How Do NSAID/Opioid Combo Analgesics Work?

NSAID/opioid combo analgesics are systemic medications prescribed for short-term management of moderate to severe pain. A combination of non-steroidal anti-inflammatory drugs (NSAIDs) and opioids is more effective than a single drug in managing acute and severe pain, because each medication works in a different way to control pain.

NSAIDs control inflammation by inhibiting the activity of enzymes known as cyclooxygenases (COX-1 and COX-2) essential for the biosynthesis of prostaglandin. Prostaglandin is a fatty compound that plays an important role in initiating inflammation which results in pain and other symptoms.

Opioids block the transmission of pain perception in the brain by binding to opiate receptors. Opiate receptors are protein molecules on nerve cell (neuron) membranes in the brain. Modulating sensory perception is one of the functions of opiate receptors. Opioid drugs have a high risk for addiction.

Opioids may also be combined with aspirin in some drug formulations. Aspirin works on the hypothalamus region of the brain to reduce fever and relieve pain.

NSAID/opioid combo analgesics are oral tablets prescribed for short periods to manage acute, moderate to severe pain. NSAID/opioid combos are not recommended for patients with kidney impairment. Caution should be exercised to avoid opioid overdose, which can have severe consequences.

Side effects of NSAID/opioid combo analgesics may include the following:

• Dizziness
• Drowsiness
• Nausea
• Vomiting
• Constipation
• Diarrhea
• Dyspepsia (indigestion)
• Flatulence
• Anorexia (loss of appetite)
• Hypotension (low blood pressure)
• Headache
• Fever
• Diaphoresis (sweating)
• Flushing
• Skin reactions such as:
  • Pruritus (itching)
  • Urticaria (hives)
  • Red rashes
  • Erythema multiforme (round lesions like bullseye)
  • Exfoliative dermatitis (redness and peeling of the skin)
  • Toxic epidermal necrolysis (a severe skin condition with widespread redness, skin cell death and exfoliation which can lead to sepsis)
  • Photosensitivity
• Hypersensitivity reactions such as:
  • Angioedema (swelling in the tissue under the skin or mucous membranes)
  • Anaphylaxis (serious allergic reaction)
• Weakness
• Fatigue
• Tinnitus (ringing in the ear)
• Lightheadedness
• Syncope (fainting)
• Mood effects such as:
  • Agitation
  • Dysphoria (unease)
  • Depression
  • Euphoria (feeling of high)
• Cognitive effects such as:
  • Mental clouding
  • Restlessness
  • Sedation
• Cholinergic effects may include:
  • Muscle contraction
  • Low heart rate (bradycardia)
  • Bronchoconstriction
  • Mucus secretion
• Respiratory depression
• Respiratory arrest
• Apnea (cessation of breathing)
• Circulatory depression
• Shock
• Gastrointestinal ulceration and/or bleeding
• Reduced blood cell counts causing conditions such as:
  • Neutropenia (low levels of neutrophil, a type of immune cell)
  • Agranulocytosis (low granulocytes, immune cells with granules)
  • Aplastic anemia (anemia due to reduced red cell production)
  • Hemolytic anemia (anemia from rapid destruction of red cells)
  • Thrombocytopenia (decrease in platelet count)
  • Thrombocytopenic purpura (easy bruising and bleeding due to thrombocytopenia)
• Reduced iron concentration in plasma
• Hepatotoxicity (toxicity to the liver)
• Jaundice
• Urinary retention
• Cystitis (inflammation of the bladder)
• Acute kidney failure
• Hyperkinesia (excessive and abnormal involuntary movements)
• Chest pain
• Amblyopia (lazy eye)
• Hypokalemia (low potassium in the blood)
• Thrombophlebitis (blood clot in the veins of legs)
• Pharyngitis (inflammation of the pharynx)
• Bronchitis (inflammation in the lining of bronchial tubes)
• Cough
• Asthma
• Pulmonary congestion
• Dysphagia (swallowing difficulties)
• Abnormal dreams
• Decreased libido
• Myalgia (muscle pain)
• Neuralgia (nerve pain)

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand name of NSAID/opioid combo analgesic drugs include:

• celecoxib/tramadol (Pending FDA approval)
• hydrocodone/ibuprofen
• oxycodone/aspirin
• oxycodone/ibuprofen
• Percodan