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"Painkiller" redirects here. For other uses, see Painkiller (disambiguation).
Tilidine, a brand of painkiller

An analgesic or 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 reversibly eliminate sensation. Analgesics include paracetamol (known in the US as acetaminophen or simply APAP), the non-steroidal anti-inflammatory drugs (NSAIDs) such as the salicylates, and opioid drugs such as morphine and oxycodone.

In choosing analgesics, the severity and response to other medication determines the choice of agent; the World Health Organization (WHO) pain ladder[1] specifies mild analgesics as its first step.

Analgesic choice is also determined by the type of pain: For neuropathic pain, traditional analgesics are less effective, and there is often benefit from classes of drugs that are not normally considered analgesics, such as tricyclic antidepressants and anticonvulsants.[2]

Name

The word analgesic derives from Greek an- (ἀν-, "without"), álgos (ἄλγος, "pain"),[3] and -ikos (-ικος, forming adjectives). Such drugs were usually known as anodynes before the 20th century.[4][5]

Major classes

Paracetamol and NSAIDs

Main article: Non-steroidal anti-inflammatory drug

The exact mechanism of action of paracetamol/acetaminophen is uncertain but appears to act centrally in the brain rather than peripherally in nerve endings. Aspirin and the other non-steroidal anti-inflammatory drugs (NSAIDs) inhibit cyclooxygenases, leading to a decrease in prostaglandin production. In contrast to paracetamol and the opioids, this reduces not only pain but inflammation as well.[citation needed]

Paracetamol has few side-effects and is regarded as generally safe in low and infrequent doses as prescribed or per manufacturer's instructions, otherwise use can lead to potentially life-threatening liver damage and occasionally kidney damage. Side effects include bloody or black, tarry stools, bloody or cloudy urine, fever with or without chills (not present before treatment and not caused by the condition being treated), pain in the lower back and/or side (severe and/or sharp), pinpoint red spots on the skin, skin rash, hives, or itching, sore throat (not present before treatment and not caused by the condition being treated), sores, ulcers, or white spots on the lips or in the mouth, sudden decrease in the amount of urine, unusual bleeding or bruising, unusual tiredness or weakness, yellow eyes or skin.[6]

While paracetamol is usually taken orally or rectally, an intravenous preparation introduced in 2002 has been shown to improve pain relief and reduce opioid consumption in the perioperative setting.

NSAIDs can predispose to in some patients peptic ulcers, renal failure, allergic reactions, and occasionally tinnitus with excess dosage, and they can increase the risk of hemorrhage by affecting platelet function. The use of aspirin in children under 16 suffering from viral illness has been linked to Reye's syndrome, a rare but severe liver disorder.

COX-2 inhibitors

Main article: COX-2 inhibitor

These drugs have been derived from NSAIDs. The cyclooxygenase enzyme inhibited by NSAIDs was discovered to have at least 2 different versions: COX1 and COX2. Research suggested most of the adverse effects of NSAIDs to be mediated by blocking the COX1 (constitutive) enzyme, with the analgesic effects being mediated by the COX2 (inducible) enzyme. Thus, the COX2 inhibitors were developed to inhibit only the COX2 enzyme (traditional NSAIDs block both versions in general). These drugs (such as rofecoxib, celecoxib, and etoricoxib) are equally effective analgesics when compared with NSAIDs, but cause less gastrointestinal hemorrhage in particular.[7]

After widespread adoption of the COX-2 inhibitors, it was discovered that most of the drugs in this class increase the risk of cardiovascular events by 40% on average. This led to the withdrawal of rofecoxib and valdecoxib, and warnings on others. Etoricoxib seems relatively safe, with the risk of thrombotic events similar to that of non-coxib NSAID diclofenac.[7]

Opioids

Main article: Opioid

Morphine, the archetypal opioid, and various other substances (e.g., codeine, oxycodone, hydrocodone, dihydromorphine, pethidine) all exert a similar influence on the cerebral opioid receptor system. Buprenorphine is thought to be a partial agonist of the opioid receptor, and tramadol is an opiate agonist with SNRI properties.[citation needed] Tramadol is structurally closer to venlafaxine than to codeine and delivers analgesia by not only delivering "opiate-like" effects (through mild agonism of the mu receptor) but also by acting as a weak but fast-acting serotonin releasing agent and norepinephrine reuptake inhibitor.[8][9][10][11] Tapentadol, with some structural similarities to tramadol, presents what is believed to be a novel drug working through two (and possibly three) different modes of action in the fashion of both a traditional opioid and as a SNRI. The effects of serotonin and norepinephrine on pain, while not completely understood, have had causal links established and drugs in the SNRI class are commonly used in conjunction with opioids (especially tapentadol and tramadol) with greater success in pain relief. Dosing of all opioids may be limited by opioid toxicity (confusion, respiratory depression, myoclonic jerks and pinpoint pupils), seizures (tramadol), but opioid-tolerant individuals usually have higher dose ceilings than patients without tolerance. [citation needed]

