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:
- Oxycodone (approximately twice as potent as same mg hydrocodone)
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.
For more extensive details, see PAIN Management: OPIOIDS, Antagonists, Other on the excellent pharmacy reference site http://www.globalrph.com/
I have been in debilitating eds related back pain for four years now nsaids gamma blockers faccett injection epidurals..all because I was terrified of becoming an opiate addict zombie… I’m crying reading these facts…why wouldn’t my Dr reassure me like you have….I have gone into shock..syncope… Spinal bleeds…I’m calling her and requesting opiates… I’m not afraid now.
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How awful – I’m so sorry you’ve had to suffer like this! As you’ve probably realized, I’m one of those people relying on opioids to make life bearable. Without opioids, I’d never be able to keep up a blog like this.
Perhaps you could show your doctor a few of the articles I’ve posted here about the medical reality of EDS and how it is known to be very painful.
Let me know if you need help convincing your doctor.
I’m going in at nine tomorrow… I can’t get syncope to stop w typical fluids feet up and cold chest compress…because the pains uncontrolled.. I am brining this with me…. I’m still so afraid of addiction.. I’m going to ask for only enough to last till spinal bleed stops and I can resume prednazone epidurals…they keep me out of this shock like state. I cant thank you enough for the encouragement..
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Being able to help another EDS-er has made my day!
My whole purpose with this blog is to share information and encouragement, so the good feelings flow both directions. I’ll keep my fingers crossed for you…
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I ended up in er…drs had to give meultiple narcotics and muscle relaxers to ease pain and stop backspams ..Dr.chin and I had a lengthy conversation about not allowing myself be in this kind of pain and told me I have ten daysvto discuss narcotic use w my Dr . because he will be on Monday. He explained I needed so many drugs because of break through pain? And told me to show my Dr my list of er meds and the fact that I was still in pain with them and needed norco and norflex be for I stabilized.. I went from never using an opiate to the strongest they make in one day….you were absolutely right..thank you for giving me the courage to say face a huge fear…I’m still shaking in pain now with the drugs but I’m moving eating and sleeping again
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Wow, your experience is horrifying! And this is the kind of pain you lived with to avoid taking opioids?
Right now, our country is in an “opioid overdose crisis”, and even though it’s caused by heroin & illicit fentanyl, our pain meds have been blamed and docs are very reluctant to prescribe. I sincerely hope your doc will see how necessary they are for you and prescribe sufficient amounts to keep your pain under some control. Sadly, I won’t be surprised if you’re denied this relief due to the current anti-opioid hysteria so I just want to prepare you for potential rejection.
Please let me know how it goes tomorrow, and Good Luck!
My er Dr didn’t give me much choice.. It took soon much morphine noroflex torodol and norco to get me stabilized… He called all my drs and strongly expressed my need and fear of narcotics… I’m adjusting well to the ones he prescribed me but still in soon much pain…I’m tempted to sneek a naproxen or five..I can’t though my kidneys can’t handle it from years of high doses
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I heard from another pain patient that gabapentoids can be used “as needed” and Lyrica has been working surprisingly well for me. I also know a few people who get decent relief from gabapentin/Neurontin.
Gabapentoids are a different class of drugs, not NSAIDs or opioids, and they can be taken in combination with the others. Lyrica is more advanced (and expensive) than gabapentin, but perhaps you could try that in addition to your other meds to get better relief.
I have a near fatal reaction to SSRI s and gama blockers…tried several… Before facette and epidural I’m wondering if an added nsaid or steroid will help… I’ll know on Wednesday day..Dr.Chin did call all my Dr.s…no bluff. They all called me this morning.
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