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: Analgesic

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None (3) · Kappa agonist; mu antagonist (1) · Kappa agonist; mu partial agonist (1) · Kappa agonist; mu partial agonist/antagonist (1) · Mu-opioid agonist; norepinephrine reuptake inhibitor (1) · Mu-opioid receptor agonist (4) · Mu-opioid receptor agonist; NMDA antagonist (1) · Mu-opioid receptor agonist; prodrug (metabolized to morphine) (1) · Mu-opioid receptor agonist; sodium channel blocker (1) · Mu/kappa/delta agonist; NMDA antagonist (1) · Partial mu-opioid agonist; kappa antagonist (1) · Phosphodiesterase inhibitor; calcium channel blocker (1) · Potent mu-opioid receptor agonist (3) · Prodrug; converted to [[Morphine|morphine]] by [[Enzyme:CYP2D6|CYP2D6]] for analgesic action. (1) · '"`UNIQ--vote-000014DD-QINU`"' The combination is the most-prescribed opioid analgesic in the US for moderate-to-severe acute pain. CPIC PGx guidance addresses CYP2D6-driven exposure variation'"`UNIQ--ref-000014DE-QINU`"'. (1) · '"`UNIQ--vote-000014F7-QINU`"' Falling out of favor for acute pain due to aspirin's GI bleeding and antiplatelet effects compared with acetaminophen-opioid combinations; still used in selected indications'"`UNIQ--ref-000014F8-QINU`"'. (1) · '"`UNIQ--vote-00001513-QINU`"' The combination with acetaminophen provides additive non-opioid analgesia and lowers required codeine dose. CYP2D6 PGx is one of the most clinically actionable in current pharmacology; CPIC supports genotype-guided opioid selection'"`UNIQ--ref-00001514-QINU`"'. (1) · '"`UNIQ--vote-00001549-QINU`"' Metabolic effects (weight gain, dyslipidemia, glucose dysregulation) dominate the long-term tolerability profile; routine metabolic monitoring is standard'"`UNIQ--ref-0000154A-QINU`"'. (1) · '"`UNIQ--vote-000015CE-QINU`"' The dual-mechanism design exploits the inflammatory component of migraine that triptan monotherapy does not fully address. Risk of serotonin syndrome with SSRIs/SNRIs is theoretical but generally not seen clinically at triptan doses'"`UNIQ--ref-000015CF-QINU`"'. (1)

None (17) · 1 tablet (4.8355 mg oxycodone / 325 mg aspirin) PO every 6 hours as needed (1) · 1 tablet (85/500 mg sumatriptan/naproxen) PO at migraine onset; may repeat after 2 hours if needed; maximum 2 tablets per 24 hours (1) · 1-2 capsules (50 mg butalbital / 325 mg acetaminophen / 40 mg caffeine each) PO every 4 hours as needed; maximum 6 capsules/d (1) · 1-2 capsules (50 mg butalbital / 325 mg aspirin / 40 mg caffeine each) PO every 4 hours as needed; maximum 6 capsules/d (1) · 1-2 tablets (15-60 mg codeine, 300-600 mg acetaminophen) PO every 4-6 hours as needed (1) · 5 mg / 325 mg PO every 4-6 hours as needed; total acetaminophen <3 g/d (1) · 6/25 mg PO once daily in the evening; titrate within range 3/25 to 18/75 mg by clinical response and tolerability (1) · Adult: 15–60 mg every 4 hours as needed. (1) · Week 1: 1 tablet (8/90 mg) PO morning; week 2: 1 tablet AM + 1 PM; week 3: 2 AM + 1 PM; week 4 onward: 2 AM + 2 PM (32 mg naltrexone / 360 mg bupropion/d) (1)

None (17) · 4.8355 mg oxycodone / 325 mg aspirin tablets (1) · 50/325/40 mg capsules (1) · 50/325/40 mg capsules and tablets; oral solution (1) · 8 mg naltrexone / 90 mg bupropion ER tablets (titration-pack design) (1) · 85 mg sumatriptan / 500 mg naproxen sodium tablets; lower-dose 10/60 mg pediatric (Treximet pediatric) (1) · Capsules: 3/25, 6/25, 6/50, 12/25, 12/50 mg olanzapine/fluoxetine (1) · Codeine/acetaminophen 15/300 (#2 historical), 30/300 (#3), 60/300 (#4) mg tablets; 12/120 mg/5 mL elixir (1) · Oxycodone/acetaminophen 2.5/325, 5/325, 7.5/325, 10/325 mg tablets; 5/325 mg/5 mL solution (1) · Tablet (15, 30, 60 mg); oral solution; combination products (with [[Acetaminophen|acetaminophen]] or ibuprofen). (1)

None (17) · 18 mg olanzapine / 75 mg fluoxetine per day (1) · 2 tablets per 24 hours; ≤4 days per month to avoid medicine-overuse headache (1) · 32 mg naltrexone / 360 mg bupropion per day (1) · 360 mg/day (1) · 6 capsules/d (300 mg butalbital, 1950 mg acetaminophen, 240 mg caffeine) (1) · 6 capsules/d (300 mg butalbital, 1950 mg aspirin, 240 mg caffeine) (1) · Acetaminophen 4 g/d absolute (3 g/d conservative); oxycodone titrated to effect (1) · Acetaminophen 4 g/d absolute; codeine 240-360 mg/d typical practical limit (1) · Aspirin GI/bleeding-limited; oxycodone titrated to effect (1)

None (17) · Oral (8) · PO (only formulation marketed in the US). (1)

