Osteoarthritis Drug Summary

Drug	Dosage	Remarks
Natural Opium Alkaloids
Dihydrocodeine tartrate	30 mg PO 4-6 hourly Max dose: 60 mg/dose	Adverse Reactions GI effects (nausea/vomiting, constipation, dry mouth); CNS effects (drowsiness, confusion, dizziness, headache, changes in mood); CV effects (bradycardia, tachycardia, palpitations) Large doses may cause respiratory depression/failure, hypotension, deepening coma, renal failure Special Instructions Avoid use in patients with acute respiratory depression, obstructive airway disease, acute alcoholism, convulsive disorder, head injuries, increased intracranial pressure, at risk of paralytic ileus, or in patients who require mental alertness (eg driving, operating machines) Use with caution in patients with hypothyroidism, adrenocortical insufficiency, asthma, renal or hepatic impairment, prostatic hyperplasia, hypotension, shock, inflammatory or obstructive bowel disease, myasthenia gravis Oxycodone: Contraindicated for use in patients <18 years old
Oxycodone	5 mg PO 4-6 hourly May increase when necessary Extended release:  5-10 mg PO 12 hourly Max dose: 400 mg/day Opioid-tolerant: 60-80 mg PO 12 hourly Opioid-naive: 10 mg PO 12 hourly
Other Opioid
Tramadol	50-100 mg PO 4-6 hourly Max dose: 400 mg/day

*Combinations with various analgesics are available. Please see the latest MIMS for specific formulations and prescribing information.

Drug	Dosage	Remarks
Duloxetine	Initial dose: 30 mg PO 24 hourly for 1 week Maintenance dose: 60 mg PO 24 hourly Max dose: 60 mg PO 24 hourly	Adverse Reactions GI effects (nausea, dry mouth); CNS effects (headache, somnolence, dizziness); Psychiatric effects (insomnia, agitation, anxiety, abnormal dreams); CV effect (palpitations); Hepatic effects (increased alkaline phosphatase, aspartate aminotransferase, alanine transaminase, liver injury); GU effects (abnormal orgasm, decreased libido, erectile dysfunction, gynecological hemorrhage, urinary frequency) Special Instructions Instruct patients to swallow whole; do not crush, chew, open capsule or mix with food or liquids Avoid use in patients with narrow-angle glaucoma and/or increased intraocular pressure Use with caution in patients with history of mania, bipolar disorder, depression, seizures, hypertension, renal impairment, hyponatremia, and in patients taking anticoagulants

Drug	Dosage	Remarks
Hydrolyzed collagen1 (Collagen hydrolysate, Collagen peptide)	1,200 mg PO 24 hourly at bedtime	Special Instructions Should be taken on an empty stomach Contraindicated in patients with liver or kidney disease, low protein diet; pregnancy and lactation

¹Various combination preparations are available. Please see the latest MIMS for specific formulations and prescribing information.

All dosage recommendations are for non-pregnant and non-breastfeeding women and non-elderly adults with normal renal and hepatic function unless otherwise stated. 
Not all products are available or approved for above use in all countries. 
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs. 
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.