Pretreatment: adjuvant analgesics

Patients entering hospital with already established adjuvant analgesic therapy should be carefully monitored for interactions and adverse effects. Reducing and changing existing adjuvant medication is often needed and should not be done without involving pain specialists.

Antidepressant
Continue. Consider reducing dosage of antidepressants with sedative effects if treatment with an opioid is initiated. Avoid tertiary tricyclic drugs (eg, amitriptyline, imipramine) because of anticholinergic adverse effects and risk of delirium.
Anticonvulsant (eg, gabapentin, pregabalin)
Continue. Consider reducing dosage if treatment with an opioid is initiated (cumulative sedative effects)
Neuroleptic
Continue. Consider reducing dosage if treatment with an opioid is initiated (cumulative sedative effects)