4.7.1 Non-opioid analgesics and compound analgesic preparations

General guidance
 

• In inflammatory conditions, NSAIDs are frequently used rather than aspirin since they may be better tolerated although their use is clearly not without risks of adverse effects.
• Paracetamol is similar in efficacy to aspirin, but has no demonstrable anti-inflammatory activity, is less irritant to the stomach and so may be more suitable as a general analgesic compared to aspirin.
• Compound analgesics are commonly used but their advantages remain unproven. The low dose of opioid may be sufficient to cause side effects but may be insufficient to add any additional analgesic efficacy to the preparation. In addition, compound analgesics do not offer the flexibility of dosing of the separate constituents often required for effective pain relief whilst minimising side effects. Their use should therefore be generally avoided.
• Compound analgesic preparations containing a full dose of opioid component (e.g. 30mg of codeine phosphate per tablet) carry the full range of opioid side-effects (including nausea, vomiting, severe constipation, drowsiness, respiratory depression, and risk of dependence on long-term administration).
• The use of regular paracetamol plus when required codeine offers a flexible alternative, allowing the patient to titrate the codeine dose to balance efficacy and side effects.
• When assessing the patients use of analgesia, especially that available over-the-counter, consider whether the dosage and frequency of administration were adequate, if not conduct a therapeutic trial of such treatment prior to initiating an alternate treatment.

Recommended drugs

Paracetamol £

Co-Codamol 30/500 ££ (Zapain Brand Optimisation)

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines      

Purple – Specialist use/initiation

Red – Non Formulary

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low