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NORGESIC (orphenadrine citrate/aspirin/caffeine)
- muscle or bone pain
25 mg-385 mg-30 mg tablet
- 1 tablet by oral route 3-4 times daily as needed
Default screening record
- 1 tablet by oral route 3 times per day
- 1 tablet by oral route 4 times per day
- 2 tablets by oral route 4 times per day
- 2 tablets by oral route 3 times per day
- 1 tablet by oral route 3-4 times daily as needed
- 2 tablets by oral route 3-4 times daily as needed
- dipyridamole
- ketorolac
- Mifeprex
- mifepristone
- Sprix
Contraindicated
- Acid Reducer (cimetidine)
- Acid Relief (cimetidine)
- Adenocard
- Adenoscan
- adenosine
- adenosine (diagnostic)
- Agrylin
- Alimta
- anagrelide
- apixaban
- Brilinta
- cimetidine
- Coumadin
- Curad Enema
- Disposable Enema
- Eliquis
- Enema
- Enema Disposable
- Fleet Enema
- Fleet Enema Extra
- Fleet Pediatric
- flu vac,qval 2013-14 (2-49yrs)
- Flumist 2013-2014
- Heartburn Relief
- Jantoven
- K-tab
- Klor-con
- Klor-con 10
- Klor-con M10
- Klor-con M15
- Klor-con M20
- Lexiscan
- Medi-lyte
- Methotrexate (anti-rheumatic)
- methotrexate sodium
- methotrexate sodium (PF)
- Oral Saline Laxative
- Osmoprep
- pemetrexed
- Phosphate Laxative
- potassium chloride
- potassium citrate
- potassium Cl-calcium phos-mag
- Preparation Cleansing
- Ready-to-use Enema
- regadenoson
- Rheumatrex
- rivaroxaban
- sod phos mono-sod phos dibasic
- sodium Cl-potassium chloride
- sodium phosphates
- Tagamet Hb
- Thermotabs
- ticagrelor
- Trexall
- Urocit-k 10
- Urocit-k 15
- Urocit-k 5
- varicella virus vacc live (PF)
- Varivax (pf)
- warfarin
- Xarelto
Severe
Moderate
- A-hydrocort
- A-methapred
- Accupril
- Accuretic
- acebutolol
- Aceon
- acetazolamide
- acetazolamide sodium
- Altace
- Amaryl
- amlodipine-benazepril
- Anucort-hc
- Anusol-hc
- Aristospan Intra-articular
- Aristospan Intralesional
- Arixtra
- Astagraf Xl
- atenolol
- atenolol-chlorthalidone
- benazepril
- benazepril-hydrochlorothiazide
- betamethasone acet & sod phos
- Betapace
- Betapace Af
- betaxolol
- bisoprolol fumarate
- bisoprolol-hydrochlorothiazide
- Brevibloc
- Brevibloc In Nacl (iso-osm)
- Brintellix
- Brisdelle
- budesonide
- bumetanide
- Bystolic
- captopril
- captopril-hydrochlorothiazide
- Celestone Soluspan
- Celexa
- citalopram
- colchicine-probenecid
- Colocort
- Corgard
- Cortef
- Cortenema
- Cortifoam
- cortisone
- Corzide
- cyclosporine
- cyclosporine modified
- Cymbalta
- dalteparin (porcine)
- Demadex
- Depacon
- Depakene
- Depakote
- Depakote Er
- Depakote Sprinkles
- Depo-medrol
- desvenlafaxine
- desvenlafaxine fumarate
- desvenlafaxine succinate
- dexamethasone
- Dexamethasone Intensol
- dexamethasone sodium phos (PF)
- dexamethasone sodium phosphate
- Dexpak 10 Day
- Dexpak 13 Day
- Dexpak 6 Day
- Diabeta
- Diamox Sequels
- divalproex
- Duetact
- duloxetine
- Dutoprol
- Effexor Xr
- Elmiron
- enalapril maleate
- enalapril-hydrochlorothiazide
- enalaprilat
- enoxaparin
- Entocort Ec
- Epaned
- escitalopram oxalate
- esmolol
- esmolol in NaCl (iso-osm)
- ethacrynate sodium
- Ez Use Joint-tunnel-trigger
- Fetzima
- First-duke's
- First-mary's Mouthwash
- Flo-pred
- fludrocortisone
- fluoxetine
- fluvoxamine
