Narcotic and NonNarcotic Analgesics
Table of Contents
Narcotic Analgesics
Narcotic analgesics, also known as opioid analgesics, are a class of powerful pain-relieving medications derived from the opium poppy or synthesized to mimic its effects. They are primarily used to manage moderate to severe pain but carry a high risk of dependence, addiction, and overdose.These medications act on the central nervous system (CNS) by binding to opioid receptors to reduce the perception of pain.
Mechanism of Action
- Bind to mu (μ), kappa (κ), and delta (δ) opioid receptors in the brain and spinal cord.
- Block pain signal transmission and increase pain threshold.
- Cause euphoria, sedation, and respiratory depression.
Clinical Uses
- Moderate to severe pain
- Post-surgical pain
- Cancer-related pain
- Palliative care
- Chronic pain (in select cases)
- Cough suppression (e.g., codeine)
- Diarrhea (e.g., loperamide)
Common Side Effects
- Drowsiness, dizziness, nausea, constipation, respiratory depression.
Serious Risks:
- Addiction & Dependence – Long-term use can lead to physical and psychological dependence.
- Tolerance – Higher doses needed over time for the same effect.
- Overdose – Can cause fatal respiratory depression (slowed or stopped breathing).
- Withdrawal Symptoms – Anxiety, sweating, nausea, muscle pain, insomnia.
- Risk of addiction and overdose
Email Us
Types of Narcotic Analgesics
Natural Opioids
- Derived directly from the opium poppy.
- Examples: Morphine, Codeine.
Semi-Synthetic Opioids
- Modified from natural opioids for enhanced effects.
- Examples: Oxycodone (OxyContin, Percocet), Hydrocodone (Vicodin), Hydromorphone (Dilaudid), Heroin (illegal).
Fully Synthetic Opioids
- Man-made with similar structures and effects.
- Examples: Fentanyl, Methadone, Tramadol, Meperidine (Demerol).
Opioid Antagonists
- Used to reverse opioid overdose.
- Examples: Naloxone (Narcan), Naltrexone.
Regulation & Abuse Potential
- Controlled Substances: Most narcotic analgesics are classified under Schedule II (high abuse potential but accepted medical use) or Schedule I (heroin, no medical use in the U.S.).
- Opioid Epidemic: Misuse of prescription opioids (e.g., oxycodone, hydrocodone) and illicit opioids (e.g., heroin, fentanyl) has led to a public health crisis in many countries.
Reversal Agent: (Rapidly Reverses Opioid Overdose)
- Naloxone (Narcan) – opioid antagonist used to reverse overdose.
- Available as nasal spray, IV, IM, SC.
Narcotic Analgesics List
| Generic Name | Brand Name | DEA Schedule | Formulation |
| Morphine | MS Contin, Kadian | C-II | Oral, IV, IM, suppository |
| Oxycodone | OxyContin, Roxicodone | C-II | Oral |
| Hydrocodone + APAP | Norco, Vicodin | C-II | Oral |
| Fentanyl | Duragesic, Sublimaze | C-II | Patch, IV, buccal, nasal spray |
| Codeine | Tylenol #3 (w/ APAP) | C-III or C-V | Oral |
| Tramadol | Ultram | C-IV | Oral |
| Methadone | Dolophine | C-II | Oral, IV |
| Oxymorphone | Opana | C-II | Oral, IV |
| Tapentadol | Nucynta | C-II | Oral |
| Meperidine | Demerol | C-II | IV, IM, oral |
| Buprenorphine | Subutex, Belbuca | C-III | Sublingual, buccal, patch |
| Buprenorphine/Naloxone | Suboxone | C-III | Sublingual film/tablet |
| Loperamide | Imodium (low-dose OTC) | Not controlled | Oral |
Non-Narcotic Analgesics
Non-narcotic analgesics are pain-relieving medications that do not act on opioid receptors and are not associated with addiction or dependence like narcotic (opioid) analgesics. They are commonly used for mild to moderate pain and inflammation.Mechanism of Action
- Acetaminophen (APAP) Inhibits prostaglandin synthesis in CNS → ↓ pain and fever
- NSAIDs Inhibit COX-1 and COX-2 enzymes → ↓ prostaglandins → ↓ pain, inflammation, fever
- Salicylates Inhibit COX + platelet aggregation (aspirin)
- Adjuvant Analgesics Antidepressants, anticonvulsants, or muscle relaxants used for nerve pain
When Are Non-Narcotic Analgesics Preferred?
