Analgesic, Anti Depressant, Sleeping Pill, Latest Clasification

analgesics
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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

Generic Brand Name
Acetaminophen Tylenol

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Generic Brand Name
Bromfenac Prolensa, Bromday
Diclofenac Cataflam, Voltaren, Zipsor
Diflunisal Dolobid
Etodolac Lodine, Lodine XL
Fenoprofen Nalfon
Flurbiprofen Ansaid
Ibuprofen Advil, Cramp End, Dolgesic, Excedrin IB, Genpril, Haltran, Ibren, Ibu, Ibuprin, Ibuprohm, Ibu-Tab, Medipren, Midol IB, Motrin, Nuprin, Pamprin-IB, Q-Profen, Rufen, Trendar
Indomethacin Indocin, Indocin SR, Tivorbex
Ketoprofen Actron, Orudis, Oruvail
Ketorolac Toradol, Sprix
Meclofenamate Meclomen
Mefenamic Acid Ponstel
Meloxicam Mobic, Vivlodex
Nabumetone Relafen
Naproxen Aleve, Anaprox,
Anaprox DS, EC-Naprosyn, Naprelan, Naprosyn
Nepafenac Nevanac
Oxaprozin Daypro
Phenylbutazone Cotylbutazone
Piroxicam Feldene
Sulindac Clinoril
Tolmetin Tolectin, Tolectin DS

COX-2 Inhibitors

Generic Brand Name
Celecoxib Celebrex

Narcotic Pain Medications (Painkillers)

Generic Brand Name
Buprenorphine Buprenex, Butrans transdermal patch
Butorphanol Stadol
Codeine
Hydrocodone
Hydromorphone Dilaudid, Dilaudid-5, Dilaudid-HP, Hydrostat IR, Exalgo ER
Levorphanol Levo-Dromoran
Meperidine Demerol
Methadone Dolophine, Methadose
Morphine Astramorph PF, AVINZA, Duramorph, Kadian,
M S Contin, MSIR, Oramorph SR, Rescudose, Roxanol
Nalbuphine Nubain
Oxycodone OxyContin, Roxicodone, Oxecta
Oxymorphone Numorphan
Pentazocine Talwin
Propoxyphene Cotanal-65, Darvon
Tapentadol Nucynta

Central Analgesics

Generic Brand Name
Tramadol Ultram
Tramadol and Acetaminophen Ultracet

Combinations

Generic Brand Name
Butalbital, Acetaminophen, and Caffeine Femcet, Fioricet, Esgic, Esgic-Plus
Butalbital, Aspirin, and Caffeine Fiorinal
Butalbital, acetaminophen, caffeine, and codeine Fioricet with Codeine
Hydrocodone and Ibuprofen Hydro seal 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 DHA plus
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
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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Topical Analgesics

Generic Brand Name
Capsaicin ArthriCare, 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.

Generic Brand Name
Benzocaine Americaine, Endocrine, Lagos
Benzocaine / Menthol Benzocol, Butyl Aminobenzoate, Dermoplast
Dibucaine Cinchocaine, Nupercainal Cream, Nupercainal Ointment
Lidocaine LidaMantle, Lidoderm, Lignocaine, Xylocaine
Lidocaine/ Prilocaine EMLA

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.

Generic Brand Name
Eszopiclone Lunesta
Zaleplon Sonata
Zolpidem Ambien, 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.

Generic Brand Name
Ramelteon Rozerem

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.

Generic Brand Name
Suvorexant Belsomra

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.

Generic Brand Name
Hypnotics
Brotizolam * Lendormin
Estazolam Prosom
Flurazepam Dalmane
Loprazolam* Dormonoct, Havlane, Sonin, Somnolent
Lormetazepam* Loramet, Noctamid
Nitrazepam* Cerson, Mogadon, Nitrazadon, Radedorm
Quazepam Doral
Temazepam Restoril
Triazolam Halcion
NOT approved in the US
Anxiolytics (not approved as hypnotics)
Alprazolam Xanax
Bromazepam Lexotan
Chlordiazepoxide Librium
Clorazepate dipotassium Tranxene, Gen-Xene
Clonazepam Klonopin
Diazepam Valium
Lorazepam Ativan
Midazolam Versed
Oxazepam Serax

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.

Generic Brand Name
Amitriptyline* Elavil, Endep, Vanatrip
Doxepin Silenor, 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.