None (17) · 10-30 minutes (1) · 15-30 minutes (1) · 30-60 minutes (3) · 30–60 min (PO) (1) · Headache relief at 30-60 minutes (1) · Modest appetite suppression within weeks; weight loss over months (1) · Mood improvement at 1-3 weeks; full effect 4-6 weeks (1)

None (17) · 12 hours (BID dosing required) (1) · 24 hours (1) · 4-6 hours (5) · 4-8 hours (1) · 4–6 hours (1)

None (17) · 2.5–3 hours (1) · Butalbital ~35 hours (long; cumulative effects with frequent use); acetaminophen 1-3 hours; caffeine 3-7 hours'"`UNIQ--ref-0000159F-QINU`"' (1) · Butalbital ~35 hours; aspirin (acetyl group) ~15 minutes, salicylate 2-3 hours; caffeine 3-7 hours'"`UNIQ--ref-000015B7-QINU`"' (1) · Codeine 2.5-3.5 hours; acetaminophen 1-3 hours'"`UNIQ--ref-00001517-QINU`"' (1) · Naltrexone ~4 hours (6β-naltrexol metabolite ~13 hours); bupropion ~21 hours'"`UNIQ--ref-00001568-QINU`"' (1) · Olanzapine ~30 hours; fluoxetine 1-4 days (norfluoxetine 7-15 days)'"`UNIQ--ref-0000154D-QINU`"' (1) · Oxycodone 3-5 hours; acetaminophen 1-3 hours'"`UNIQ--ref-000014E2-QINU`"' (1) · Oxycodone 3-5 hours; aspirin (acetyl group) 15-20 minutes, salicylate 2-3 hours at therapeutic doses'"`UNIQ--ref-000014FA-QINU`"' (1) · Sumatriptan ~2.5 hours; naproxen 12-15 hours'"`UNIQ--ref-000015D1-QINU`"' (1)

None (17) · Butalbital well-absorbed; aspirin 50-75%; caffeine ~100%'"`UNIQ--ref-000015B8-QINU`"' (1) · Butalbital well-absorbed; caffeine ~100%; acetaminophen 85-98%'"`UNIQ--ref-000015A0-QINU`"' (1) · Codeine ~60% (oral); acetaminophen 85-98%'"`UNIQ--ref-00001518-QINU`"' (1) · Naltrexone ~5% (oral, extensive first-pass to 6β-naltrexol); bupropion ER ~87%'"`UNIQ--ref-00001569-QINU`"' (1) · Olanzapine 60% (oral); fluoxetine high (oral)'"`UNIQ--ref-0000154E-QINU`"' (1) · Oxycodone 60-87%; aspirin 50-75%'"`UNIQ--ref-000014FB-QINU`"' (1) · Sumatriptan ~15% (oral; substantial first-pass); naproxen ~95%'"`UNIQ--ref-000015D2-QINU`"' (1) · ~50% (variable, CYP2D6-dependent for analgesic effect). (1) · ~60-87% oxycodone (high and predictable, less CYP-genotype-dependent than codeine or hydrocodone); 85-98% acetaminophen'"`UNIQ--ref-000014E3-QINU`"' (1)

None (18) · Avoid; aspirin teratogenicity concerns plus opioid neonatal withdrawal.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Avoid; NSAID-class restriction after 20 weeks (FDA 2020) and limited triptan pregnancy data.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Avoid; risk of neonatal opioid withdrawal with chronic use; UM-mother breastfeeding contraindicated. (1) · Avoided; barbiturate + aspirin teratogenicity and bleeding concerns.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Contraindicated in pregnancy (FDA label).[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Generally avoided; barbiturate exposure in late pregnancy can produce neonatal withdrawal and respiratory depression.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Limited data; fluoxetine has reassuring data but olanzapine carries metabolic-syndrome and gestational diabetes signals.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Limited use in pregnancy; chronic third-trimester opioid exposure produces neonatal opioid withdrawal syndrome and respiratory depression at delivery.[[[Pharmacopedia:Citation needed|citation needed]]] (1)

None (19) · US Schedule II (single-entity); Schedule III–V (combination products by content). (1) · [[USLegal:Prescription only|Rx-only]] in US. Carries the '''antidepressant Boxed Warning''' for suicidality in children/adolescents/young adults and the atypical-neuroleptic '''Boxed Warning''' for increased mortality in elderly dementia patients'"`UNIQ--ref-0000154F-QINU`"' (1) · [[USLegal:Prescription only|Rx-only]] in US. NSAID-class '''Boxed Warning''' for CV thrombotic events and GI bleeding; triptans contraindicated in coronary artery disease, peripheral vascular disease, uncontrolled hypertension, and recent ergot or MAOI use'"`UNIQ--ref-000015D3-QINU`"' (1) · [[USLegal:Schedule III|Schedule III controlled substance]] in US (Fiorinal is scheduled federally; Fioricet with acetaminophen is unscheduled federally despite identical butalbital content, a regulatory quirk) (1) · [[USLegal:Schedule III|Schedule III controlled substance]] in US. '''Contraindicated in children <12''' for any indication and in any age post-tonsillectomy/adenoidectomy (FDA 2017 black-box advisory)'"`UNIQ--ref-00001519-QINU`"' (1) · [[USLegal:Schedule II|Schedule II controlled substance]] in US (1) · [[USLegal:Schedule II|Schedule II controlled substance]] in US. Acetaminophen content limited to ≤325 mg per dosage unit (FDA 2014) (1)