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 |
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.
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.
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 |
`
| 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 |