- fondaparinux
- fosinopril
- fosinopril-hydrochlorothiazide
- Fragmin
- furosemide
- Gengraf
- glimepiride
- glipizide
- glipizide-metformin
- Glucotrol
- Glucotrol Xl
- Glucovance
- glyburide
- glyburide micronized
- glyburide-metformin
- Glynase
- Grx Hicort 25
- Hecoria
- Hemril-30
- heparin (porcine)
- heparin (porcine) in D5W
- heparin(porcine) in 0.45% NaCl
- heparin, porcine (PF)
- hydrocortisone
- hydrocortisone acetate
- hydrocortisone sod succ (PF)
- hydrocortisone sod succinate
- Inderal La
- Inderal Xl
- Innopran Xl
- Kenalog
- Khedezla
- Lasix
- lepirudin
- Levatol
- levomilnacipran
- Lexapro
- lisinopril
- lisinopril-hydrochlorothiazide
- lithium carbonate
- lithium citrate
- Lithobid
- Lopressor
- Lopressor Hct
- Lotensin
- Lotrel
- Lovenox
- Luvox Cr
- Mavik
- Medrol
- Medrol (pak)
- methazolamide
- methylprednisolone
- methylprednisolone acetate
- methylprednisolone sod suc(PF)
- methylprednisolone sodium succ
- methylprednisolone-bupivacaine
- metoprolol su-hydrochlorothiaz
- metoprolol succinate
- metoprolol ta-hydrochlorothiaz
- metoprolol tartrate
- Millipred
- Millipred Dp
- milnacipran
- moexipril
- moexipril-hydrochlorothiazide
- nadolol
- nadolol-bendroflumethiazide
- nateglinide
- nebivolol
- Neoral
- Neptazane
- nystatin-hydrocortisone-diphen
- nystatin-TCN-HC-diphenhydramin
- olanzapine-fluoxetine
- Orapred
- Orapred Odt
- paroxetine HCl
- paroxetine mesylate
- Paxil
- Paxil Cr
- Pediapred
- penbutolol
- pentosan polysulfate sodium
- perindopril erbumine
- Pexeva
- Physicians Ez Use M-pred
- pindolol
- pioglitazone-glimepiride
- prednisolone
- prednisolone acetate
- prednisolone sodium phosphate
- prednisone
- Prednisone Intensol
- Prinivil
- Pristiq
- probenecid
- Proctocort
- Prograf
- propranolol
- propranolol-hydrochlorothiazid
- Prozac
- Prozac Weekly
- quinapril
- quinapril-hydrochlorothiazide
- ramipril
- Rapamune
- Rayos
- Rectacort-hc
- Refludan
- Sandimmune
- Sarafem
- Savella
- Sectral
- sertraline
- sirolimus
- Sodium Edecrin
- Solu-cortef
- Solu-cortef (pf)
- Solu-medrol
- Solu-medrol (pf)
- Sorine
- sotalol
- Sotalol Af
- Starlix
- Stavzor
- Symbyax
- tacrolimus
- Tarka
- Tenoretic 100
- Tenoretic 50
- Tenormin
- ticlopidine
- timolol maleate
- tolazamide
- tolbutamide
- Toprol Xl
- torsemide
- trandolapril
- trandolapril-verapamil
- triamcinolone acetonide
- triamcinolone hexacetonide
- triamcinolone-lidocaine
- Uceris
- Uniretic
- Univasc
- valproate sodium
- valproic acid
- valproic acid (as sodium salt)
- Vaseretic
- Vasotec
- venlafaxine
- Veripred 20
- Viibryd
- vilazodone
- vortioxetine
- Zebeta
- Zestoretic
- Zestril
- Ziac
- Zoloft
- Achalasia of esophagus
- Aspirin exacerbated respiratory disease
- Benign prostatic hyperplasia
- Bladder outflow obstruction
- Duodenal obstruction
- Gastrointestinal hemorrhage
- Glaucoma
- Hemolytic anemia from pyruvate kinase and g6PD deficienc
- Hemophilia
- Lactation
- Myasthenia gravis
- Pregnancy
- Pyloroduodenal obstruction
- Reye's syndrome
- Stenosing peptic ulcer
- Von willebrand's disease
Contraindicated
- Alcoholism
- Chronic kidney disease stage 4 (severe) GFR 15-29 ml/min
- Chronic kidney disease stage 5 (failure) GFr<15 ml/min
