Acute pain
Third line
Severe acute pain uncontrolled by non-opioid analgesics or weak opioids: postoperative pain, severe trauma, acute breakthrough cancer pain, renal colic refractory to NSAIDs. Per SED 2024 and SEMERGEN 2023 – third-line after paracetamol, NSAIDs, and weak opioids. Dose: 5-10 mg every 4-6 hours (immediate release) or 10-20 mg every 12 hours (controlled release). Short course ≤7 days outside oncology. Taper at discontinuation to avoid withdrawal.