Pain Medication Reference: Naming and Composition
I’ve noticed there’s a lot of confusion about the most common pain medications used, so I’ve tried to explain the basics of how they are formulated and named.
I. Two most common opiates used:
II. Two Common Synergistic Agents added to opiates
B. other NSAID (Non-Steroidal Anti-Inflammatory Drug)
III. Two basic formulations: combination medications or single ingredient
A. Opiate combined with NSAIDs (Aspirin, Acetaminophen, Ibuprofen)
- It is the NSAID portion of the medication that is toxic, not the opiate portion
- to prevent toxicity from NSAIDs, combination medications must be limited
- Used for short term, acute, or breakthrough pain
- Effective from 4-6 hours
B. Opiate alone
- Doses can be much higher because there are no toxic NSAIDs included
- Used for chronic pain in sustained release formulas
- Sustained release formulas contain the combined opiate dose of several short-acting doses taken over the course of a day
IV. Generic and Brand names
- Dosages/Numbers: first number is mg of opiate, second number is mg of NSAID
- Generics will be named hydrocodone (mg opiate/mg NSAID) or oxycodone (mg opiate/mg NSAID)
- Brand name medications may not include these numbers, so the list below shows the composition of the most popular brands
A. Hydrocodone-based medications:
- Vicodin (5/500), ES (7.5/750), HP (10/660)
- Norco: (5/325), (7.5/324), (10/325)
- Lortab 2.5 (2.5/500), 5 (5/500), 7.5 (7.5/500), 10 (10/500)
with Ibuprofen: Vicoprofen (7.5/200)
Alone: Zohydro (as of 2014): time-release version
B. Oxycodone-based medications:
with Aspririn: Percodan, Endodan
with Acetaminophen: Percocet, oxycodone (5/500), oxycodone (10/325)
Alone: OxyContin: time-release version
V. Other less common pain medications:
- Tylenol #2 with Acetaminophen (15/300)
- Tylenol #3 with Acetaminophen (30/300)
- Tylenol #4 with Acetaminophen (60/300)
- Codeine Sulfate: 15mg, 30mg, 60mg
- MSContin: morphine sulfate, time release
MSContin/Morphine is an opioid analgesic drug, and the main psychoactive chemical in opium. In clinical medicine, morphine is regarded as the gold standard of analgesics used to relieve intense pain.
Opana/Oxymorphone is a powerful semi-synthetic opioid analgesic
Dilaudid/Hydromorphone/dihydromorphinone is a very potent centrally acting analgesic drug of the opioid class. It is a semi-synthetic derivative of morphine. Hydromorphone is commonly used in the hospital setting, mostly intravenously (IV) because its bioavailability orally, rectally, and intranasally is very low.
Levorphanol/Levo-Dromoran is the levorotatory stereoisomer of the synthetic morphinan (Dromoran) and a pure opioid agonist. Levorphanol has opioid, NMDA antagonist and monoamine reuptake inhibitor activity; it binds strongly to the mu opioid receptor.
VI. Synthetic Opioids (available in last ~70 years)
Fentanyl is a potent, synthetic opioid analgesic with a rapid onset and short duration of action. It is a strong agonist at the μ-opioid receptors. Historically, it has been used to treat breakthrough pain and is commonly used in pre-procedures as a pain reliever. Fentanyl is approximately 80 to 100 times more potent than morphine and many times more potent than heroin.
- Actiq (lollipop)
Methadone is a synthetic opioid. It is used medically as an analgesic and a maintenance anti-addictive and reductive preparation for use by patients with opioid dependence. It is an acyclic analog of morphine and heroin. Methadone acts on the same opioid receptors as these drugs, and has many of the same effects. Methadone is also used in managing severe chronic pain, owing to its long duration of action, strong analgesic effect, and very low cost.
VII. New Atypical Opioids (available in last ~30 years)
Tramadol/Ultram is a centrally-acting atypical opioid analgesic with additional serotonin-norepinephrine reuptake-inhibiting effects used to treat moderate to moderately severe pain. Tramadol is an atypical opioid because it is a serotonin-norepinephrine reuptake inhibitor of and, by itself, a fairly weak μ-opioid receptor agonist. Tramadol has about one-tenth the potency of morphine
Nucynta/Tapentadol is a centrally acting analgesic with a dual mode of action as an agonist of the μ-opioid receptor and as a norepinephrine reuptake inhibitor. Unlike tramadol, it has only weak effects on the reuptake of serotonin, is a significantly more potent opioid. It has about one-fifth the potency of morphine.