- Gastrointestinal ulcer
- Hypoprothrombinemia
- Necrotizing enterocolitis
- Peptic ulcer
- Salicylate intoxication
- Severe hepatic disease
- Systemic mastocytosis
- Thrombocytopenic disorder
- Thrombotic thrombocytopenic purpura
Severe
Moderate
- Acute decompensated heart failure
- Anemia
- Cardiac arrhythmia
- Chronic myocardial ischemia
- Disease of liver
- Gout
- Kidney disease with reduction in GFR
- Nasal polyp
- Seizure disorder
- Tachyarrhythmia
- Vitamin K deficiency
NORGESIC (orphenadrine citrate/aspirin/caffeine)
- muscle or bone pain
- None
- Abdominal pain with cramps
- Gastric acid hypersecretory conditions
- Gastrointestinal irritation
- Heartburn
- Insomnia
- Nausea
- Nervousness
- Vomiting
More Frequent
Severe
Less Severe
- Ocular hypertension
- Palpitations
- Syncope
- Tachycardia
- Abdominal pain with cramps
- Acute confusion
- Blurred vision
- Constipation
- Diplopia
- Dizziness
- Drowsy
- Dysuria
- Excitement
- Headache disorder
- Insomnia
- Nausea
- Nervousness
- Tremor
- Visual changes
- Vomiting
- Xerostomia
Less Frequent
Severe
Less Severe
Rare / Very Rare
Severe
- Allergic dermatitis
- Anaphylaxis
- Anemia
- Angioedema
- Aplastic anemia
- Blistering skin
- Bronchospastic pulmonary disease
- DRESS syndrome
- Drug-induced hepatitis
- Dyspnea
- Extrasystoles
- Gastrointestinal hemorrhage
- Gastrointestinal perforation
- Gastrointestinal ulcer
- Hallucinations
- Hemolytic anemia
- Hemorrhage
- Interstitial nephritis
- Intracranial bleeding
- Leukopenia
- Pancytopenia
- Platelet aggregation inhibition
- Purpura
- Rectal bleeding
- Seizure disorder
- Thrombocytopenic disorder
- Urticaria
- Wheezing
Less Severe
- Abnormal hepatic function tests
- Agitation
- Anorexia
- Anticholinergic toxicity
- Black tarry stools
- Drowsy
- Dyspepsia
- Ecchymosis
- Epistaxis
- Erythema
- Gastritis
- Gingival bleeding
- Hematoma
- Hyperesthesia
- Hyperglycemia
- Irritability
- Muscle weakness
- Nausea
- Pruritus of skin
- Scotomata
- Skin rash
- Symptoms of anxiety
- Tachycardia
- Tinnitus
- Tremor
- Vomiting
Contraindicated
None
Severe Precaution
Aspirin
Reye syndrome risk with viral illness, fever, and/or flu symptoms.
- 1 Day – 16 Years
- Reye syndrome risk with viral illness, fever, and/or flu symptoms.
Management or Monitoring Precaution
Caffeine
Caution in infants with seizure disorder, cardiovascular disease, renal impairment, or hepatic impairment.
Adverse CNS effects (e.g. insomnia, restlessness, nervousness, and mild delirium) may be more severe in children.
Safety and efficacy not established in children age less than 12 years.
- 1 Day – 364 Days
- Caution in infants with seizure disorder, cardiovascular disease, renal impairment, or hepatic impairment.
- Adverse CNS effects (e.g. insomnia, restlessness, nervousness, and mild delirium) may be more severe in children.
- 1 Years – 13 Years
- Caution in infants with seizure disorder, cardiovascular disease, renal impairment, or hepatic impairment.
- Adverse CNS effects (e.g. insomnia, restlessness, nervousness, and mild delirium) may be more severe in children.
- 1 Day – 12 Years
- Caution in infants with seizure disorder, cardiovascular disease, renal impairment, or hepatic impairment.
