Prescription strength ibuprofen, naproxen, and naproxen sodium are more effective than codeine with APAP, 60/650 mg (Table 3).36 Consequently, full doses of NSAIDs are the drugs of choice for the treatment of moderate-to-severe odontogenic pain.37-43 It is also of note that full doses of NSAIDs administered concurrently with APAP (325 to 650 mg) are more effective for the treatment of odontogenic pain than full dose of a NSAID or APAP (650 mg) alone.44,45,46
Table 3. NSAIDs for Moderate-to-severe Odontogenic Pain.
|Drug||Usual oral single dose in milligrams||Dosing||Maximum daily dose in milligrams||“Add-on” APAP doses in milligrams|
|Ibuprofen (generic, Motrin)||400||q4h||2,400||325 to 650|
|Naproxen (generic, Naprosyn)||250||q6h||1,000|
If moderate-to-severe odontogenic pain is not relieved with full doses of ibuprofen with “add-on” doses of APAP, a weak, full μ-receptor agonist such as fixed-dose hydrocodone w/ibuprofen, 5/200 mg, with “add-on” doses of ibuprofen (and APAP) should be considered (Table 4). When NSAIDs are contraindicated alternative options include fixed-doses of hydrocodone w/APAP, 5/325 mg, or codeine w/APAP, 30/325 mg, up to a maximum of two tablets per dose and no “add-on” doses of APAP.
Table 4. Weak, Full μ-receptor Agonists for Moderate-to-severe Odontogenic Pain.
|Drug||Fixed-dose oral formulations in milligrams||“Add-on” options||Dosing|
|Hydrocodone w/ibuprofen (Vicoprofen, Reprexain)||5/200||Ibuprofen, 400 mg
APAP, 325 to 650 mg
|Ibuprofen, 600 mg
APAP, 325 to 650 mg
|Hydrocodone w/APAP (generic, Vicodin, others)||5/325||N/A||q4-6h|
|Codeine w/APAP (generic, Tylenol w/codeine)||30/325||N/A||q4-6h|
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