When needed, the plasters may be cut into smaller sizes with scissors.
• Expected treatment duration: 4 to 6 weeks. Patients are to be actively reviewed and treatment stopped when there is no perceived effect.