- Adverse CNS effects (e.g. insomnia, restlessness, nervousness, and mild delirium) may be more severe in children.
Orphenadrine
Caution in infants with seizure disorder, cardiovascular disease, renal impairment, or hepatic impairment.
Adverse CNS effects (e.g. insomnia, restlessness, nervousness, and mild delirium) may be more severe in children.
Safety and efficacy not established in children age less than 12 years.
- 1 Day – 364 Days
- Safety and efficacy not established in children age less than 12 years.
- 1 Years – 13 Years
- Safety and efficacy not established in children age less than 12 years.
- 1 Day – 12 Years
- Safety and efficacy not established in children age less than 12 years.
Aspirin (>162.5Mg)
- Severity Level:
1
- Additional Notes: No fda category; not recommended near or after 20 weeks gestation
Caffeine
- Severity Level:
C
- Additional Notes: Insufficient human data available
Orphenadrine
- Severity Level:
C
- Additional Notes: Insuff human data avail; consider maternal benefit vs neonatal risk
Contraindicated
Aspirin (>162.5Mg)
One report of metabolic acidosis; risk of reye's synd in viral illness.
| General | Excretion Potential | Effect on Infant | Notes |
| Drug should not be given to breast feeding mothers | Excreted | Drug shown to have adverse effect | One report of metabolic acidosis; risk of reye's synd in viral illness. |
Precaution Exists
Caffeine
High doses may cause hyperactivity and wakefulness in infant.
Insufficient human data available
| General | Excretion Potential | Effect on Infant | Notes |
| Evaluate use carefully | Excreted | Drug shown to have adverse effect | High doses may cause hyperactivity and wakefulness in infant. |
Orphenadrine
High doses may cause hyperactivity and wakefulness in infant.
Insufficient human data available
| General | Excretion Potential | Effect on Infant | Notes |
| Evaluate use carefully | Unknown | Not known; no or inclusive data | Insufficient human data available |
No Known Risk
None
| General | Excretion Potential | Effect on Infant | Notes |
| None |
Contraindicated
None
Precaution Exists
Aspirin (>325 Mg)
Gastrointestinal-Aspirin doses > 325 mg/day carry an increased risk for hemorrhage, GI ulcer, or GI bleed. Lower doses preferred. Cardiovascular-May exacerbate pre-existing hypertension. Renal-Risk for exacerbation of CKD.
Neuro/Psych-Anticholinergic effects may cause sedation, worsen cognitive impairment and increase fall risk. Gastrointestinal-May cause or worsen pre-existing constipation. Genitourinary-Best avoided in patients with urinary retention from any cause.
| Organ / System | HEP | REN | CARD | ENDO | NEURO / PSYCH | PULM |
| Increased Risk / Adverse Effects | Y | N | Y | N | N | N |
BEERS: Y HEDIS: N STOPP: Y
Orphenadrine
Gastrointestinal-Aspirin doses > 325 mg/day carry an increased risk for hemorrhage, GI ulcer, or GI bleed. Lower doses preferred. Cardiovascular-May exacerbate pre-existing hypertension. Renal-Risk for exacerbation of CKD.
Neuro/Psych-Anticholinergic effects may cause sedation, worsen cognitive impairment and increase fall risk. Gastrointestinal-May cause or worsen pre-existing constipation. Genitourinary-Best avoided in patients with urinary retention from any cause.
