6. Pain
Analgesics
| Non-opioid analgesics | Preparations | Comments |
| Paracetamol | 500mg tablets 500mg dispersible tablets 250mg/5ml oral suspension |
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| Co-codamol † (codeine phosphate/ paracetamol) | 8/500, 30/500 tablets | BNF indicates these preparations are less suitable for prescribing. They reduce the scope for effective titration of individual components in the management of pain of varying intensity. The advantages of using compound preparations with low dose opioids have not been substantiated. Low dose opioids can often lead to opioid side-effects such as constipation but may not provide additional pain relief. A full dose of opioid component (e.g. 60mg codeine phosphate) effectively augments analgesic activity but is associated with full range of opioid side-effects, including risk of dependence. |
| Co-dydramol † (dihydrocodeine/ paracetamol) | 10/500 tablets |
| Non-steroidal anti-inflammatory drugs (NSAIDs) | Preparations | Comments |
| For short term use in the management of acute pain. Consider co-prescribing a proton pump inhibitor in those at risk of developing GI ulceration with a non-selective oral NSAID e.g. lansoprazole 15 to 30mg daily Use with caution in elderly, in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, Crohns disease and ulcerative colitis. NSAIDs are contra-indicated in severe heart failure, patients with history of hypersensitivity to aspirin or NSAID, coagulation defects, active GI ulceration or bleeding, history of recurrent GI ulceration or haemorrhage, history of GI bleeding or perforation related to previous NSAID therapy. |
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| Ibuprofen | 200mg and 400mg tablets 100mg/5ml oral suspension 5% topical gel |
Topical gel is a useful alternative to oral NSAIDs for relief of musculoskeletal pain. |
| Naproxen | 250mg and 500mg tablets | |
| Opioid analgesics | Preparations | Comments |
| Codeine phosphate | 15mg, 30mg and tablets 25mg/5ml syrup |
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| Dihydrocodeine tartrate | 30mg tablets 10mg/5ml oral solution |
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| Morphine sulphate | 10mg 20mg, 50mg tablets 10mg/5ml oral solution |
CD |
| Tramadol | 50mg capsules | CD |
Continue to 7. Sleep disorders