Opioids, while very effective analgesics, may have some unpleasant side-effects. Patients starting morphine may experience nausea and vomiting (generally relieved by a short course of antiemetics such as phenergan). Pruritus (itching) may require switching to a different opioid. Constipation occurs in almost all patients on opioids, and laxatives (lactulose, macrogol-containing or co-danthramer) are typically co-prescribed.[12]

When used appropriately, opioids and similar narcotic analgesics are otherwise safe and effective, however risks such as addiction and the body's becoming used to the drug (tolerance) can occur. The effect of tolerance means that frequent use of the drug may result in its diminished effect so, when safe to do so, the dosage may need to be increased to maintain effectiveness. This may be of particular concern regarding patients suffering with chronic pain.[citation needed]

Flupirtine

Flupirtine is a centrally acting K+ channel opener with weak NMDA antagonist properties.[13] It is used in Europe for moderate to strong pain and migraine and its muscle-relaxant properties. It has no anticholinergic properties and is believed to be devoid of any activity on dopamine, serotonin, or histamine receptors. It is not addictive, and tolerance usually does not develop.[14] However, tolerance may develop in single cases.[15]

Specific agents

In patients with chronic or neuropathic pain, various other substances may have analgesic properties. Tricyclic antidepressants, especially amitriptyline, have been shown to improve pain in what appears to be a central manner.[citation needed] Nefopam is used in Europe for pain relief with concurrent opioids. The exact mechanism of carbamazepine, gabapentin, and pregabalin is similarly unclear, but these anticonvulsants are used to treat neuropathic pain with differing degrees of success. Anticonvulsants are most commonly used for neuropathic pain as their mechanism of action tends to inhibit pain sensation.[16]

Specific forms and uses

Combinations

Analgesics are frequently used in combination, such as the paracetamol and codeine preparations found in many non-prescription pain relievers. They can also be found in combination with vasoconstrictor drugs such as pseudoephedrine for sinus-related preparations, or with antihistamine drugs for allergy sufferers.

While the use of paracetamol, aspirin, ibuprofen, naproxen, and other NSAIDS concurrently with weak to mid-range opiates (up to about the hydrocodone level) has been said to show beneficial synergistic effects by combatting pain at multiple sites of action,[17] several combination analgesic products have been shown to have few efficacy benefits when compared to similar doses of their individual components. Moreover, these combination analgesics can often result in significant adverse events, including accidental overdoses, most often due to confusion that arises from the multiple (and often non-acting) components of these combinations.[18]

Topical or systemic

Topical analgesia is generally recommended to avoid systemic side-effects. Painful joints, for example, may be treated with an ibuprofen- or diclofenac-containing gel (The labeling for topical diclofenac has been updated to warn about drug-induced hepatotoxicity.[19]); capsaicin also is used topically. Lidocaine, an anesthetic, and steroids may be injected into painful joints for longer-term pain relief. Lidocaine is also used for painful mouth sores and to numb areas for dental work and minor medical procedures. In February 2007 the FDA notified consumers and healthcare professionals of the potential hazards of the use of topical anesthetics. These topical anesthetics contain anesthetic drugs such as lidocaine, tetracaine, benzocaine, and prilocaine in a cream, ointment, or gel.[20]

Psychotropic agents

Tetrahydrocannabinol (THC) and some other cannabinoids, either from the Cannabis sativa plant or synthetic, have analgesic properties, although the use of cannabis derivatives is currently illegal in many countries. A recent study finds that inhaled cannabis is effective in alleviating neuropathy and pain resulting from, e.g., spinal injury and multiple sclerosis.[21] Other psychotropic analgesic agents include ketamine (an NMDA receptor antagonist), clonidine and other α2-adrenoreceptor agonists, and mexiletine and other local anaesthetic analogues.

