LOWER BACK PAIN DRUG TREATMENT BASICS

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Drug

Dosage

Comment

Acetaminophen (Tylenol)

3000 – 4000 mg total daily dose

(1 or 2 XST tabs QID)

1st line

Safest of all

Use around the clock instead of as needed

2 to 4 weeks duration

Ibuprofen (e.g. Advil, Motrin)

Anti-inflammatory agent (NSAID)

Up to 800mg TID

1st line

May be more effective than acetaminophen

Use around the clock instead of as needed

2 to 4 weeks duration

Avoid if hypertension, heart failure, GI ulcers, kidney diseases

Naproxen (e.g. Aleve)

Anti-inflammatory agent (NSAID)

500mg BID

1st line

May be more effective than acetaminophen

Use around the clock instead of as needed

2 to 4 weeks duration

Avoid if hypertension, heart failure, GI ulcers, kidney diseases

Cyclobenzaprine

Muscle relaxant

5 – 10 mg TID

2nd line

High incidence of CNS side effects (e.g. sedation)

Avoid in seniors (risk of falls)

Limit use to 7 days only

Tizanidine (e.g. Zanaflex)

Muscle relaxant

2mg starting dose TID

Increase gradually, if needed, to maximum 12mg TID

2nd line

Hypotension (20% drop in blood pressure)

Limit use to 7 days

Methocarbamol (e.g. Robax Platinum, Robaxacet)

Muscle relaxant

1 to 2 tablets TID

2nd line

Less drowsiness than cyclobenzaprine

Discolored urine (brown or green)

Gabapentin (e.g. Neurontin)

 

300 – 600mg TID

2nd line

For sciatica related back pain

Drowsiness & fatigue

Tramadol (e.g. Zytram XL, Tramacet) or short-acting opioid (e.g. Oxycodone)

Tramacet 1-2 tabs QID

Xytram XL 150 to 400mg daily

Oxycoet 1 tab q6h

3rd line

For pain not controlled by acetaminophen or NSAID

No more effective than NSAID for low back pain

Avoid tramadol if history of seizures or on SSRI

Use only 1 to 2 weeks

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