Types of Painkillers, Uses, doses, and Side Effects

Analgesic medicine reduces pain sensation. Provides relief from all types of pain.

• Headaches, 
• Back pain, 
• Muscle pain, 
• Stomach pain, 
• Pain due to any injury, 
• Pain due to burning, etc. 

There are 2 types of analgesic drugs. 

• Narcotics analgesic or Opioid analgesic drugs, and 
• Non-narcotic analgesics.

Narcotic analgesics

The drugs that reduce pain with loss of consciousness and produce sleep are called narcotics medicine. Narcotic analgesics drugs are also called opioid analgesic drugs.

The narcotic analgesic drugs affect the central nervous system and provide effective relief in all muscular pains. 

Example of narcotic drugs

• Morphine
• Codeine
• Heroin
• Pethidine
• Methadone.

Classification of narcotic analgesics

1. Natural opium alkaloids, such as morphine, codeine.
2. Synthetic derivatives such as heroin
3. Synthetic morphine substitutes, such as pethidine, methadone.

Narcotic analgesic drugs list 

• Dextropropoxyphene

• Pentazocine

• Buprenorphine

• morphine Sulphate

• Tramadol Hydrochloride

• Pethidine Hydrochloride

• Butorphanol.

Non-narcotic analgesics

Medicines that reduce pain without affecting consciousness are called non-narcotic analgesics. 

Example of non-narcotic analgesics

• Aspirin
• Paracetamol
• Phenylbutazone
•  Diclofenac
• Ibuprofen
• Piroxicam
• Aceclofenac.

Non-opioid Analgesic

Non-narcotic analgesic medicine is used to reduce or eliminate pain without loss of consciousness. Meaning, there is no sleep or fainting with the use of these drugs.

Classification of non-narcotic analgesics

• Salicylates and their derivatives,  aspirin, sodium salicylate

• P-aminophenol derivatives,  Paracetamol, phenacetin

• Pyrazolone derivatives,  phenylbutazone, oxyphenbutazone

• Indole-acetic acid derivatives, indomethacin, sulindac

• Phenylacetic acid derivatives, Diclofenac

• Propionic acid derivatives, Ibuprofen, ketoprofen, fenoprofen

• Fenamates, mefenamic acid, fluphenazine acid

• Oxicams, piroxicam.

Antipyretic drugs

The medicines that are used in normalizing the body temperature are called antipyretic. 

Antipyretics drugs are used to keep the normal body temperature when our body temperature rises due to any reason. Normal body temperature is 98. 6 degrees Fahrenheit.

The drugs which lower elevated body temperature to normal is called antipyretics.

example - paracetamol.

Anti-inflammatory drugs (NSAIDs)

NSAIDs are also used to reduce inflammation in the body besides reducing pain.
The drugs which are used to reduce inflammation are called anti-inflammatory agents.

Examples  

• Aspirin
• Ibuprofen
• Phenylbutazone
• Indomethacin
• Diclofenac, etc.

Uses of anti-inflammatory drug NSAIDs 

• Headache 
• Rheumatoid arthritis
• Rheumatism
• Toothache
• Migraine pain 
• Arthritis
• Ankylosing spondylitis
• Antigout.

List of the non-opioid analgesic drug

Aspirin

Uses - mild to moderate pain, fever, and juvenile rheumatoid arthritis

Doses - child -  80 - 100 mg/kg daily in 5 or 6 divided doses in juvenile rheumatoid arthritis.
       
 Adult - 325 - 650 mg repeated every 4-6 hr in mild to moderate pain & fever.
           
 Adult - 2.4 - 3.6 g /day in divided doses in musculoskeletal & joint disorder.

Leflunomide

Ibuprofen, naproxen, Ketoprofen, Fenoprofen, flurbiprofen:

 It is propionic acid derivatives.

Uses - analgesic, antipyretic, dysmenorrhoea disorders, soft tissue injuries, gout.

Dosage - Ibuprofen - 200- 600 mg thrice daily divided the dose.

• Naproxen - 250 mg twice daily divided the dose.

• Ketoprofen - 50 mg twice daily divided the dose.

• Fenoprofen - 300-600 mg thrice daily divided the dose.

• Flurbiprofen - 150- 200 mg daily in divided doses.

Dexibuprofen

Uses - pain and inflammation associated with musculoskeletal, joint, and soft tissue

Dosage - 600 - 900 mg daily in 2-3 divided doses.

Side effects - Drowsiness, dizziness, diarrhea, dyspepsia, headache.

Oxyphenbutazone

Uses - rheumatic disorder.

Dosage - 100- 200 mg 2-3 time daily.

Metamizole : (dipyrone) analgin

Uses - pain, fever.

Dosages - .5 - 1.5 gm in 2-3 divided dose.


Side effects - red coloration of urine, agranulocytosis.

Propyphenazone

Uses - pain, fever.

Dosage - 150 - 300 mg 3 times daily a day.

Indomethacin:

Uses - rheumatoid arthritis, ankylosing spondylitis, gout.

Dosage - 25 - 50 mg 2-4 times daily.

Side effects - gastric irritation, nausea, anorexia, diarrhea, mental confusion, hallucination.

Auranofin

Uses - rheumatoid arthritis

Dosage - 6 mg daily in 2 divided doses

Side effects - diarrhea, nausea, abdominal pain, rashes, taste disturbance, nephrotic syndrome

Phenacetin and paracetamol

Uses - pain, fever

Dosage - .5 - 1 gm up to 4 gm daily in divided dose

Side effects - nausea, rashes.