Atypical, adjuvant analgesics & potentiators

Drugs that have been introduced for uses other than analgesics are also used in pain management. Both first-generation (such as amitriptyline) and newer anti-depressants (such as duloxetine) are used alongside NSAIDs and opioids for pain involving nerve damage and similar problems. Other agents directly potentiate the effects of analgesics, such as using hydroxyzine, promethazine, carisoprodol, or tripelennamine to increase the pain-killing ability of a given dose of opioid analgesic.

Adjuvant analgesics, also called atypical analgesics, include nefopam, orphenadrine, pregabalin, gabapentin, cyclobenzaprine, scopolamine, and other drugs possessing anticonvulsant, anticholinergic, and/or antispasmodic properties, as well as many other drugs with CNS actions. These drugs are used along with analgesics to modulate and/or modify the action of opioids when used against pain, especially of neuropathic origin.

Dextromethorphan has been noted to slow the development of tolerance to opioids and exert additional analgesia by acting upon the NMDA receptors;[citation needed] some analgesics such as methadone and ketobemidone and perhaps piritramide have intrinsic NMDA action.[citation needed]

High-alcohol liquor, two forms of which found in the US Pharmacopoeia up until 1916 and in common use by physicians well into the 1930s, has been used in the past as an agent for dulling pain, due to the CNS depressant effects of ethyl alcohol, a notable example being the American Civil War. However, the ability of alcohol to relieve severe pain is likely inferior to many analgesics used today (e.g., morphine, codeine). As such, in general, the idea of alcohol for analgesia is considered a primitive practice in virtually all industrialized countries today.

The use of adjuvant analgesics is an important and growing part of the pain-control field and new discoveries are made practically every year. Many of these drugs combat the side-effects of opioid analgesics, an added bonus. For example, antihistamines including orphenadrine combat the release of histamine caused by many opioids. Stimulants such as methylphenidate, caffeine, ephedrine, dextroamphetamine, methamphetamine, and cocaine work against heavy sedation and may elevate mood in distressed patients as do the antidepressants.[citation needed] The use of medicinal cannabis remains a debated issue.

