List of Opioid Analgesics

Following is a comrehencive list of opioid pain medications. The listing is regularly updated and includes latest new drug approvals.

Analgesics are not designed to and do not treat the problem causing the pain, but they only temporary lessen the intensity, duration, or sensation of pain.

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Opioid (Narcotic) Drugs

Opioids (also called narcotic analgesics) remain the most potent and effective pain relievers available today and are often called "painkillers". They provide powerful dose-dependent relief of moderate to severe pain.

List of opioids grouped according to their activity at opioid receptors:

Generic Brand Name Legal status2
Full Opioid Agonists
Codeine   Rx,
Sch.III
Fentanyl Duragesic, Sublimaze Rx,
Sch.II
Hydrocodone Zohydro ER, Hysingla ER Rx,
Sch.II
Hydromorphone Dilaudid, Dilaudid-5, Dilaudid-HP, Hydrostat IR, Exalgo ER Rx,
Sch.II
Levorphanol Levo-Dromoran Rx,
Sch.II
Meperidine Demerol Rx,
Sch.II
Methadone Dolophine, Methadose Rx,
Sch.II
Morphine Astramorph PF, AVINZA, Duramorph, Kadian,
MS Contin, MSIR, Oramorph SR, Rescudose, Roxanol
Rx,
Sch.II
Oxycodone OxyContin, Roxicodone, Oxecta Rx,
Sch.II
Oxymorphone Numorphan Rx,
Sch.II
Propoxyphene Cotanal-65, Darvon Rx,
Sch.IV
Tapentadol Nucynta Rx,
Sch.II
Partial Opioid Agonists
Tramadol Ultram Rx,
Sch.IV
Mixed Opioid Agonists
Buprenorphine Buprenex, Butrans transdermal patch Rx,
Sch.III
Butorphanol Stadol Rx,
Sch.IV
Nalbuphine Nubain Rx*
Pentazocine Talwin Rx,
Sch.IV
Opioid Antagonists block the effects of opioid. These drugs are not analgesics and are used mainly to reverse the undesirable effects of the opioid agonists.
Naloxone Narcan Rx
Naltrexone Revia Rx
* Currently Nalbuphine remains the only opioid analgesic in the U.S. that is not a scheduled substance under the Controlled Substances Act.

Opioid analgesics work by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. They inhibit pain-transmitting neurons and stimulate pain-inhibitory neurons thus changing the brain's interpretation of pain.

Long-term use of narcotic analgesics can lead to physical dependence, tolerance, and addiction.

Schedule II medications have high potential for abuse and development of severe psychological or physical dependence.

Schedule III medications have high potential for abuse but moderate to low potential for serious psychological or physical dependence. Schedule III drugs have slightly less restrictive prescribing rules.

Opioid Classification

Type Description
Opiates Natural derivatives of opium alkaloids (e.g. morphine, codeine, papaverine).
Semi-synthetics Synthesized from naturally occurring derivatives, such as morphine or codeine (e.g. hydromorphone, hydrocodone, oxymorphone, oxycodone, buprenorphine, levorphanol, pentazocine, nalbuphine).
Synthetics Non-morphinians, which are manufactured chemically and have structures unrelated to the opium alkaloids (e.g. fentanyl, meperidine, methadone, tramadol, tapentadol, propoxyphene).
Endogenous opioids Natural peptides produced in the body (endorphins).

Narcotic Analgesics from Strongest to Weakest

Relative potency of opioid painkillers from strongest to weakest:

Fentanyl > Buprenorphine > Levorphanol > Oxymorphone > Hydromorphone > Phenazocine > Methadone > Oxycodone > Morphine > Hydrocodone > Tapentadol > Dihydrocodeine > Tramadol ≥ Codeine.

Opioids from strongest to seakest

Combnation Pain Relievers

Compound or combined analgesics usually contain a small amount of a mild narcotic, and a simple analgesic such as aspirin, acetaminophen, or ibuprofen. This type of analgesics is often prescribed when non-narcotic painkillers don't provide adequate analgesia.

Generic Brand Name
Hydrocodone and Ibuprofen Hydrostal IR, Vicoprofen
Morphine/Naltrexone Embeda
Oxycodone/Naltrexone Troxyca ER
Pentazocine/Naloxone Talwin NX
Narcotic Analgesics and Acetaminophen
Acetaminophen and Codeine Capital with Codeine, Margesic #3, Phenaphen with Codeine, Tylenol with Codeine
Dihydrocodeine, Acetaminophen, and Caffeine DHCplus
Hydrocodone and Acetaminophen Allay, Anexsia 5/500, Anexsia 7.5/650, Dolacet, Dolagesic, Duocet, Hycomed, Hydrocet, Hydrogesic, HY-PHEN, Lorcet 10/650, Lorcet-HD, Lortab, Panacet 5/500, Panlor, Stagesic, T-Gesic, Ugesic, Vicodin, Zydone
Oxycodone and Acetaminophen Endocet, Percocet, Roxicet, Roxilox, Tylox; Xartemis XR
Pentazocine and Acetaminophen Talacen
Propoxyphene and Acetaminophen Darvocet-N 50,
Darvocet-N 100, E-Lor, Propacet 100
Tramadol and Acetaminophen Ultracet
Narcotic Analgesics and Aspirin
Aspirin, Caffeine, and Dihydrocodeine Synalgos-DC
Aspirin and Codeine Empirin with Codeine
Hydrocodone and Aspirin Damason-P, Lortab ASA, Panasal 5/500
Oxycodone and Aspirin Endodan, Percodan, Percodan-Demi, Roxiprin
Pentazocine and Aspirin Talwin Compound
Propoxyphene, Aspirin, and Caffeine Darvon Compound-65, PC-Cap, Propoxyphene Compound-65


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Advantages of Opioids

  • Highly effective and rapid pain relief for moderate, severe and very severe pain.
  • No analgesic dose ceiling.
  • Selective analgesia: reduction in pain suffering, minimal effects on pain localization
  • No harmful effects on important organs: cardiovascular system, kidney, liver, and hemostatic safety.
  • Multiple dosage formulations and routes of administration.
  • Many opioid drugs are relatively inexpensive.

Disadvantages of Opioids

  • Controlled status.
  • Annoying side effects: nausea, sedation, constipation, itching
  • Serious side effects: respiratory depression, airway obstruction.
  • Potential for abuse, addiction, development of psychological or physical dependence.

Related resources


Resources

  • 1. New FDA Approved Drugs CenterWatch
  • 2. Controlled Substances by CSA Schedule DEA

Published: May 05, 2018
Last updated: May 05, 2018

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