Generic Brand Name
Amobarbital Amytal Sodium
Butabarbital Butisol
Pentobarbital Nembutal
Phenobarbital
Secobarbital Seconal Sodium

Other sedative-hypnotic agents

Generic/Class Brand Name
Chloral hydrate
(sedative, hypnotic)
Somnote, Noctec, Aquachloral
Dexmedetomidine Precedex, Dexdor, Dexdomitor
Ethchlorvynol Placidyl

Over-the-counter sleep aids

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

Generic Brand Name
Diphenhydramine Benadryl
Doxylamine Unisom SleepTabs, Good Sense Sleep Aid

 

Dietary supplements, herbal products

Name Class
Melatonin the hormone secreted by the pineal gland, available as a dietary supplement
Kava herbal product
Passionflower herbal product
St. John’s Wort herbal product
Valerian herbal product

“Off-label” Sleep Aids

Generic Brand Name
Atypical antipsychotics
Olanzapine Zyprexa
Quetiapine Seroquel, Seroquel XR
Anticonvulsant
Gabapentin Neurontin
Tiagabine Gabitril
Antihistamines
Chlorpheniramine Antagonate, Chlor-Trimeton, Kloromin, Phenetron, Pyridamal 100, Teldrin
Hydroxyzine and its combinations Vistaril, Atarax
Promethazine Phenergan, Remsed
Trimeprazine Temaril, 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.

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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 name Brand name
Amphetamine Dyanavel XR, Adzenys XR, Evoker
Amphetamine/ dextroamphetamine salts Adderall, Adderall XR
Dexmethylphenidate Focalin, Focalin XR, Dexedrine, Dextrostat, ProCentra, Zenzedi
Lisdexamfetamine Vyvanse
Methamphetamine Desoxyn
Methylphenidate Ritalin, Ritalin SR, Ritalin LA, Methylin, Methylin ER, Quillichew ER, Quillivant XR, Aptensio XR, Concerta ER, Metadate CD
Methylphenidate transdermal Daytrana

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 name Brand name
Selective Norepinephrine Reuptake Inhibitor
Atomoxetine Strattera
Alpha-2 Noradrenergic Agonists
Clonidine extended-release Kapvay
Guanfacine extended-release Intuniv

“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 name Brand name
Short-acting forms Alpha-2 Noradrenergic Agonists
Clonidine Catapres
Guanfacine Tenex
Antipsychotics
Aripiprazole Abilify
Olanzapine Zyprexa
Quetiapine Seroque
Risperidone Risperdal
Ziprasidone Geodon
Wakefulness-promoting eugeroic() drugs
Armodafinil Nuvigil
Modafinil Nuvigil
Antidepressants
Desipramine Norpramin
Imipramine Tofranil
Bupropion Wellbutrin SR, Wellbutrin XL

ADHD medications under investigation

Generic name, Class Brand 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 Name Brand 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)

Generic Brand Name
Citalopram Celexa
Escitalopram Lexapro, Cipralex
Fluoxetine Prozac, Sarafem; Pexeva
Fluvoxamine Luvox
Paroxetine Paxil, Paxil CR
Sertraline Zoloft

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.
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Tricyclics (TCA)

Generic Brand Name
Amitriptyline Elavil, Endep, Levante
Amoxapine Asendin
Clomipramine Anafranil
Desipramine Norpramin, Pertofrane
Dosulepin Prothiaden, Thaden
Doxepin Adapin, Sinequan
Imipramine Tofranil
Lofepramine Gamanil, Lomont
Maprotiline Deprilept, Ludiomil, Psymion
Mianserin Bolvidon, Norval, Tolvan
Nortriptyline Pamelor
Protriptyline Vivactil
Trimipramine Surmontil

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)

Generic Brand Name
Desvenlafaxine Pristiq
Duloxetine Cymbalta
Levomilnacipran Fetzima
Milnacipran Savella
Venlafaxine Effexor, 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)

Generic Brand Name
Mirtazapine Remeron, 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)

Generic Brand Name
Bupropion Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban; Aplenzin

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Generic Brand 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
Vortioxetine Brintellix
Combinations
Fluoxetine/Olanzapine
(SSRI/antipsychotic)
Symbyax
Amitriptyline/Perphenazine
(TCA/antipsychotic)
Etrafon, Triavil

MAOIs (Monoamine Oxidase Inhibitors)

Generic Brand Name
Isocarboxazid Marplan
Moclobemide Manerix
Phenelzine Nardil
Tranylcypromine Parnate
Selegiline Emsam (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:

Generic Brand Name
Lithium Eskalith, Lithane, Lithobid
Quetiapine Seroquel, Xeroquel, Ketipinor

Atypical antipsychotics

Certain atypical antipsychotics licensed to treat depression are:

Generic Brand Name
Brexpiprazole Rexulti
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