Comparison of available agents

See also

References

  1. ^ Anonymous (1990). Cancer pain relief and palliative care; report of a WHO expert committee. World Health Organization Technical Report Series, 804. Geneva, Switzerland: World Health Organization. pp. 1–75. ISBN 92-4-120804-X.
  2. ^ Dworkin RH, Backonja M, Rowbotham MC, Allen RR, Argoff CR, Bennett GJ, Bushnell MC, Farrar JT, Galer BS, Haythornthwaite JA, Hewitt DJ, Loeser JD, Max MB, Saltarelli M, Schmader KE, Stein C, Thompson D, Turk DC, Wallace MS, Watkins LR, Weinstein SM; Backonja; Rowbotham; Allen; Argoff; Bennett; Bushnell; Farrar; Galer; Haythornthwaite; Hewitt; Loeser; Max; Saltarelli; Schmader; Stein; Thompson; Turk; Wallace; Watkins; Weinstein (2003). "Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations". Arch. Neurol. 60 (11): 1524–34. doi:10.1001/archneur.60.11.1524. PMID 14623723.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. ^ Harper,D. (2001). "Online Etymology Dictionary: Analgesia". Retrieved December 3, 2012.
  4. ^ EB (1878).
  5. ^ EB (1911).
  6. ^ Acetaminophen Side Effects in Detail - Drugs.com
  7. ^ a b Conaghan PG (June 2012). "A turbulent decade for NSAIDs: update on current concepts of classification, epidemiology, comparative efficacy, and toxicity". Rheumatol. Int. 32 (6): 1491–502. doi:10.1007/s00296-011-2263-6. PMC 3364420. PMID 22193214.
  8. ^ Driessen B, Reimann W; Reimann (January 1992). "Interaction of the central analgesic, tramadol, with the uptake and release of 5-hydroxytryptamine in the rat brain in vitro". British Journal of Pharmacology. 105 (1): 147–51. doi:10.1111/j.1476-5381.1992.tb14226.x. PMC 1908625. PMID 1596676.
  9. ^ Bamigbade TA, Davidson C, Langford RM, Stamford JA; Davidson; Langford; Stamford (September 1997). "Actions of tramadol, its enantiomers and principal metabolite, O-desmethyltramadol, on serotonin (5-HT) efflux and uptake in the rat dorsal raphe nucleus". British Journal of Anaesthesia. 79 (3): 352–6. doi:10.1093/bja/79.3.352. PMID 9389855.{{cite journal}}: CS1 maint: multiple names: authors list (link)[dead link‍]
  10. ^ Reimann W, Schneider F; Schneider (May 1998). "Induction of 5-hydroxytryptamine release by tramadol, fenfluramine and reserpine". European Journal of Pharmacology. 349 (2–3): 199–203. doi:10.1016/S0014-2999(98)00195-2. PMID 9671098.
  11. ^ Gobbi M, Moia M, Pirona L, Ceglia I, Reyes-Parada M, Scorza C, Mennini T; Moia; Pirona; Ceglia; Reyes-Parada; Scorza; Mennini (September 2002). "p-Methylthioamphetamine and 1-(m-chlorophenyl)piperazine, two non-neurotoxic 5-HT releasers in vivo, differ from neurotoxic amphetamine derivatives in their mode of action at 5-HT nerve endings in vitro". Journal of Neurochemistry. 82 (6): 1435–43. doi:10.1046/j.1471-4159.2002.01073.x. PMID 12354291.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. ^ Oxford Textbook of Palliative Medicine, 3rd ed. (Doyle D, Hanks G, Cherney I and Calman K, eds. Oxford University Press, 2004).
  13. ^ Kornhuber J, Bleich S, Wiltfang J, Maler M, Parsons CG; Bleich; Wiltfang; Maler; Parsons (1999). "Flupirtine shows functional NMDA receptor antagonism by enhancing Mg2+ block via activation of voltage independent potassium channels. Rapid communication". J Neural Transm. 106 (9–10): 857–67. doi:10.1007/s007020050206. PMID 10599868.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. ^ Klawe C, Maschke M; Maschke (2009). "Flupirtine: pharmacology and clinical applications of a nonopioid analgesic and potentially neuroprotective compound". Expert opinion on pharmacotherapy. 10 (9): 1495–500. doi:10.1517/14656560902988528. PMID 19505216.
  15. ^ Stoessel C, Heberlein A, Hillemacher T, Bleich S, Kornhuber J; Heberlein; Hillemacher; Bleich; Kornhuber (August 2010). "Positive reinforcing effects of flupirtine--two case reports". Prog. Neuropsychopharmacol. Biol. Psychiatry. 34 (6): 1120–1. doi:10.1016/j.pnpbp.2010.03.031. PMID 20362025.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  16. ^ Ian Eardley, Peter Whelan, Roger Kirby, Anthony Schaeffer. "Drugs Used In The Treatment Of Interstitial Cystitis". Drug Treatment in Urology. John Wiley & Sons, 2008. p. 65.{{cite book}}: CS1 maint: multiple names: authors list (link)
