Narcotic analgesic combinations
What are Narcotic analgesic combinations?
Narcotic analgesic combinations are products that contain a narcotic analgesic in combination with at least one other analgesic; for example, hydrocodone and acetaminophen, oxycodone and acetaminophen. Narcotic analgesic combinations should only be used to treat moderate-to-severe pain that is not responsive to other less potent analgesics. An analgesic is the name used to describe a medicine that relieves pain.
Experts believe that narcotic analgesic combinations have been overused, overprescribed, and misused in the past which has resulted in more than two million people in the U.S. alone having a substance misuse disorder involving prescription narcotic analgesics.
Narcotic analgesics work by binding to opioid receptors, which form part of the opioid system responsible for sensing pain and controlling pleasurable and addictive behaviors. Opioid receptors are more abundant in the brain and spinal cord but are also located elsewhere in the body such as the stomach and the lungs. The main opioid receptor that narcotic analgesics bind to is the mu receptor.
The other analgesics, such as acetaminophen or ibuprofen, typically found in narcotic analgesic combinations mainly work by inhibiting enzymes called cyclo-oxygenase (COX) enzymes that produce prostaglandins. Prostaglandins promote inflammation, pain and fever.
Narcotic analgesic combinations relieve acute and chronic severe pain by a dual mechanism of action: binding to opioid receptors and inhibiting COX enzymes. Even though narcotic analgesic combinations are very effective at relieving pain, they also tend to cause addiction, dependence, and tolerance (where increasing dosages are needed to provide the same pain-relieving effect).
What are narcotic analgesic combinations used for?
In the past, narcotic analgesic combinations have been used for all types of pain, which may explain why there are so many people addicted to them today.
The most appropriate use of narcotic analgesic combinations is for the relief of short-term, intense pain, such as that occurring immediately after surgery or due to a medical condition.
Narcotic analgesic combinations are also appropriate for relief of pain due to active cancer treatment, palliative care and end-or life care. However, they should only be considered to treat other types of chronic pain conditions under strict conditions and with close monitoring.
What are the differences between narcotic analgesic combinations?
Narcotic analgesic combinations differ in their ingredients. Some contain two active ingredients, others contain up to four. These ingredients all differ with regards to how they work in the body, how potent they are, and how they absorbed, distributed, metabolized and excreted. See narcotic analgesics for an explanation of the different types of narcotics (opioids) that are available.
Common narcotic analgesic combinations available in the U.S.
| Generic name | Examples Brand names |
|---|---|
| codeine + acetaminophen | Generic |
| codeine + acetaminophen + butalbital + caffeine | Fioricet with codeine |
| codeine + aspirin + butalbital + caffeine | Ascomp with codeine, Fiorinal with codeine |
| dihydrocodeine + acetaminophen + caffeine | Trezix |
| hydrocodone + acetaminophen | Generic |
| hydrocodone + ibuprofen | Generic |
| oxycodone + acetaminophen | Percocet |
| tramadol + acetaminophen | Ultracet |
Are combination narcotic analgesics safe?
There are serious risks associated with narcotic analgesic combination use including respiratory depression (unusually slow and shallow breathing), opioid-use disorder, and potentially fatal overdose.
Opioid-use disorder is defined as the repeated occurrence of at least two out of 11 specific opioid-associated problems, including using opioids in increased amounts or for longer than intended; continued use despite interference with daily activities; or still using while in hazardous situations. Severe opioid-use disorder is defined as a cluster of 6 or more problems and it can affect people from all educational and socioeconomic backgrounds.
Narcotic analgesic combinations are potentially addictive and the risk of becoming emotionally and physically dependent on them increases the more you take and the longer you take them for. When prescribed by a doctor and used for short periods of time, such as for less than five days for pain relief after surgery, the risk of becoming addicted to them is relatively low.
The number of deaths from opioid overdose continues to rise and legislation has been enacted to restrict the prescribing of opioids. More than 110,000 people died in 2022 because of a drug overdose; many of these deaths involved a prescription narcotic analgesic.
When taken exactly as prescribed by a doctor, for short periods of time, for the relief of severe pain, and under strict monitoring, narcotic analgesic combinations are considered acceptable to use. However, they may still be associated with some severe side effects, despite proper use.
What are the side effects of combination narcotic analgesics?
Narcotic analgesic combinations have many side effects, although people with cancer or terminal illness taking these for the control of persistent pain may become tolerant to some of these side effects.
Drowsiness, sleepiness, or dizziness is common with the narcotic component of narcotic analgesic combinations. This can affect your driving or ability to operate machinery or perform other hazardous tasks. Alcohol may potentiate these effects.
