Analgesic, Anti Depressant, Sleeping Pill, Latest Clasification

analgesics
If this article seems to be helpful ,please rate us & share to others
Sending
User Review
5 (4 votes)

Analgesic/painkiller is any member of the group of drugs used to achieve analgesia, relief from pain. Analgesic drugs act in various ways on the peripheral and central nervous systems. They are distinct from anesthetics, which temporarily affected, and in some instances completely eliminate sensation. Analgesics include paracetamol (known in North America as acetaminophen or simply APAP), the nonsteroidal anti-inflammatory drugs (NSAIDs) such as the salicylates, and opioid drugs such as morphine and oxycodone.

When choosing analgesics, the severity and response to other medication determine the choice of agent; the World Health Organization (WHO) pain ladder specifies mild analgesics as its first step.

The number of analgesics and adjunct agents are available for addressing different pain conditions. Following is a complete list of pain medications which includes new drug approvals.

Analgesics and adjunct pain medications share their mechanism of action. They all deliver analgesic effect by interfering with the pain signaling cascade.

Non-Narcotic Analgesics

GenericBrand Name
AcetaminophenTylenol

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

GenericBrand Name
BromfenacProlensa, Bromday
DiclofenacCataflam, Voltaren, Zipsor
DiflunisalDolobid
EtodolacLodine, Lodine XL
FenoprofenNalfon
FlurbiprofenAnsaid
IbuprofenAdvil, Cramp End, Dolgesic, Excedrin IB, Genpril, Haltran, Ibren, Ibu, Ibuprin, Ibuprohm, Ibu-Tab, Medipren, Midol IB, Motrin, Nuprin, Pamprin-IB, Q-Profen, Rufen, Trendar
IndomethacinIndocin, Indocin SR, Tivorbex
KetoprofenActron, Orudis, Oruvail
KetorolacToradol, Sprix
MeclofenamateMeclomen
Mefenamic AcidPonstel
MeloxicamMobic, Vivlodex
NabumetoneRelafen
NaproxenAleve, Anaprox,
Anaprox DS, EC-Naprosyn, Naprelan, Naprosyn
NepafenacNevanac
OxaprozinDaypro
PhenylbutazoneCotylbutazone
PiroxicamFeldene
SulindacClinoril
TolmetinTolectin, Tolectin DS

COX-2 Inhibitors

GenericBrand Name
CelecoxibCelebrex

Narcotic Pain Medications (Painkillers)

GenericBrand Name
BuprenorphineBuprenex, Butrans transdermal patch
ButorphanolStadol
Codeine
Hydrocodone
HydromorphoneDilaudid, Dilaudid-5, Dilaudid-HP, Hydrostat IR, Exalgo ER
LevorphanolLevo-Dromoran
MeperidineDemerol
MethadoneDolophine, Methadose
MorphineAstramorph PF, AVINZA, Duramorph, Kadian,
M S Contin, MSIR, Oramorph SR, Rescudose, Roxanol
NalbuphineNubain
OxycodoneOxyContin, Roxicodone, Oxecta
OxymorphoneNumorphan
PentazocineTalwin
PropoxypheneCotanal-65, Darvon
TapentadolNucynta