  17. ^ Mehlisch DR (2002). "The efficacy of combination analgesic therapy in relieving dental pain". J Am Dent Assoc. 133 (7): 861–71. doi:10.14219/jada.archive.2002.0300. PMID 12148679.[dead link‍]
  18. ^ Murnion B. "Combination analgesics in adults". Australian Prescriber (33): 113–5. Retrieved 12 August 2010.
  19. ^ Voltaren Gel (diclofenac sodium topical gel) 1% - Hepatic Effects Labeling Changes
  20. ^ [1][dead link‍]
  21. ^ CMCR: CMCR Report February 17th, California, 2010. http://www.cmcr.ucsd.edu/CMCR_REPORT_FEB17.pdf
  22. ^ a b c d e Brayfield, A (ed.). "Martindale: The Complete Drug Reference". Medicines Complete. Pharmaceutical Press. Retrieved 9 April 2014.
  23. ^ a b c d Brunton, L; Chabner, B; Knollman, B (2010). Goodman and Gilman's The Pharmacological Basis of Therapeutics (12th ed.). New York: McGraw-Hill Professional. ISBN 978-0-07-162442-8.
  24. ^ a b c d e f g h i Rossi, S, ed. (2013). Australian Medicines Handbook (2013 ed.). Adelaide: The Australian Medicines Handbook Unit Trust. ISBN 978-0-9805790-9-3.
  25. ^ a b c Joint Formulary Committee (2013). British National Formulary (BNF) (65 ed.). London, UK: Pharmaceutical Press. ISBN 978-0-85711-084-8.
  26. ^ "Zorprin, Bayer Buffered Aspirin (aspirin) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 6 April 2014.
  27. ^ "Seractil 300mg Film-Coated Tablets - Summary of Product Characteristics". electronic Medicines Compendium. Genus Pharmaceuticals. 30 September 2005. Retrieved 7 April 2014.
  28. ^ Derry S, Best J, Moore RA; Best; Moore (October 2013). "Single dose oral dexibuprofen [S(+)-ibuprofen] for acute postoperative pain in adults" (PDF). The Cochrane Database of Systematic Reviews. 10: CD007550. doi:10.1002/14651858.CD007550.pub3. PMID 24151035.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  29. ^ a b "Cardiovascular safety of Cox-2 inhibitors and non-selective NSAIDs". MHRA. 26 July 2013. Retrieved 7 April 2014.[dead link‍]
  30. ^ "(diflunisal) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 7 April 2014.
  31. ^ "Nalfon (fenoprofen) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 7 April 2014.
  32. ^ a b Abdel-Aziz AA, Al-Badr AA, Hafez GA; Al-Badr; Hafez (2012). "Flurbiprofen" (PDF). Profiles of Drug Substances, Excipients, and Related Methodology. Profiles of Drug Substances, Excipients and Related Methodology. 37: 113–81. doi:10.1016/B978-0-12-397220-0.00004-0. ISBN 9780123972200. PMID 22469318.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  33. ^ Smith HS, Voss B; Voss (February 2012). "Pharmacokinetics of intravenous ibuprofen: implications of time of infusion in the treatment of pain and fever". Drugs. 72 (3): 327–37. doi:10.2165/11599230-000000000-00000. PMID 22316349.
  34. ^ Neumann R, Schulzke SM, Bührer C; Schulzke; Bührer (2012). "Oral ibuprofen versus intravenous ibuprofen or intravenous indomethacin for the treatment of patent ductus arteriosus in preterm infants: a systematic review and meta-analysis". Neonatology. 102 (1): 9–15. doi:10.1159/000335332. PMID 22414850.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  35. ^ Johnston PG, Gillam-Krakauer M, Fuller MP, Reese J; Gillam-Krakauer; Fuller; Reese (March 2012). "Evidence-based use of indomethacin and ibuprofen in the neonatal intensive care unit" (PDF). Clinics in Perinatology. 39 (1): 111–36. doi:10.1016/j.clp.2011.12.002. PMC 3598606. PMID 22341541.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  36. ^ "Arthrexin Indomethacin PRODUCT INFORMATION" (PDF). TGA eBusiness Services. Alphapharm Pty Limited. 14 October 2011. Retrieved 7 April 2014.
  37. ^ Coaccioli S (August 2011). "Ketoprofen 2.5% gel: a clinical overview". European Review for Medical and Pharmacological Sciences. 15 (8): 943–9. PMID 21845805.
  38. ^ Adachi H, Ioppolo F, Paoloni M, Santilli V; Ioppolo; Paoloni; Santilli (July 2011). "Physical characteristics, pharmacological properties and clinical efficacy of the ketoprofen patch: a new patch formulation". European Review for Medical and Pharmacological Sciences. 15 (7): 823–30. PMID 21780552.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  39. ^ Kokki, H (October 2010). "Ketoprofen pharmacokinetics, efficacy, and tolerability in pediatric patients". Paediatric drugs. 12 (5): 313–29. doi:10.2165/11534910-000000000-00000. PMID 20799760.
