Moderate-to-severe Odontogenic Pain

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
600 q6h
800 q8h
Naproxen (generic, Naprosyn) 250 q6h 1,000
500 q12h
Naproxen sodium
(generic, Anaprox)
275 q6h 1,100
550 q12h

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
q6h
Ibuprofen, 600 mg
+
APAP, 325 to 650 mg
q8h
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