ATC Group: N02AJ Opioids in combination with non-opioid analgesics

Ibuprofen is an NSAID which acts peripherally, inhibiting prostaglandin synthesis and the action of chemical mediators of pain. In humans, ibuprofen reduces inflammatory pain, swellings and fever. Codeine is a centrally acting weak analgesic. Codeine exerts its effect through μ opioid receptors, although codeine has low affinity for these receptors, and its analgesic effect is due to its conversion to morphine. The combination of a well tolerated peripheral analgesic with a centrally acting analgesic provides optimum pain relief with a lower potential for producing side effects.

The combination of paracetamol with codeine is a well-tolerated and effective analgesic. It consists of complementary active substances with different properties, but with common indication, the relief of pain. A special feature of the combination of paracetamol and codeine is the rapid onset of action after 10-20 minutes and the duration of action for 4-6 hours.

The combination of dihydrocodeine and paracetamol is used to treat aches and pains, including headaches, migraines, muscle and joint pain, period pain and toothache.

Oxycodone and paracetamol combination is used to relieve moderate to severe pain. Oxycodone is a full opioid agonist with relative selectivity for the mu-opioid receptor, although it can interact with other opioid receptors at higher doses. The principal therapeutic action of oxycodone is analgesia. The precise mechanism of the analgesic properties of acetaminophen is not established but is thought to involve central actions.

Tramadol hydrochloride is a centrally acting synthetic opioid analgesic. It is a non-selective, partial agonist of μ-, δ- and κ-opioid receptors with a higher affinity for μ-receptors. Tramadol has an antitussive action. In contrast to morphine, analgesic doses of tramadol over a wide range have no respiratory depressant effect. Dexketoprofen is an analgesic, anti-inflammatory and antipyretic drug, which belongs to the non-steroidal anti-inflammatory group of drugs. The mechanism of action of non-steroidal antiinflammatory drugs is related to the reduction of prostaglandin synthesis by the inhibition of cyclooxygenase pathway.

Tramadol is an opioid analgesic that acts on the central nervous system. Tramadol is a pure non selective agonists of the µ, δ, and κ opioid receptors with a higher affinity for the µ receptors. Tramadol has an antitussive effect. The precise mechanism of the analgesic properties of paracetamol is unknown and may involve central and peripheral effects. Tramadol/paracetamol is positioned as a step II analgesic in the WHO pain ladder and should be utilised accordingly by the physician.