Symptoms | Medication | Usual effective dose range (adult) | Notes |
Anxiety | |||
Anxiety, irritability, restlessness | Diphenhydramine* | 50 to 100 mg orally every 4 to 6 hours as needed (maximum 300 mg daily) |
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Hydroxyzine | 25 to 100 mg orally every 6 to 8 hours as needed (maximum 400 mg daily) |
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Clonazepam¶ | 0.5 to 1.5 mg orally every 6 to 8 hours as needed (maximum 6 mg daily) |
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Lorazepam¶ | 1 mg orally every 4 to 6 hours as needed (maximum 6 mg daily) |
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Oxazepam¶ | 15 to 30 mg orally every 6 to 8 hours as needed (maximum 120 mg daily) |
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Buspirone | 10 to 15 mg every 8 hours as needed (maximum 60 mg daily) |
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Gastrointestinal | |||
Abdominal cramping | Dicyclomine* | 10 to 20 mg orally every 6 to 8 hours as needed (maximum 160 mg daily) |
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Diarrhea | Bismuth* | ~524 mg orally every 30 to 60 minutes as needed (up to 4200 mg daily) |
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Loperamide | 4 mg orally followed by 2 mg after each loose stool (maximum 16 mg daily) | ||
Nausea/vomiting | Ondansetron*Δ | 4 to 8 mg orally or IV every 12 hours as needed (maximum 16 mg/day) |
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Prochlorperazine | 5 to 10 mg orally three times daily before meals or every six hours as needed (maximum 40 mg/day) |
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Promethazine | 12.5 to 25 mg orally every 4 to 6 hours as needed (maximum 50 mg/day) |
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Insomnia, pain, muscle spasm, and restless legs | |||
Insomnia | Trazodone* | 25 to 100 mg orally at bedtime |
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Doxepin | 6 to 50 mg orally at bedtime |
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Mirtazapine | 7.5 to 15 mg orally at bedtime |
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Quetiapine | 50 to 100 mg orally at bedtime |
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Zolpidem¶ | 5 to 10 mg orally at bedtime |
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Muscle aches◊, joint pain, headache | Ibuprofen*§ | 400 mg orally every 4 to 6 hours as needed (maximum 2400 mg daily) |
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Acetaminophen | 650 to 1000 mg orally every 4 to 6 hours as needed (maximum 4000 mg daily) |
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Ketorolac§ | 15 to 30 mg IV or IM every 6 hours as needed (maximum 120 mg daily) |
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Naproxen§ | 500 mg orally twice daily with meals |
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Muscle spasm◊, restless legs | Cyclobenzaprine* | 5 to 10 mg orally every 8 hours as needed (maximum 30 mg daily) |
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Baclofen | 5 to 10 mg orally every 8 hours as needed (maximum 60 mg daily) |
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Diazepam¶ | 5 to 10 mg orally every 6 to 12 hours as needed (maximum 40 mg daily) |
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Methocarbamol | 750 to 1500 mg orally every 8 hours as needed (maximum 6 g daily) |
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IM: intramuscular; IV: intravenous; NSAID: nonsteroidal anti-inflammatory drug.
* Author's first choice.
¶ Use of benzodiazepines and benzodiazepine agonists (eg, zolpidem) is NOT recommended in patients receiving methadone or buprenorphine therapy unless under close medical supervision. Patients who resume heroin (diamorphine) use after a period of abstinence are at high risk of fatally overdosing, particularly if heroin use is resumed in combination with benzodiazepines, alcohol, or other drugs with sedative characteristics (eg, quetiapine). The use of benzodiazepines should be limited to 5 to 10 days in total and tapered. They are not recommended for use in supervised outpatient withdrawal and should be reserved for inpatient settings where frequent clinical monitoring is provided.
Δ Risk of QTc prolongation or torsades de pointes is also elevated with advanced age, female sex, heart disease, congenital long QT syndrome, hypokalemia or hypomagnesemia, overly rapid IV administration, and combination of drugs with QTc prolonging effects (eg, methadone). Refer to topic on acquired long QT syndrome.
◊ Warm baths, rehydration, and gentle stretching are also helpful for relieving muscle aches and cramps.
§ Safety concerns of NSAID use in older adults and patients with, or at elevated risk for, cardiovascular disease, gastrointestinal bleeding, organ dysfunction, or thrombotic events are addressed separately in UpToDate.Do you want to add Medilib to your home screen?