| Organ / System | HEP | REN | CARD | ENDO | NEURO / PSYCH | PULM |
| Increased Risk / Adverse Effects | N | N | Y | Y | N | N |
BEERS: Y HEDIS: Y STOPP: Y
No Known Risk
None
- None
| Musculoskeletal pain | |
| M25.5 | Pain in joint |
| M25.50 | Pain in unspecified joint |
| M25.51 | Pain in shoulder |
| M25.511 | Pain in right shoulder |
| M25.512 | Pain in left shoulder |
| M25.519 | Pain in unspecified shoulder |
| M25.52 | Pain in elbow |
| M25.521 | Pain in right elbow |
| M25.522 | Pain in left elbow |
| M25.529 | Pain in unspecified elbow |
| M25.53 | Pain in wrist |
| M25.531 | Pain in right wrist |
| M25.532 | Pain in left wrist |
| M25.539 | Pain in unspecified wrist |
| M25.54 | Pain in joints of hand |
| M25.541 | Pain in joints of right hand |
| M25.542 | Pain in joints of left hand |
| M25.549 | Pain in joints of unspecified hand |
| M25.55 | Pain in hip |
| M25.551 | Pain in right hip |
| M25.552 | Pain in left hip |
| M25.559 | Pain in unspecified hip |
| M25.56 | Pain in knee |
| M25.561 | Pain in right knee |
| M25.562 | Pain in left knee |
| M25.569 | Pain in unspecified knee |
| M25.57 | Pain in ankle and joints of foot |
| M25.571 | Pain in right ankle and joints of right foot |
| M25.572 | Pain in left ankle and joints of left foot |
| M25.579 | Pain in unspecified ankle and joints of unspecified foot |
| M25.59 | Pain in other specified joint |
| M54 | Dorsalgia |
| M54.2 | Cervicalgia |
| M54.4 | Lumbago with sciatica |
| M54.40 | Lumbago with sciatica, unspecified side |
| M54.41 | Lumbago with sciatica, right side |
| M54.42 | Lumbago with sciatica, left side |
| M54.5 | Low back pain |
| M54.50 | Low back pain, unspecified |
| M54.51 | Vertebrogenic low back pain |
| M54.59 | Other low back pain |
| M54.6 | Pain in thoracic spine |
| M54.8 | Other dorsalgia |
| M54.89 | Other dorsalgia |
| M54.9 | Dorsalgia, unspecified |
| M76.60 | Achilles tendinitis, unspecified leg |
| M77.40 | Metatarsalgia, unspecified foot |
| M79.1 | Myalgia |
| M79.10 | Myalgia, unspecified site |
| M79.11 | Myalgia of mastication muscle |
| M79.12 | Myalgia of auxiliary muscles, head and neck |
| M79.18 | Myalgia, other site |
| M79.6 | Pain in limb, hand, foot, fingers and toes |
| M79.60 | Pain in limb, unspecified |
| M79.601 | Pain in right arm |
| M79.602 | Pain in left arm |
| M79.603 | Pain in arm, unspecified |
| M79.604 | Pain in right leg |
| M79.605 | Pain in left leg |
| M79.606 | Pain in leg, unspecified |
| M79.609 | Pain in unspecified limb |
| M79.62 | Pain in upper arm |
| M79.621 | Pain in right upper arm |
| M79.622 | Pain in left upper arm |
| M79.629 | Pain in unspecified upper arm |
| M79.63 | Pain in forearm |
| M79.631 | Pain in right forearm |
| M79.632 | Pain in left forearm |
| M79.639 | Pain in unspecified forearm |
| M79.64 | Pain in hand and fingers |
| M79.641 | Pain in right hand |
| M79.642 | Pain in left hand |
| M79.643 | Pain in unspecified hand |
| M79.644 | Pain in right finger(s) |
| M79.645 | Pain in left finger(s) |
| M79.646 | Pain in unspecified finger(s) |
| M79.65 | Pain in thigh |
| M79.651 | Pain in right thigh |
| M79.652 | Pain in left thigh |
| M79.659 | Pain in unspecified thigh |
| M79.66 | Pain in lower leg |
| M79.661 | Pain in right lower leg |
| M79.662 | Pain in left lower leg |
| M79.669 | Pain in unspecified lower leg |
| M79.67 | Pain in foot and toes |
| M79.671 | Pain in right foot |
| M79.672 | Pain in left foot |
| M79.673 | Pain in unspecified foot |
| M79.674 | Pain in right toe(s) |
| M79.675 | Pain in left toe(s) |
| M79.676 | Pain in unspecified toe(s) |
