HIV/AIDS Treatment and Care : Clinical protocols for the European ...

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HIV/AIDS TREATMENT AND CARE CLINICAL PROTOCOLS FOR THE WHO EUROPEAN REGION
Type of pain or treatment Usual starting dose (adults) Recommendations
Muscle spasms Diazepam
5–10 mg 2–3 times daily
In terminal care, with no referral
and:
• swelling around tumour;
• severe oesophageal candidiasis
with ulceration and swallowing
problems;
• nerve compression; or
• persistent severe headache due
to increased intracranial pressure.
Tetrazepam
50 mg/day, up to 200 mg/day in
2 doses
Baclofen
Begin with 5 mg three times
daily (TID), increase every 3
days up to 25 mg TID.
Dexamethasone
2–6 mg per day
Prednisolone
15–40 mg for 7 days or as provided
by trained health worker
Gastrointestinal pain from colic Butylscopolamine
10-20 mg 2-3 times daily
C. Non-medical treatment
Psychological, spiritual and/or
emotional support and counselling
to accompany pain medication
Relaxation techniques, including
physical methods, such as massage
and breathing techniques; and cognitive
methods, such as music
Codeine
30 mg every 4 hours
Trimebutin
100–200 mg TID before meals
IDUs: before administering consider
carefully the possibility of polysubstance
misuse. Should only be used in the short
term (6–8 weeks maximum).
Helpful in terminal care; improves appetite
and makes patient feel comfortable.
Reduce dose to lowest possible.
Withdraw if no benefit in 3 weeks.
Dexamethasone is about seven times
stronger than prednisolone. If prednisolone
needs to be used, multiply the dexamethasone
dose by seven.
Corticosteroids may cause candidiasis.
Butylscopolamine has different half-lives:
IV is more rapid, while per os (PO) is
slower, though dosage remains the same
for both. Start with IV, followed by PO; if
stable PO, dose with IV for peaks.
Codeine can cause constipation and
worsening of symptoms in injecting drug
users (IDU). Be aware of possible abuse of
codeine or morphine-related drugs.
—
Not applicable Pain may be more difficult to bear when
accompanied by guilt, fear of dying, loneliness,
anxiety or depression. Relieve fear
and anxiety by explaining events.
Not applicable Contraindicated if the patient is psychotic
or severely depressed.
a Administer only one drug from the non-opioid and opioid choices at a time; aspirin every 4 hours can be given along with
paracetamol every 4 hours by offsetting the schedule so that the patient is being given one of the two every 2 hours.
b See equianalgesic dose chart in Annex 1, which can be used to help select or substitute for specific opioid analgesics.
c If pain is controlled, reduce morphine rapidly or stop if used for only a short time; reduce gradually if used for more than 2
weeks.
d Morphine and oxycodone are frequently available in long-acting (sustained-release) forms; the guidelines above refer to acute
pain management, which should be initiated with short-acting preparations and then converted to long-acting formulations if
the need for chronic analgesia persists.