List of Opioid Analgesics
- Opioid Drugs
- Opioids Classification
- Relative Potency of Opioids
- Combination Pain Medications
- See Non-Narcotic Pain Medications
Based on "Essential Pain Pharmacology"
written by Howard S. Smith MD, Marco Pappagallo MD
Following is a comprehensive list of opioid drugs indicated for pain management. 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. These medications only temporary lessen the intensity, duration, or sensation of pain.
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|
|Hydrocodone||Zohydro ER, Hysingla ER||Rx,
|Hydromorphone||Dilaudid, Dilaudid-5, Dilaudid-HP, Hydrostat IR, Exalgo ER||Rx,
|Morphine||Astramorph PF, AVINZA, Duramorph, Kadian,
MS Contin, MSIR, Oramorph SR, Rescudose, Roxanol
|Oxycodone||OxyContin, Roxicodone, Oxecta||Rx,
|Partial Opioid Agonists
|Mixed Opioid Agonists|
|Buprenorphine||Buprenex, Butrans transdermal patch||Rx,
|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.
|* 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.
|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).|
Relative potency of opioid painkillers from strongest to weakest:
Fentanyl > Buprenorphine > Levorphanol > Oxymorphone > Hydromorphone > Phenazocine > Methadone > Oxycodone > Morphine > Hydrocodone > Tapentadol > Dihydrocodeine > Tramadol ≥ Codeine.
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.
|Hydrocodone and Ibuprofen||Hydrostal IR, Vicoprofen|
|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|
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.
Published: May 05, 2018
Last updated: May 05, 2018