Other commonly reported side effects related to the narcotic component include:
- Constipation
- Breathing difficulty
- Itching or a skin rash
- Loss of appetite
- Low blood pressure
- Miosis (constriction of the pupil of the eye)
- Nausea and vomiting
- Problems with urination
- Shakiness or a tremor
- Slow heartbeat.
Withdrawal symptoms may occur when people who have been taking narcotic analgesic combinations abruptly stop taking them. Symptoms are like having the flu, and may include body aches, chills, depression, diarrhea, goose-bumps, headaches, high blood pressure, insomnia, irritability, a runny nose and sweats. Withdrawal symptoms usually last about a week.
Side effects can also occur due to other ingredients included in the narcotic analgesic combination, for example:
- Acetaminophen: potential for liver damage particularly in people who exceed the recommended dosage, drink more than three alcoholic drinks a day, or with pre-existing liver disease
- Ibuprofen: stomach related side effects (such as indigestion and heartburn) and potential for cardiac-related events although risk with ibuprofen is low
- Aspirin: high risk of stomach-related side effects and may interact with some medicines
- Butalbital: may cause drowsiness, constipation, and is potentially addictive
- Caffeine: may cause constipation, headaches or insomnia.
List drug with Narcotic analgesic combinations
| Drug Name |
|---|
| Acetaminophen and benzhydrocodone Generic name: Acetaminophen And Benzhydrocodone |
| Acetaminophen and codeine Generic name: Acetaminophen And Codeine |
| Acetaminophen and Oxycodone Generic name: Oxycodone And Acetaminophen |
| Acetaminophen and tramadol Generic name: Acetaminophen And Tramadol |
| Acetaminophen, butalbital, caffeine, and codeine Generic name: Acetaminophen, Butalbital, Caffeine, And Codeine |
| Acetaminophen, caffeine, and dihydrocodeine Generic name: Acetaminophen, Caffeine, And Dihydrocodeine |
| Anexsia Generic name: Hydrocodone And Acetaminophen |
| Apadaz Generic name: Acetaminophen And Benzhydrocodone |
| APAP w/Codeine Generic name: Acetaminophen And Codeine |
| Ascomp w/Codeine Generic name: Butalbital, Aspirin, Caffeine, And Codeine |
| Ascomp with Codeine Generic name: Aspirin, Butalbital, Caffeine, And Codeine |
| Aspirin, butalbital, caffeine, and codeine Generic name: Aspirin, Butalbital, Caffeine, And Codeine |
| Aspirin, caffeine, and dihydrocodeine Generic name: Aspirin, Caffeine, And Dihydrocodeine |
| Co-Gesic Generic name: Hydrocodone And Acetaminophen |
| Combunox Generic name: Ibuprofen And Oxycodone |
| Belladonna and opium Generic name: Belladonna And Opium |
| Belladonna and opium rectal Generic name: Belladonna And Opium (rectal) |
| Benzhydrocodone and acetaminophen Generic name: Benzhydrocodone And Acetaminophen |
| Bunavail Generic name: Buprenorphine And Naloxone (oral/sublingual) |
| Buprenorphine & Naloxone Generic name: Buprenorphine And Naloxone (oral/sublingual) |
| Buprenorphine/naloxone Generic name: Buprenorphine/naloxone |
| Butalbital, acetaminophen, caffeine, and codeine Generic name: Butalbital, Acetaminophen, Caffeine, And Codeine |
| Butalbital, aspirin, caffeine, and codeine Generic name: Butalbital, Aspirin, Caffeine, And Codeine |
| Capital w/Codeine Generic name: Acetaminophen And Codeine |
| Cassipa Generic name: Buprenorphine/naloxone |
| Celecoxib and tramadol Generic name: Celecoxib And Tramadol |
| Ceta Plus Generic name: Hydrocodone And Acetaminophen |
| Darvocet Generic name: Acetaminophen And Propoxyphene |
| Dolorex Forte Generic name: Hydrocodone And Acetaminophen |
| Dvorah Generic name: Acetaminophen, Caffeine, And Dihydrocodeine |
| Embeda Generic name: Morphine And Naltrexone |
| Endocet Generic name: Acetaminophen And Oxycodone |
| Endocet 10/325 Generic name: Acetaminophen And Oxycodone |
| Endocet 2.5/325 Generic name: Acetaminophen And Oxycodone |
| Endocet 5/325 Generic name: Acetaminophen And Oxycodone |
| Endocet 7.5/325 Generic name: Acetaminophen And Oxycodone |
| Endodan Generic name: Oxycodone And Aspirin |