- Mild to moderate pain (headaches, menstrual cramps, minor injuries)
- Chronic conditions (arthritis, back pain) where opioids pose long-term risks
- Patients with addiction history (to avoid opioids)
- Post-surgical pain management (often combined with opioids to reduce dosage)
Types of Non-Narcotic Analgesics
1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
- Mechanism: Inhibit COX enzymes, reducing prostaglandin production (which causes pain and inflammation).
- Uses: Pain, inflammation, fever (e.g., headaches, arthritis, muscle aches).
Examples:
- Over-the-counter (OTC):
- Ibuprofen (Advil, Motrin)
- Naproxen (Aleve)
- Aspirin (also has antiplatelet effects)
- Prescription-strength:
- Celecoxib (Celebrex, a COX-2 selective NSAID)
- Diclofenac (Voltaren)
- Meloxicam (Mobic)
Side Effects:
- Stomach irritation, ulcers
- Increased bleeding risk (except COX-2 inhibitors)
- Kidney damage (with long-term use)
- Cardiovascular risks (high doses/long-term use)
2. Acetaminophen (Tylenol)
- Mechanism: Acts on the central nervous system (CNS) to reduce pain and fever; weak anti-inflammatory effects.
- Uses: Mild to moderate pain (headaches, toothaches, post-vaccine fever).
Example: Tylenol
Side Effects:
- Liver toxicity (in high doses or with alcohol)
- No anti-inflammatory effect (unlike NSAIDs)
3. COX-2 Inhibitors (Selective NSAIDs)
- Mechanism: Block COX-2 (inflammation-related) more than COX-1 (stomach-protective).
- Uses: Arthritis, chronic pain (for patients at risk of stomach bleeding).
Example: Celecoxib (Celebrex).
Side Effects:
- Lower stomach irritation than traditional NSAIDs
- Possible increased cardiovascular risk
4. Topical Analgesics
- Mechanism: Applied to skin for localized pain relief.
Examples:
- NSAID gels (Diclofenac gel – Voltaren Gel)
- Capsaicin cream (for nerve pain)
- Lidocaine patches (numbing effect)
5. Adjuvant Analgesics (Non-Traditional Pain Relievers)
- Mechanism: Not primarily painkillers but help with certain pain types.
Examples:
- Antidepressants (Amitriptyline, Duloxetine – for nerve pain)
- Anticonvulsants (Gabapentin, Pregabalin – for neuropathic pain)
- Muscle relaxants (Cyclobenzaprine – for muscle spasms)
What are key pharmacological properties to be NSAIDs
- Anti-Inflammatory Effects: Reduces swelling, redness, and joint stiffness
- Analgesic (Pain-Relieving) Effects: Mild to moderate pain (headaches, dental pain, menstrual cramps), weaker for neuropathic or severe pain.
- Antipyretic (Fever-Reducing) Effects: Lowers fever by acting on the hypothalamus (Brain)
Non-Narcotic Analgesics Medications List
| Generic Name | Brand Name | Drug Class | Use |
| Acetaminophen | Tylenol | Analgesic/Antipyretic | Pain, fever |
| Ibuprofen | Advil, Motrin | NSAID |
Pain, fever, inflammation
|
| Naproxen | Aleve, Naprosyn | NSAID |
Pain, inflammation
|
| Aspirin (ASA) | Bayer, Ecotrin | Salicylate |
Pain, inflammation, antiplatelet
|
| Celecoxib | Celebrex | COX-2 selective NSAID | Pain, arthritis |
| Ketorolac | Toradol | NSAID |
Short-term severe pain (Rx only)
|
| Diclofenac | Voltaren | NSAID |
Pain, arthritis (topical & oral)
|
| Meloxicam | Mobic | NSAID |
Osteoarthritis, RA
|
| Etodolac | Lodine | NSAID | Arthritis |
| Indomethacin | Indocin | NSAID |
Inflammation, gout
|
Narcotic vs. Non-Narcotic Analgesics
| Category | Narcotic Analgesics | Non-Narcotic Analgesics |
| Also Known As | Opioids | Non-opioids |
| Mechanism of Action | Act on opioid receptors (mu, kappa, delta) in CNS to block pain perception | Inhibit prostaglandin synthesis (COX inhibition), reducing inflammation and pain |
| Primary Site of Action | Central Nervous System (CNS) | Peripheral and some central sites |
| Pain Type Treated | Moderate to severe pain | Mild to moderate pain |
| Risk of Dependence | High (can cause addiction, tolerance, withdrawal) | Low to none |
| Controlled Substance? | Yes (classified under DEA schedules) | No (OTC or Rx but not controlled) |
| Examples (Generic) | Morphine, Oxycodone, Hydrocodone, Fentanyl, Codeine | Acetaminophen, Ibuprofen, Naproxen, Aspirin |
| Examples (Brand) | MS Contin, OxyContin, Norco, Duragesic, Tylenol #3 | Tylenol, Advil, Aleve, Bayer |
| Common Side Effects | Respiratory depression, constipation, sedation, nausea | GI upset, liver/kidney toxicity (long-term or overdose) |
| Reversal Agent | Naloxone (Narcan) | None specific |
| Legal Considerations | Strict regulations on prescribing and dispensing | OTC or standard Rx laws |
| Auxiliary Labels |
|
|
- Narcotic Analgesics (Opioids): Potent drugs used for post-op, cancer, or severe injury-related pain. E.g., Morphine.
