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Narcotic analgesic combinations

Medically reviewed by C. Fookes, BPharm. Last updated on March 20, 2018.

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.

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 this has resulted in government officials introducing new legislation to further restrict the prescribing of opioids. More than 42,000 people died in 2016 because of an opioid overdose; 40% 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:

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.

References

  1. Opioid Addiction. 2016 Facts & Figures. American Society of Addiction Medicine. https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf
  2. Drewes AM, Jensen RD, Nielsen LM, et al. Differences between opioids: pharmacological, experimental, clinical and economical perspectives. British Journal of Clinical Pharmacology. 2013;75(1):60-78. doi:10.1111/j.1365-2125.2012.04317.x.
  3. Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain Michael G. DeGroote. National Pain Centre. McMaster University. http://nationalpaincentre.mcmaster.ca/opioid_2010/cgop_b02_r08.html
  4. Rational Opioid use. Stanford Education 2008. http://ether.stanford.edu/ca1/text08/i.pdf.
  5. An Overview of Opioids, Pharmacy Times. http://www.pharmacytimes.com/publications/issue/2011/june2011/an-overview-of-opioids

 

List of Narcotic analgesic combinations:

View by  Brand | Generic
Drug Name Avg. Rating Reviews
Suboxone (Pro)
Generic name: buprenorphine / naloxone
8.6
698 reviews
Norco (Pro)
Generic name: acetaminophen / hydrocodone
6.8
348 reviews
Percocet (Pro)
Generic name: acetaminophen / oxycodone
8.5
229 reviews
Lortab (Pro)
Generic name: acetaminophen / hydrocodone
7.9
148 reviews
Tylenol with Codeine #3
Generic name: acetaminophen / codeine
4.7
146 reviews
Vicodin (Pro)
Generic name: acetaminophen / hydrocodone
7.9
142 reviews
Zubsolv (Pro)
Generic name: buprenorphine / naloxone
7.2
118 reviews
Bunavail (Pro)
Generic name: buprenorphine / naloxone
6.2
61 reviews
Embeda (Pro)
Generic name: morphine / naltrexone
5.3
49 reviews
Endocet (Pro)
Generic name: acetaminophen / oxycodone
8.0
47 reviews
Vicoprofen (Pro)
Generic name: hydrocodone / ibuprofen
8.3
44 reviews
Ultracet (Pro)
Generic name: acetaminophen / tramadol
7.4
31 reviews
Roxicet (Pro)
Generic name: acetaminophen / oxycodone
7.8
28 reviews
Fioricet with Codeine (Pro)
Generic name: acetaminophen / butalbital / caffeine / codeine
9.4
20 reviews
Talwin Nx
Generic name: naloxone / pentazocine
6.9
17 reviews
Fiorinal with Codeine (Pro)
Generic name: aspirin / butalbital / caffeine / codeine
9.4
16 reviews
Vicodin ES
Generic name: acetaminophen / hydrocodone
8.4
15 reviews
Trezix (Pro)
Generic name: acetaminophen / caffeine / dihydrocodeine
5.9
14 reviews
Tylox (Pro)
Generic name: acetaminophen / oxycodone
8.6
13 reviews
Tylenol with Codeine #4
Generic name: acetaminophen / codeine
5.1
13 reviews
Lorcet 10/650
Generic name: acetaminophen / hydrocodone
8.7
13 reviews
Reprexain (Pro)
Generic name: hydrocodone / ibuprofen
8.7
12 reviews
Vicodin HP (Pro)
Generic name: acetaminophen / hydrocodone
8.1
10 reviews
Fiorinal with Codeine III
Generic name: aspirin / butalbital / caffeine / codeine
9.8
9 reviews
Panlor SS
Generic name: acetaminophen / caffeine / dihydrocodeine
7.8
7 reviews
Xartemis XR (Pro)
Generic name: acetaminophen / oxycodone
7.5
5 reviews
Darvocet A500
Generic name: acetaminophen/propoxyphene
6.6
5 reviews