Central Analgesics

GenericBrand Name
TramadolUltram
Tramadol and AcetaminophenUltracet

Combinations

GenericBrand Name
Butalbital, Acetaminophen, and CaffeineFemcet, Fioricet, Esgic, Esgic-Plus
Butalbital, Aspirin, and CaffeineFiorinal
Butalbital, acetaminophen, caffeine, and codeineFioricet with Codeine
Hydrocodone and IbuprofenHydro seal IR, Vicoprofen
Morphine/NaltrexoneEmbeda
Oxycodone/NaltrexoneTroxyca ER
Pentazocine/NaloxoneTalwin NX
Narcotic Analgesics and Acetaminophen
Acetaminophen and CodeineCapital with Codeine, Margesic #3, Phenaphen with Codeine, Tylenol with Codeine
Dihydrocodeine, Acetaminophen, and CaffeineDHA plus
Hydrocodone and AcetaminophenAllay, 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 AcetaminophenEndocet, Percocet, Roxicet, Roxilox, Tylox; Xartemis XR
Pentazocine and AcetaminophenTalacen
Propoxyphene and AcetaminophenDarvocet-N 50,
Darvocet-N 100, E-Lor, Propacet 100
Narcotic Analgesics and Aspirin
Aspirin, Caffeine, and DihydrocodeineSynalgos-DC
Aspirin and CodeineEmpirin with Codeine
Hydrocodone and AspirinDamason-P, Lortab ASA, Panasal 5/500
Oxycodone and AspirinEndodan, Percodan, Percodan-Demi, Roxiprin
Pentazocine and AspirinTalwin Compound
Propoxyphene, Aspirin, and CaffeineDarvon Compound-65, PC-Cap, Propoxyphene Compound-65
You Can Also Like   Brimonidine - Uses, Dosage, Side Effects, Interactions

Topical Analgesics

GenericBrand Name
CapsaicinArthriCare, ARTH-RX, Axsain, Capsagel, Dura-Patch, Methacin, Qutenza, Zotrix, Zotrix-HP

Topical Anesthetics

While analgesics lessen the sensation of pain, anesthetics block all physical feelings, including pain.

GenericBrand Name
BenzocaineAmericaine, Endocrine, Lagos
Benzocaine / MentholBenzocol, Butyl Aminobenzoate, Dermoplast
DibucaineCinchocaine, Nupercainal Cream, Nupercainal Ointment
LidocaineLidaMantle, Lidoderm, Lignocaine, Xylocaine
Lidocaine/ PrilocaineEMLA

Sleeping pill

Several different classes of medications are used to treat insomnia. This list includes both prescription and over-the-counter sedative-hypnotic medications.

Non-Benzodiazepine hypnotics (Z-Drugs)

Z-drugs are structurally unrelated to each other. These medications have largely replaced traditional benzodiazepines in the treatment of insomnia.

GenericBrand Name
EszopicloneLunesta
ZaleplonSonata
ZolpidemAmbien, Intermezzo, Zolpimist
Zopiclone *Zimovane
NOT approved in the US

Melatonin receptor agonists

Ramelteon is currently the only FDA-approved melatonin receptor agonist. Ramelteon is used for sleep onset insomnia and has little value for maintaining sleep.

GenericBrand Name
RamelteonRozerem

Orexin receptor antagonists

Orexin-receptor antagonists is a novel pharmacologic class of hypnotics. The first – and by far the only – member of this class was approved in 2014.

GenericBrand Name
SuvorexantBelsomra

Benzodiazepines

Benzodiazepine hypnotics are used for the short-term treatment of insomnia. Benzodiazepines produce sedative, hypnotic, anxiolytic, and muscle relaxant effects.

Benzodiazepines shorten sleep latency and reduce the number of awakenings and the time spent in the stage of wakefulness.

All benzodiazepines are controlled substances in schedule IV.

GenericBrand Name
Hypnotics
Brotizolam *Lendormin
EstazolamProsom
FlurazepamDalmane
Loprazolam*Dormonoct, Havlane, Sonin, Somnolent
Lormetazepam*Loramet, Noctamid
Nitrazepam*Cerson, Mogadon, Nitrazadon, Radedorm
QuazepamDoral
TemazepamRestoril
TriazolamHalcion
NOT approved in the US
Anxiolytics (not approved as hypnotics)
AlprazolamXanax
BromazepamLexotan
ChlordiazepoxideLibrium
Clorazepate dipotassiumTranxene, Gen-Xene
ClonazepamKlonopin
DiazepamValium
LorazepamAtivan
MidazolamVersed
OxazepamSerax

Sedating antidepressants

Sedating antidepressants are widely used for insomnia, but are not officially licensed for this indication. Currently doxepin is the only antidepressant approved by the U.S. FDA for the treatment of insomnia.