  40. ^ Shohin, IE; Kulinich, JI; Ramenskaya, GV; Abrahamsson, B; Kopp, S; Langguth, P; Polli, JE; Shah, VP; et al. (October 2012). "Biowaiver monographs for immediate-release solid oral dosage forms: ketoprofen" (PDF). Journal of Pharmaceutical Sciences. 101 (10): 3593–603. doi:10.1002/jps.23233. PMID 22786667.
  41. ^ Sarzi-Puttini, P; Atzeni, F; Lanata, L; Bagnasco, M; Colombo, M; Fischer, F; D'Imporzano, M (July–September 2010). "Pain and ketoprofen: what is its role in clinical practice?" (PDF). Reumatismo. 62 (3): 172–88. doi:10.4081/reumatismo.2010.172. PMID 21052564.
  42. ^ "NAME OF THE MEDICINE TORADOL® (ketorolac trometamol)" (PDF). TGA eBusiness Services. ROCHE PRODUCTS PTY LIMITED. 3 February 2012. Retrieved 7 April 2014.
  43. ^ McCormack PL (July 2011). "Ketorolac 0.45% ophthalmic solution". Drugs & Aging. 28 (7): 583–9. doi:10.2165/11207450-000000000-00000. PMID 21721602.
  44. ^ Sinha VR, Kumar RV, Singh G; Kumar; Singh (September 2009). "Ketorolac tromethamine formulations: an overview". Expert Opinion on Drug Delivery. 6 (9): 961–75. doi:10.1517/17425240903116006. PMID 19663721.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  45. ^ De Oliveira GS, Agarwal D, Benzon HT; Agarwal; Benzon (February 2012). "Perioperative single dose ketorolac to prevent postoperative pain: a meta-analysis of randomized trials". Anesthesia and Analgesia. 114 (2): 424–33. doi:10.1213/ANE.0b013e3182334d68. PMID 21965355.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  46. ^ Garnock-Jones KP (June 2012). "Intranasal ketorolac: for short-term pain management". Clinical Drug Investigation. 32 (6): 361–71. doi:10.2165/11209240-000000000-00000. PMID 22574632.
  47. ^ He A, Hersh EV; Hersh (December 2012). "A review of intranasal ketorolac tromethamine for the short-term management of moderate to moderately severe pain that requires analgesia at the opioid level". Current Medical Research and Opinion. 28 (12): 1873–80. doi:10.1185/03007995.2012.744302. PMID 23098098.
  48. ^ Taggart E, Doran S, Kokotillo A, Campbell S, Villa-Roel C, Rowe BH; Doran; Kokotillo; Campbell; Villa-Roel; Rowe (February 2013). "Ketorolac in the treatment of acute migraine: a systematic review". Headache. 53 (2): 277–87. doi:10.1111/head.12009. PMID 23298250.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  49. ^ Yilmaz T, Cordero-Coma M, Gallagher MJ; Cordero-Coma; Gallagher (February 2012). "Ketorolac therapy for the prevention of acute pseudophakic cystoid macular edema: a systematic review" (PDF). Eye. 26 (2): 252–8. doi:10.1038/eye.2011.296. PMC 3272202. PMID 22094296.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  50. ^ Balfour JA, Fitton A, Barradell LB; Fitton; Barradell (April 1996). "Lornoxicam. A review of its pharmacology and therapeutic potential in the management of painful and inflammatory conditions". Drugs. 51 (4): 639–57. doi:10.2165/00003495-199651040-00008. PMID 8706598.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  51. ^ Skjodt NM, Davies NM; Davies (June 1998). "Clinical pharmacokinetics of lornoxicam. A short half-life oxicam". Clinical Pharmacokinetics. 34 (6): 421–8. doi:10.2165/00003088-199834060-00001. PMID 9646006.
  52. ^ "PRODUCT INFORMATION PONSTAN® CAPSULES (mefenamic acid)" (PDF). TGA eBusiness Services. Pfizer Australia Pty Ltd. 12 October 2012. Retrieved 7 April 2014.
  53. ^ "Relafen (nabumetone) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 7 April 2014.
  54. ^ Todd PA, Clissold SP; Clissold (July 1990). "Naproxen. A reappraisal of its pharmacology, and therapeutic use in rheumatic diseases and pain states". Drugs. 40 (1): 91–137. doi:10.2165/00003495-199040010-00006. PMID 2202585.
  55. ^ "Daypro (oxaprozin) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 7 April 2014.
  56. ^ Todd PA, Brogden RN; Brogden (October 1986). "Oxaprozin. A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy". Drugs. 32 (4): 291–312. doi:10.2165/00003495-198632040-00001. PMID 3536423.
  57. ^ "CHEMMART PIROXICAM CAPSULES" (PDF). TGA eBusiness Services. Apotex Pty Ltd. 18 December 2013. Retrieved 7 April 2014.