| Fioricet with Codeine Generic name: Acetaminophen, Butalbital, Caffeine, And Codeine |
| Fiorinal w/Codeine Generic name: Butalbital, Aspirin, Caffeine, And Codeine |
| Fiorinal with Codeine Generic name: Aspirin, Butalbital, Caffeine, And Codeine |
| Hycet Generic name: Acetaminophen And Hydrocodone |
| Hydrocodone and Acetaminophen Generic name: Acetaminophen And Hydrocodone |
| Hydrocodone and ibuprofen Generic name: Hydrocodone And Ibuprofen |
| Ibudone Generic name: Hydrocodone And Ibuprofen |
| Lorcet Generic name: Acetaminophen And Hydrocodone |
| Lortab Generic name: Acetaminophen And Hydrocodone |
| Lortab Elixir Generic name: Acetaminophen And Hydrocodone |
| Magnacet Generic name: Oxycodone And Acetaminophen |
| Maxidone Generic name: Hydrocodone And Acetaminophen |
| Morphine and naltrexone Generic name: Morphine And Naltrexone |
| Nalocet Generic name: Acetaminophen And Oxycodone |
| Naloxone and pentazocine Generic name: Naloxone And Pentazocine (oral) |
| Narvox Generic name: Oxycodone And Acetaminophen |
| Norco Generic name: Acetaminophen And Hydrocodone |
| Oxycodone and acetaminophen Generic name: Oxycodone And Acetaminophen |
| Oxycodone and aspirin Generic name: Oxycodone And Aspirin |
| Oxycodone and ibuprofen Generic name: Oxycodone And Ibuprofen |
| Oxycodone and naloxone Generic name: Oxycodone And Naloxone |
| Oxycodone and naltrexone Generic name: Oxycodone And Naltrexone |
| Panlor Tablet Generic name: Acetaminophen, Caffeine, And Dihydrocodeine |
| Panlor-DC Generic name: Acetaminophen, Caffeine, And Dihydrocodeine |
| Panlor-SS Generic name: Acetaminophen, Caffeine, And Dihydrocodeine |
| Pentazocine and naloxone Generic name: Pentazocine And Naloxone |
| Percocet Generic name: Acetaminophen And Oxycodone |
| Percodan Generic name: Aspirin And Oxycodone |
| Perloxx Generic name: Oxycodone And Acetaminophen |
| Phrenilin with Caffeine and Codeine Generic name: Butalbital, Acetaminophen, Caffeine, And Codeine |
| Primalev Generic name: Oxycodone And Acetaminophen |
| Primlev Generic name: Acetaminophen And Oxycodone |
| Prolate Generic name: Acetaminophen And Oxycodone |
| Pyregesic-C Generic name: Acetaminophen And Codeine |
| Reprexain Generic name: Hydrocodone And Ibuprofen |
| Roxicet Generic name: Acetaminophen And Oxycodone |
| Roxilox Generic name: Oxycodone And Acetaminophen |
| Seglentis Generic name: Celecoxib And Tramadol Hydrochloride |
| Stagesic Generic name: Hydrocodone And Acetaminophen |
| Suboxone Generic name: Buprenorphine And Naloxone (oral/sublingual) |
| Synalgos-DC Generic name: Aspirin, Caffeine, And Dihydrocodeine |
| Talwin NX Generic name: Pentazocine And Naloxone |
| Targiniq ER Generic name: Naloxone And Oxycodone Extended Release Tablets |
| Tramadol and acetaminophen Generic name: Tramadol And Acetaminophen |
| Trezix Generic name: Acetaminophen, Caffeine, And Dihydrocodeine |
| Tylenol w/Codeine Generic name: Acetaminophen And Codeine |
| Tylenol w/Codeine #3 Generic name: Acetaminophen And Codeine |
| Tylenol w/Codeine #4 Generic name: Acetaminophen And Codeine |
| Tylenol with Codeine #3 Generic name: Acetaminophen And Codeine |
| Tylenol with Codeine #4 Generic name: Acetaminophen And Codeine |
| Tylenol with Codeine No. 3 Generic name: Acetaminophen And Codeine |
| Tylox Generic name: Acetaminophen And Oxycodone |
| Ultracet Generic name: Acetaminophen And Tramadol |
| Verdrocet Generic name: Acetaminophen And Hydrocodone |
| Vicodin Generic name: Acetaminophen And Hydrocodone |
| Vicodin HP Generic name: Hydrocodone And Acetaminophen |
| Vicoprofen Generic name: Hydrocodone And Ibuprofen |
| Vopac Generic name: Acetaminophen And Codeine |
| Xartemix XR Generic name: Oxycodone And Acetaminophen |
| Xodol Generic name: Acetaminophen And Hydrocodone |
| Xolox Generic name: Oxycodone And Acetaminophen |
| Zamicet Generic name: Acetaminophen And Hydrocodone |
| Zerlor Generic name: Acetaminophen, Caffeine, And Dihydrocodeine |
| Zubsolv Generic name: Buprenorphine And Naloxone (sublingual Tablets) |
| Zydone Generic name: Hydrocodone And Acetaminophen |
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