GenericBrand Name
Amitriptyline*Elavil, Endep, Vanatrip
DoxepinSilenor, Sinequan, Adapin
Mirtazapine*Remeron
Trazodone*Desyrel, Oleptro, Trittico
NOT FDA approved for insomnia

Barbiturates

Currently, barbiturates are not recommended for routine use for insomnia due to the high incidence of tolerance and dependence.

GenericBrand Name
AmobarbitalAmytal Sodium
ButabarbitalButisol
PentobarbitalNembutal
Phenobarbital
SecobarbitalSeconal Sodium

Other sedative-hypnotic agents

Generic/ClassBrand Name
Chloral hydrate
(sedative, hypnotic)
Somnote, Noctec, Aquachloral
DexmedetomidinePrecedex, Dexdor, Dexdomitor
EthchlorvynolPlacidyl

Over-the-counter sleep aids

Most of the over-the-counter sleep aids contain sedating antihistamine (histamine type 1 receptor blocker).

GenericBrand Name
DiphenhydramineBenadryl
DoxylamineUnisom SleepTabs, Good Sense Sleep Aid

 

Dietary supplements, herbal products

NameClass
Melatoninthe hormone secreted by the pineal gland, available as a dietary supplement
Kavaherbal product
Passionflowerherbal product
St. John’s Wortherbal product
Valerianherbal product

“Off-label” Sleep Aids

GenericBrand Name
Atypical antipsychotics
OlanzapineZyprexa
QuetiapineSeroquel, Seroquel XR
Anticonvulsant
GabapentinNeurontin
TiagabineGabitril
Antihistamines
ChlorpheniramineAntagonate, Chlor-Trimeton, Kloromin, Phenetron, Pyridamal 100, Teldrin
Hydroxyzine and its combinationsVistaril, Atarax
PromethazinePhenergan, Remsed
TrimeprazineTemaril, Vallergan

Psychostimulants

The two classes of psychostimulants indicated for the treatment of ADHD are methylphenidate and amphetamines. Stimulants function by increasing the amount of dopamine and noradrenaline in the brain and stimulating the central nervous system.

You Can Also Like   Furosemide; Uses, Dosage, Side Effects, Interactions, Pregnan

Stimulants are the most potent, and also the most effective class of ADHD medications. Stimulants are considered a first-line therapy for controlling ADHD symptoms unless there are contraindications that preclude their use. Methylphenidate and amphetamines are equally effective, with efficacy rates ranging from 70% to 90%

Stimulants are available in many different formulations including short-acting, intermediate-acting, and long-acting preparations.

Generic nameBrand name
AmphetamineDyanavel XR, Adzenys XR, Evoker
Amphetamine/ dextroamphetamine saltsAdderall, Adderall XR
DexmethylphenidateFocalin, Focalin XR, Dexedrine, Dextrostat, ProCentra, Zenzedi
LisdexamfetamineVyvanse
MethamphetamineDesoxyn
MethylphenidateRitalin, Ritalin SR, Ritalin LA, Methylin, Methylin ER, Quillichew ER, Quillivant XR, Aptensio XR, Concerta ER, Metadate CD
Methylphenidate transdermalDaytrana

Non-Stimulants

Non-stimulant medications approved for the treatment of ADHD have the different mode of action compared to psychostimulants and are considered non-addictive with more favorable side effect profiles.

On the other hand, non-stimulants are generally less effective than stimulants in the treatment of ADHD. The non-stimulants are usually considered second- and third-line medications.

Atomoxetine is a selective norepinephrine reuptake inhibitor with a unique mechanism of action. Atomoxetine is thought to have minimal abuse potential and significantly fewer withdrawal symptoms than psychostimulants. The main drawback is that atomoxetine doesn’t directly influence dopamine and it may take several weeks before the drug elicits a therapeutic effect.