  58. ^ Brogden RN, Heel RC, Speight TM, Avery GS; Heel; Speight; Avery (October 1984). "Piroxicam. A reappraisal of its pharmacology and therapeutic efficacy". Drugs. 28 (4): 292–323. doi:10.2165/00003495-199448060-00007. PMID 6386426.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  59. ^ "(salsalate) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 7 April 2014.
  60. ^ "Aclin Sulindac" (PDF). TGA eBusiness Services. Alphapharm Pty Limited. 8 November 2011. Retrieved 7 April 2014.
  61. ^ Gonzalez JP, Todd PA; Todd (September 1987). "Tenoxicam. A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy". Drugs. 34 (3): 289–310. doi:10.2165/00003495-198734030-00001. PMID 3315620.
  62. ^ Davies NM (November 1996). "Clinical pharmacokinetics of tiaprofenic acid and its enantiomers". Clinical pharmacokinetics. 31 (5): 331–47. doi:10.2165/00003088-199631050-00002. PMID 9118583.
  63. ^ Brogden RN, Heel RC, Speight TM, Avery GS; Heel; Speight; Avery (June 1978). "Tolmetin: a review of its pharmacological properties and therapeutic efficacy in rheumatic diseases". Drugs. 15 (6): 429–50. doi:10.2165/00003495-197815060-00002. PMID 350558.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  64. ^ McCormack PL (December 2011). "Celecoxib: a review of its use for symptomatic relief in the treatment of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis". Drugs. 71 (18): 2457–89. doi:10.2165/11208240-000000000-00000. PMID 22141388.
  65. ^ Lynch S, Brogden RN; Brogden (April 1986). "Etodolac. A preliminary review of its pharmacodynamic activity and therapeutic use". Drugs. 31 (4): 288–300. doi:10.2165/00003495-198631040-00002. PMID 2940079.
  66. ^ Balfour JA, Buckley MM; Buckley (August 1991). "Etodolac. A reappraisal of its pharmacology and therapeutic use in rheumatic diseases and pain states". Drugs. 42 (2): 274–99. doi:10.2165/00003495-199142020-00008. PMID 1717225.
  67. ^ Brocks DR, Jamali F; Jamali (April 1994). "Etodolac clinical pharmacokinetics". Clinical pharmacokinetics. 26 (4): 259–74. doi:10.2165/00003088-199426040-00003. PMID 8013160.
  68. ^ Takemoto JK, Reynolds JK, Remsberg CM, Vega-Villa KR, Davies NM; Reynolds; Remsberg; Vega-Villa; Davies (2008). "Clinical pharmacokinetic and pharmacodynamic profile of etoricoxib". Clinical Pharmacokinetics. 47 (11): 703–20. doi:10.2165/00003088-200847110-00002. PMID 18840026.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  69. ^ Bannwarth B, Bérenbaum F; Bérenbaum (July 2007). "Lumiracoxib in the management of osteoarthritis and acute pain". Expert Opinion on Pharmacotherapy. 8 (10): 1551–64. doi:10.1517/14656566.8.10.1551. PMID 17661736.
  70. ^ Davies NM, Skjodt NM; Skjodt (February 1999). "Clinical pharmacokinetics of meloxicam. A cyclo-oxygenase-2 preferential nonsteroidal anti-inflammatory drug". Clinical Pharmacokinetics. 36 (2): 115–26. doi:10.2165/00003088-199936020-00003. PMID 10092958.
  71. ^ "PRODUCT INFORMATION DYNASTAT parecoxib (as sodium)" (PDF). TGA eBusiness Services. Pfizer Australia Pty Ltd. 6 February 2013. Retrieved 7 April 2014.
  72. ^ Scott LJ, Lamb HM; Lamb (September 1999). "Rofecoxib". Drugs. 58 (3): 499–505, discussion 506–7. doi:10.2165/00003495-199958030-00016. PMID 10493277.
  73. ^ Hillson JL, Furst DE; Furst (July 2000). "Rofecoxib". Expert Opinion on Pharmacotherapy. 1 (5): 1053–66. doi:10.1517/14656566.1.5.1053. PMID 11249495.
  74. ^ Ormrod D, Wellington K, Wagstaff AJ; Wellington; Wagstaff (2002). "Valdecoxib". Drugs. 62 (14): 2059–71, discussion 2072–3. doi:10.2165/00003495-200262140-00005. PMID 12269850.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  75. ^ "Buprenex, Subutex (buprenorphine) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 9 April 2014.
  76. ^ "PRODUCT INFORMATION ACTACODE" (PDF). TGA eBusiness Services. Aspen Pharma Pty Ltd. 19 September 2006. Retrieved 8 April 2014.
  77. ^ "Zohydro ER (hydrocodone) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 8 April 2014.
  78. ^ "Dilaudid, Dilaudid HP (hydromorphone) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 8 April 2014.
  79. ^ "Roxicodone, OxyContin (oxycodone) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 8 April 2014.
  80. ^ "Opana, Opana ER (oxymorphone) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 8 April 2014.
  81. ^ "Stadol (butorphanol) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 8 April 2014.