Tylenol with Codeine (Pro)
Generic name: acetaminophen / codeine
7.8
4 reviews
Percodan (Pro)
Generic name: aspirin / oxycodone
6.7
4 reviews
Darvocet-N 50 (Pro)
Generic name: acetaminophen/propoxyphene
7.5
4 reviews
Primlev (Pro)
Generic name: acetaminophen / oxycodone
9.0
3 reviews
B & O Supprettes
Generic name: belladonna / opium
10
3 reviews
Ascomp with Codeine (Pro)
Generic name: aspirin / butalbital / caffeine / codeine
10
3 reviews
Xodol (Pro)
Generic name: acetaminophen / hydrocodone
8.7
2 reviews
Targiniq ER (Pro)
Generic name: naloxone / oxycodone
9.0
2 reviews
Talacen
Generic name: acetaminophen/pentazocine
8.3
2 reviews
Nalocet (Pro)
Generic name: acetaminophen / oxycodone
6.5
2 reviews
Magnacet (Pro)
Generic name: acetaminophen / oxycodone
9.7
2 reviews
Balacet
Generic name: acetaminophen/propoxyphene
6.3
2 reviews
Anexsia
Generic name: acetaminophen / hydrocodone
7.2
2 reviews
Zolvit
Generic name: acetaminophen / hydrocodone
10
1 review
Xolox
Generic name: acetaminophen / oxycodone
8.5
1 review
Synalgos-DC (Pro)
Generic name: aspirin / caffeine / dihydrocodeine
10
1 review
Panlor DC
Generic name: acetaminophen / caffeine / dihydrocodeine
8.7
1 review
Maxidone (Pro)
Generic name: acetaminophen / hydrocodone
10
1 review
Lorcet
Generic name: acetaminophen / hydrocodone
10
1 review
Ibudone (Pro)
Generic name: hydrocodone / ibuprofen
8.7
1 review
Zydone (Pro)
Generic name: acetaminophen / hydrocodone
5.0
No reviews
Zerlor
Generic name: acetaminophen / caffeine / dihydrocodeine
No reviews
Zamicet (Pro)
Generic name: acetaminophen / hydrocodone
6.0
No reviews
Verdrocet
Generic name: acetaminophen / hydrocodone
No reviews
Troxyca ER (Pro)
Generic name: naltrexone / oxycodone
No reviews
Tramapap
Generic name: acetaminophen / tramadol
No reviews
Theracodophen Low 90
Generic name: acetaminophen / hydrocodone
No reviews
Stagesic (Pro)
Generic name: acetaminophen / hydrocodone
8.0
No reviews
Seglentis (Pro)
Generic name: celecoxib / tramadol
No reviews
Roxilox
Generic name: acetaminophen / oxycodone
No reviews
Prolate
Generic name: acetaminophen / oxycodone
No reviews
Phrenilin with Caffeine and Codeine (Pro)
Generic name: acetaminophen / butalbital / caffeine / codeine
No reviews
Perloxx
Generic name: acetaminophen / oxycodone
No reviews
Panlor (Pro)
Generic name: acetaminophen / caffeine / dihydrocodeine
No reviews
Narvox
Generic name: acetaminophen / oxycodone
5.0
No reviews
Lorcet Plus
Generic name: acetaminophen / hydrocodone
9.2
No reviews
Liquicet
Generic name: acetaminophen / hydrocodone
7.0
No reviews
Hycet (Pro)
Generic name: acetaminophen / hydrocodone
8.3
No reviews
Endodan (Pro)
Generic name: aspirin / oxycodone
No reviews
Dvorah (Pro)
Generic name: acetaminophen / caffeine / dihydrocodeine
No reviews
Combunox (Pro)
Generic name: ibuprofen / oxycodone
8.5
No reviews
Codrix
Generic name: acetaminophen / codeine
No reviews
Cocet Plus
Generic name: acetaminophen / codeine
No reviews
Co-Gesic (Pro)
Generic name: acetaminophen / hydrocodone
No reviews
Cassipa
Generic name: buprenorphine / naloxone
No reviews
Capital w/Codeine
Generic name: acetaminophen / codeine
No reviews
Apadaz (Pro)
Generic name: acetaminophen / benzhydrocodone
No reviews
For ratings, users were asked how effective they found the medicine while considering positive/adverse effects and ease of use (1 = not effective, 10 = most effective).

See Also

Medical conditions associated with narcotic analgesic combinations:

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.