Two antihypertensive drugs (alpha-2 noradrenergic agonists) are approved by the FDA to treat ADHD. These drugs reduce activity in the central nervous system but are considered less effective than stimulants. Clonidine and guanfacine are considered relatively safe over the long-term.

Generic nameBrand name
Selective Norepinephrine Reuptake Inhibitor
AtomoxetineStrattera
Alpha-2 Noradrenergic Agonists
Clonidine extended-releaseKapvay
Guanfacine extended-releaseIntuniv

“Off-label” Medications

There are several medications used to treat attention-deficit hyperactivity disorder “off-label”. While they are not approved for this disease, these medications can improve productivity, concentration, and overall cognitive function. Additionally, many are used as an augmentation strategy to treat patients that have comorbid depression or other disorders.

Generic nameBrand name
Short-acting forms Alpha-2 Noradrenergic Agonists
ClonidineCatapres
GuanfacineTenex
Antipsychotics
AripiprazoleAbilify
OlanzapineZyprexa
QuetiapineSeroque
RisperidoneRisperdal
ZiprasidoneGeodon
Wakefulness-promoting eugeroic() drugs
ArmodafinilNuvigil
ModafinilNuvigil
Antidepressants
DesipramineNorpramin
ImipramineTofranil
BupropionWellbutrin SR, Wellbutrin XL

ADHD medications under investigation

Generic name, ClassBrand name
Vortioxetine
(serotonin modulator and stimulator)
Brintellix, Trintellix
Centanafadine
(serotonin-norepinephrine-dopamine reuptake inhibitor)
Dasotraline
(serotonin-norepinephrine-dopamine reuptake inhibitor )
Metadoxine

Antidepressants:

Common features of all antidepressants:

  • 1. All antidepressants work by increasing the levels of neurotransmitters (chemical messengers) in the brain.
  • 2. Antidepressants are NOT controlled substances.
  • 3. Antidepressants improve depressive symptoms at about the same rate.

New Antidepressants

Generic NameBrand Name
Vortioxetine (serotonin modulator and stimulator)Brintellix, approved September 2013
Levomilnacipran (SNRI)Fetzima, approved July 2013
Vilazodone (SSRI)Viibryd, approved January 2011

SSRIs (Selective Serotonin Reuptake Inhibitors)

GenericBrand Name
CitalopramCelexa
EscitalopramLexapro, Cipralex
FluoxetineProzac, Sarafem; Pexeva
FluvoxamineLuvox
ParoxetinePaxil, Paxil CR
SertralineZoloft

Selective serotonin reuptake inhibitors are the most widely prescribed antidepressants. SSRIs selectively inhibit the reuptake of serotonin resulting in increased serotonin concentration in the brain.
Main beneficial features of SSRIs over older antidepressants (MAOIs and TCAs):

  • Low overdose toxicity potential.
  • Low risk of severe systemic adverse effects, especially anticholinergic and cardiovascular side effects.

The major drawbacks of SSRIs:

  • Sexual dysfunction, which is the most common SSRI-induced side effect that leads to drug discontinuation.
You Can Also Like   Calcium Dobesilate A drug treatment for diabetic retinopathy

Tricyclics (TCA)

GenericBrand Name
AmitriptylineElavil, Endep, Levante
AmoxapineAsendin
ClomipramineAnafranil
DesipramineNorpramin, Pertofrane
DosulepinProthiaden, Thaden
DoxepinAdapin, Sinequan
ImipramineTofranil
LofepramineGamanil, Lomont
MaprotilineDeprilept, Ludiomil, Psymion
MianserinBolvidon, Norval, Tolvan
NortriptylinePamelor
ProtriptylineVivactil
TrimipramineSurmontil

Tricyclic antidepressants represent the oldest class of drugs for depression. Currently, TCAs are considered second-line antidepressants in cases when SSRIs are ineffective or as adjunct therapy with newer drugs. TCAs act as non-selective inhibitors of the reuptake of serotonin and norepinephrine.