  82. ^ a b Prommer E (March 2007). "Levorphanol: the forgotten opioid". Supportive Care in Cancer. 15 (3): 259–64. doi:10.1007/s00520-006-0146-2. PMID 17039381.
  83. ^ "Levo Dromoran (levorphanol) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 9 April 2014.
  84. ^ "Nubain (nalbuphine) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 9 April 2014.
  85. ^ Errick JK, Heel RC; Heel (September 1983). "Nalbuphine. A preliminary review of its pharmacological properties and therapeutic efficacy". Drugs. 26 (3): 191–211. doi:10.2165/00003495-198326030-00002. PMID 6137354.
  86. ^ Brogden RN, Speight TM, Avery GS; Speight; Avery (1973). "Pentazocine: a review of its pharmacological properties, therapeutic efficacy and dependence liability". Drugs. 5 (1): 6–91. doi:10.2165/00003495-197305010-00002. PMID 4578369.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  87. ^ "Talwin (pentazocine) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 9 April 2014.
  88. ^ Anderson P, Arnér S, Bondesson U, Boréus LO, Hartvig P; Arnér; Bondesson; Boréus; Hartvig (1982). "Single-dose kinetics and bioavailability of ketobemidone". Acta Anaesthesiologica Scandinavica. Supplementum. 74: 59–62. PMID 6124079.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  89. ^ "Demerol, Pethidine (meperidine) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 9 April 2014.
  90. ^ Shipton E (March 2006). "Should New Zealand continue signing up to the Pethidine Protocol?" (PDF). The New Zealand Medical Journal. 119 (1230): U1875. PMID 16532042.[dead link‍]
  91. ^ Latta KS, Ginsberg B, Barkin RL; Ginsberg; Barkin (January–February 2002). "Meperidine: a critical review". American Journal of Therapeutics. 9 (1): 53–68. doi:10.1097/00045391-200201000-00010. PMID 11782820.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  92. ^ MacPherson, RD; Duguid, MD (2008). "Strategy to Eliminate Pethidine Use in Hospitals" (PDF). Journal of Pharmacy Practice and Research. 38 (2): 88–89.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  93. ^ Mather LE, Meffin PJ; Meffin (September–October 1978). "Clinical pharmacokinetics of pethidine". Clinical Pharmacokinetics. 3 (5): 352–68. doi:10.2165/00003088-197803050-00002. PMID 359212.
  94. ^ "Dipipanone 10mg + Cyclizine 30mg Tablets - Summary of Product Characteristics". 22 August 2012. Retrieved 9 April 2014.
  95. ^ Holmes B, Ward A; Ward (October 1985). "Meptazinol. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic efficacy". Drugs. 30 (4): 285–312. doi:10.2165/00003495-198530040-00001. PMID 2998723.
  96. ^ Lugo RA, Satterfield KL, Kern SE; Satterfield; Kern (2005). "Pharmacokinetics of methadone". Journal of Pain & Palliative Care Pharmacotherapy. 19 (4): 13–24. doi:10.1080/J354v19n04_05. PMID 16431829.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  97. ^ "Marinol (dronabinol) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 9 April 2014.
  98. ^ "Cymbalta (duloxetine) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 9 April 2014.
  99. ^ Szelenyi I (March 2013). "Flupirtine, a re-discovered drug, revisited". Inflammation Research. 62 (3): 251–8. doi:10.1007/s00011-013-0592-5. PMID 23322112.
  100. ^ Devulder J (October 2010). "Flupirtine in pain management: pharmacological properties and clinical use". CNS Drugs. 24 (10): 867–81. doi:10.2165/11536230-000000000-00000. PMID 20839897.
  101. ^ "Savella (milnacipran) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 9 April 2014.
  102. ^ Evans MS, Lysakowski C, Tramèr MR; Lysakowski; Tramèr (November 2008). "Nefopam for the prevention of postoperative pain: quantitative systematic review" (PDF). British Journal of Anaesthesia. 101 (5): 610–7. doi:10.1093/bja/aen267. PMID 18796441.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  103. ^ "Tylenol, Tylenol Infants' Drops (acetaminophen) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 8 April 2014.
  104. ^ McKeage K, Keam SJ; Keam (2009). "Pregabalin: in the treatment of postherpetic neuralgia". Drugs & Aging. 26 (10): 883–92. doi:10.2165/11203750-000000000-00000. PMID 19761281.
  105. ^ a b "Prialt (ziconotide) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 8 April 2014.
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