- Non-Narcotic Analgesics: Common for headaches, arthritis, fever. E.g., Acetaminophen, NSAIDs.
Aspirin vs Acetaminophen
| Features | Aspirin | Acetaminophen |
| Drug Class | NSAID / Salicylate | Analgesic / Antipyretic (non-NSAID) |
Mechanism of Action | NSAID (Nonsteroidal Anti-Inflammatory Drug) | Not an NSAID (no significant anti-inflammatory effect) |
| Blocks COX-1 & COX-2 enzymes → reduces prostaglandins (pain, inflammation, fever) | Acts mainly in the central nervous system (CNS) to block pain/fever signals | |
| Anti-inflammatory effect (helps with swelling, arthritis) | No anti-inflammatory effect (not useful for swelling or arthritis) | |
| Antiplatelet effect (thins blood by blocking thromboxane A₂) | No effect on blood clotting | |
Uses | Pain relief (headaches, muscle aches, toothaches) | Pain relief (headaches, mild arthritis, back pain) |
| Fever reduction (Antipyretic) | Fever reduction (preferred for children) (Antipyretic) | |
| Anti-inflammatory (arthritis, sprains) | Not effective for inflammation | |
| Heart attack & stroke prevention (low-dose aspirin) | No cardiovascular benefits | |
Side Effects & Risks | Stomach irritation (ulcers, bleeding risk) | Safe for stomach (no bleeding risk) |
| Increased bleeding risk (due to antiplatelet effect) | Liver toxicity (overdose can cause liver failure) | |
| Reye’s syndrome (rare but serious risk in children with viral infections) | Safer for children (no Reye’s syndrome risk) | |
| Kidney damage (with long-term/high-dose use) | Kidney-safe (unless taken in extreme excess) | |
| Tinnitus (ringing in ears) at high doses | No hearing-related side effects | |
| Dosage & Overdose Risks |
|
|
| Common Drug Interactions |
|
|
| Cautions & Contraindications |
|
|
When to Choose Aspirin
- You need anti-inflammatory effects (e.g., arthritis, swelling)
- Heart protection (low-dose aspirin for at-risk adults)
- Mild pain with inflammation (e.g., sprains)
- No bleeding risk (not before surgery)
When to Avoid Aspirin
- History of stomach ulcers or bleeding disorders
- Allergy to NSAIDs (e.g., ibuprofen)
- Children with viral infections (Reye’s syndrome risk)
- Before surgery (increases bleeding risk)
“May Cause Drowsiness/Dizziness – Avoid Alcohol”
“May Cause Drowsiness/Dizziness – Avoid Alcohol”
When to Choose Acetaminophen
- You have stomach issues (ulcers, GERD)
- Fever in children (safer than aspirin)
- Pain without inflammation (e.g., headaches, post-vaccine fever)
- Taking blood thinners (no bleeding risk)
When to Avoid Acetaminophen
- You have stomach issues (ulcers, GERD)
- Fever in children (safer than aspirin)
- Pain without inflammation (e.g., headaches, post-vaccine fever)
- Taking blood thinners (no bleeding risk)