Nefopam

Uses - pain, dental, cancer, musculoskeletal traumatic pain

Dosage - 30 -90 mg 3 times a day

Side effects - dry mouth, dizziness, nausea, blurred vision, insomnia, headache, tachycardia. 

Carbamazepine

Uses - Trigeminal neuralgia

Dosage - 100 - 200 mg once or twice daily

Side effects - fatal hepatitis, aplastic anemia, rash, blurred vision. Ankle swelling, Stevens-Johnson's syndrome.

Oxcarbazepine

Uses - partial seizure, in adults or children with epilepsy

Dosage - 300 mg twice a day

Side effects - nausea, vomiting, dizziness, abdominal pain, abnormal vision.

Ketorolac Tromethamine

Uses - short term management of post-operative pain

Dosage - injection - initially 30-60 mg by i. m than 10-30 mg every 4-6 hrs. max 150 mg for 1 day

Side effects - gastric ulceration & bleeding, edema, nausea, dyspepsia, headache, sweating.

Mefenamic Acid and flu fenamic Acid

Uses - analgesic in muscle, joint, and soft tissue pain, arthritis

Dosage - 250- 500 mg 3 a day

Side effects - diarrhea, epigastric distress, skin rashes, dizziness.

Piroxicam

Uses - rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, gout

Dosage - 20 mg daily as a single dose

Contraindications - Hypersensitivity, pregnancy, child patients who develop asthma, lactation

Side effects -  heartburn, nausea, anorexia, rashes, edema.



Another combination of piroxicam

• Piroxicam-⻏-cyclodextrin

Tenoxicam

Uses - Osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, gout

Dosage - 20 mg daily

Contraindications - peptic ulcer, G I bleeding, gastritis, hypersensitivity

Meloxicam

Uses - Rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis

Dosage - 7.5 to 15 mg once daily

Contraindications - hypersensitivity



Other combinations of  meloxicam:

• Meloxicam with paracetamol

Lornoxicam

Uses - pain relief

Dosages - 8- 16 mg daily, max 24 mg daily

Side effects - nausea, hematologic disorders, abdominal pain, dizziness, diarrhea, tinnitus, insomnia, pancreatitis.

Nabumetone

Uses - osteoarthritis and rheumatoid arthritis, soft tissue rheumatism

Dosage - 1-2 g daily single dose at bedtime

Side effects - abnormal vision, stomatitis, headache, leukopenia, dizziness, rash, abdominal pain, weight loss

Combination of nabumetone

• Nabumetone with paracetamol

Diclofenac sodium

Uses - Rheumatoid arthritis, osteoarthritis, low back pain, ankylosing spondylitis, gout, sprain, a painful inflammatory condition in gynecology, peri arthritis, tendonitis, painful post-operative condition

Doses - 100 - 150 mg daily in 2-3 divided dose

Side effects - epigastric pain, nausea, diarrhea, tiredness, insomnia, skin rash, itching, retention of fluid

Another combination of diclofenac sodium

• Diclofenac sodium with paracetamol

• Diclofenac sodium with serratiopeptidase. 

Diclofenac Potassium

it is a non-steroidal anti-inflammatory, analgesic & antipyretic drug. It is ideally suited for patients on a sodium-free diet, hypertensive patients to treat a painful inflammatory condition of patients on diuretic therapy.

Uses - muscular & skeletal pain, spondylitis, rheumatoid arthritis & osteoarthritis, painful inflammatory condition gynecology

Doses - 50 mg 3 times daily.



Another combination of diclofenac potassium

• Diclofenac Potassium with Paracetamol

• Diclofenac potassium with serratiopeptidase

Aceclofenac

It is a phenylacetic acid derivative showing effective anti-inflammatory and analgesic properties.

Uses

dose - Adult 100 mg bid (two times a day)


Other combination aceclofenac:

• Aceclofenac with paracetamol,

• Aceclofenac with serratiopeptidase,

• Aceclofenac in beta-cyclodextrin. 

Nimesulide:

It is an analgesic, antipyretic, and anti-inflammatory action. It is rapidly and completely after oral administration.

Uses - Rheumatoid arthritis, osteoarthritis, low back pain, dysmenorrhoea, gynecological condition, dental pain, and ENT inflammation

Dosage - 100 mg twice daily

Contraindication- hypersensitivity, peptic ulcer, hepatic impairment.



Another combination of Nimesulide

• Nimesulide with paracetamol

• Nimesulide with serratiopeptidase

• Nimesulide with Race-Methionine

• nimesulide in Beta -Cyclodextrin. 

Sulphasalazine

Uses - rheumatoid arthritis

Dosage - 1 gm / day for 3-5 days, increase over next 3-5 days to 1.5 gm/ day, maximum 3gm/day

Contraindications - hypersensitivity to sulphas and salicylates.

Diacerein

It is an anthraquinone derivative

Use - Osteoarthritis, symptomatic relief from deep achy pain, morning stiffness, and muscle spasm

Dosage - 50 mg daily up to a maximum of 100 mg/day

Contraindication - pregnancy, pediatrics, lactation.

Etodolac

It is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits anti-inflammatory, analgesic, and antipyretics activity

Uses - osteoarthritis,  rheumatoid arthritis, and acute painful condition

Dosage - starting 300 mg 2 to 3 times /day or 400 mg twice daily

Contraindication - Hypersensitivity, asthma, urticaria, peptic ulcer, renal impairment.

Glucosamine Sulphate

Uses - Osteoarthritis, Rheumatoid arthritis, a painful condition

Dosage - 500 mg orally 3 times daily for up to 3 months

Contraindication - not recommended in pregnancy and lactation.

Note -  Pain reliever should not be taken without a prescription. only for information and educational purposes.