Advantages of TCAs:

  • Proven efficacy.
  • Low cost.

Drawbacks of TCAs:

  • Adverse effects such as orthostatic hypotension, anticholinergic effects, cardiovascular effects (arrhythmias and tachycardia).
  • Overdose toxicity.

SNRIs (Serotonin and Noradrenaline Reuptake Inhibitors)

GenericBrand Name
DesvenlafaxinePristiq
DuloxetineCymbalta
LevomilnacipranFetzima
MilnacipranSavella
VenlafaxineEffexor, Effexor XR

Unlike SSRI antidepressants SNRIs block the reuptake of both serotonin and noradrenaline. Generally, SNRIs have side effect profile as SSRIs but are more likely to produce anticholinergic side effects.

NaSSA (Noradrenergic and Specific Serotonergic Antidepressant)

GenericBrand Name
MirtazapineRemeron, Remeron SolTab

Mirtazapine enhances the presynaptic release of serotonin and norepinephrine in the brain. It works via antagonist activity in the presynaptic alpha 2-adrenergic receptors.

NDRIs (Norepinephrine and Dopamine Reuptake Inhibitors)

GenericBrand Name
BupropionWellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban; Aplenzin

`

GenericBrand Name
Atomoxetine (Norepinephrine Reuptake Inhibitor)Strattera
Agomelatine (5-HT2C receptor antagonist)Valdoxan
Buspirone
(5HT1A receptor agonist)
Buspar
Nefazodone
(5HT2-receptor antagonist)
Nefadar, Serzone
Tandospirone (azapirone, 5HT1A receptor agonist)Sediel
Tianeptine
(Serotonin reuptake enhancer)
Stablon
Trazodone
(5HT2-receptor antagonist, triazolopyridine-derivative)
Desyrel, Apo-Trazodone, Oleptro
Reboxetine
(Norepinephrine Reuptake Inhibitor)
Edronax, Vestra
Viloxazine (Norepinephrine Reuptake Inhibitor)Vivian
Vilazodone
(Selective serotonin reuptake inhibitor, Serotonin 5HT 1A receptor agonist)
Viibryd
Serotonin Modulator and Stimulator
VortioxetineBrintellix
Combinations
Fluoxetine/Olanzapine
(SSRI/antipsychotic)
Symbyax
Amitriptyline/Perphenazine
(TCA/antipsychotic)
Etrafon, Triavil

MAOIs (Monoamine Oxidase Inhibitors)

GenericBrand Name
IsocarboxazidMarplan
MoclobemideManerix
PhenelzineNardil
TranylcypromineParnate
SelegilineEmsam (transdermal patch)

 

Monoamine Oxidase Inhibitors (MAOIs) are irreversible inhibitors of the enzyme monoamine oxidase. MAOIs inactivate neurotransmitters norepinephrine, serotonin, and dopamine. Currently, MAOIs have a place in treating Parkinson’s disease, atypical depression, as well as depression that does not respond to other antidepressant drugs.

The main dangers of MAOIs:

  • Dietary restrictions. MAOIs have potentially lethal interactions with foods and drugs containing tyramine. Foods containing tyramine include cheese, smoked meats, and red wine.
  • Potential to cause a hypertensive crisis and serotonin syndrome.
  • Risk of orthostatic hypotension

Advantages of MAOIs:

  • Effective for atypical depression.
  • Highly effective for mood and anxiety disorders.
  • Minimal anticholinergic and antihistamine effects.
  • Inexpensive.

Mood Stabilizers

Some mood stabilizers used to treat depressive symptoms are:

GenericBrand Name
LithiumEskalith, Lithane, Lithobid
QuetiapineSeroquel, Xeroquel, Ketipinor

Atypical antipsychotics

Certain atypical antipsychotics licensed to treat depression are:

GenericBrand Name
BrexpiprazoleRexulti
Print Friendly, PDF & Email