| R10.2 | Pelvic and perineal pain |
| R52 | Pain, unspecified |
| R68.84 | Jaw pain |
| 0-9 | A-Z |
|---|---|
| M25.5 | Pain in joint |
| M25.50 | Pain in unspecified joint |
| M25.51 | Pain in shoulder |
| M25.511 | Pain in right shoulder |
| M25.512 | Pain in left shoulder |
| M25.519 | Pain in unspecified shoulder |
| M25.52 | Pain in elbow |
| M25.521 | Pain in right elbow |
| M25.522 | Pain in left elbow |
| M25.529 | Pain in unspecified elbow |
| M25.53 | Pain in wrist |
| M25.531 | Pain in right wrist |
| M25.532 | Pain in left wrist |
| M25.539 | Pain in unspecified wrist |
| M25.54 | Pain in joints of hand |
| M25.541 | Pain in joints of right hand |
| M25.542 | Pain in joints of left hand |
| M25.549 | Pain in joints of unspecified hand |
| M25.55 | Pain in hip |
| M25.551 | Pain in right hip |
| M25.552 | Pain in left hip |
| M25.559 | Pain in unspecified hip |
| M25.56 | Pain in knee |
| M25.561 | Pain in right knee |
| M25.562 | Pain in left knee |
| M25.569 | Pain in unspecified knee |
| M25.57 | Pain in ankle and joints of foot |
| M25.571 | Pain in right ankle and joints of right foot |
| M25.572 | Pain in left ankle and joints of left foot |
| M25.579 | Pain in unspecified ankle and joints of unspecified foot |
| M25.59 | Pain in other specified joint |
| M54 | Dorsalgia |
| M54.2 | Cervicalgia |
| M54.4 | Lumbago with sciatica |
| M54.40 | Lumbago with sciatica, unspecified side |
| M54.41 | Lumbago with sciatica, right side |
| M54.42 | Lumbago with sciatica, left side |
| M54.5 | Low back pain |
| M54.50 | Low back pain, unspecified |
| M54.51 | Vertebrogenic low back pain |
| M54.59 | Other low back pain |
| M54.6 | Pain in thoracic spine |
| M54.8 | Other dorsalgia |
| M54.89 | Other dorsalgia |
| M54.9 | Dorsalgia, unspecified |
| M76.60 | Achilles tendinitis, unspecified leg |
| M77.40 | Metatarsalgia, unspecified foot |
| M79.1 | Myalgia |
| M79.10 | Myalgia, unspecified site |
| M79.11 | Myalgia of mastication muscle |
| M79.12 | Myalgia of auxiliary muscles, head and neck |
| M79.18 | Myalgia, other site |
| M79.6 | Pain in limb, hand, foot, fingers and toes |
| M79.60 | Pain in limb, unspecified |
| M79.601 | Pain in right arm |
| M79.602 | Pain in left arm |
| M79.603 | Pain in arm, unspecified |
| M79.604 | Pain in right leg |
| M79.605 | Pain in left leg |
| M79.606 | Pain in leg, unspecified |
| M79.609 | Pain in unspecified limb |
| M79.62 | Pain in upper arm |
| M79.621 | Pain in right upper arm |
| M79.622 | Pain in left upper arm |
| M79.629 | Pain in unspecified upper arm |
| M79.63 | Pain in forearm |
| M79.631 | Pain in right forearm |
| M79.632 | Pain in left forearm |
| M79.639 | Pain in unspecified forearm |
| M79.64 | Pain in hand and fingers |
| M79.641 | Pain in right hand |
| M79.642 | Pain in left hand |
| M79.643 | Pain in unspecified hand |
| M79.644 | Pain in right finger(s) |
| M79.645 | Pain in left finger(s) |
| M79.646 | Pain in unspecified finger(s) |
| M79.65 | Pain in thigh |
| M79.651 | Pain in right thigh |
| M79.652 | Pain in left thigh |
| M79.659 | Pain in unspecified thigh |
| M79.66 | Pain in lower leg |
| M79.661 | Pain in right lower leg |
| M79.662 | Pain in left lower leg |
| M79.669 | Pain in unspecified lower leg |
| M79.67 | Pain in foot and toes |
| M79.671 | Pain in right foot |
| M79.672 | Pain in left foot |
| M79.673 | Pain in unspecified foot |
| M79.674 | Pain in right toe(s) |
| M79.675 | Pain in left toe(s) |
| M79.676 | Pain in unspecified toe(s) |
| R10.2 | Pelvic and perineal pain |
| R52 | Pain, unspecified |
| R68.84 | Jaw pain |
Formulary Reference Tool