Genital Organs
Male Genital Organs
Female Genital Organs
Pregnancy, Postpartum Period, Infancy
Growth and Development
Eyes
Ears
Nose, Sense of Smell and Taste
Neurological Disorders
Voice, Speech, and Language Disorders
Pain
Psychological Disorders, Behavioral Disorders, Psychosocial Problems
Infectious and Parasitic Diseases
Neoplasms
Diseases of the Blood and Blood-Forming Organs
Endocrine, Nutritional, and Metabolic Diseases
Psychological and Behavioral Disorders
Diseases of the Nervous System
Diseases of the Eye and Adnexa
Diseases of the Ear and Mastoid Process
Diseases of the Circulatory System
Diseases of the Respiratory System
Diseases of the Digestive System
Diseases of the Skin and Subcutaneous Tissue
Diseases of the Musculoskeletal System and Connective Tissue
Diseases of the Genitourinary System
Pregnancy, Childbirth, and the Puerperium
Certain Conditions Originating in the Perinatal Period
Congenital Malformations, Deformations, and Chromosomal Abnormalities
Symptoms and Abnormal Clinical and Laboratory Findings
Injuries, Poisonings, and Certain Other Consequences of External Causes
Pathology
Pathophysiology
Clinical Chemistry
Medical Microbiology
Immunology
Hygiene
Medical Biometry/Statistics
Human Genetics
Medical History
Pharmacology
Acute Emergencies
Radiology
Surgery
Anesthesiology and Emergency Medicine
General Medicine
Naturopathy
History of Medicine
Occupational Medicine
Dental, Oral, and Maxillofacial Diseases

Co-Analgetics

Tricyclic Antidepressants

  • Example: Amitriptyline (e.g., Saroten) 25–75 mg/day, taken at night.
  • Effect: Analgesic effect at low doses.
  • Indications: Chronic pain.
  • Contraindications:
  • Absolute:
    • AV block III°, narrow-angle glaucoma, prostatic adenoma with residual urine formation, acute intoxication, delirium, paralytic ileus, combination with MAO inhibitors.
  • Relative:
    • AV block I°/II°, prostatic adenoma without residual urine formation, increased seizure risk, severe liver and kidney damage, pregnancy, lactation.
  • Side Effects: Fatigue, dry mouth, constipation, urination and accommodation disturbances, tremor, arrhythmias, leukopenia, agranulocytosis, weight gain.

Neuroleptics

  • Examples:
  • Low-Potency: Levomepromazine (e.g., Neurocil) 50–300 mg/day.
  • High-Potency: Haloperidol (e.g., Haldol) 1–50 mg/day; Olanzapine (e.g., Zyprexa) 15 mg/day.
  • Effect: Pain relief, with less extrapyramidal side effects in atypical neuroleptics like Olanzapine.
  • Indications: Chronic pain.
  • Contraindications:
  • Absolute: Acute intoxication with CNS-active substances, coma.
  • Relative: Liver/kidney damage, cardiac conditions, severe hypotension, prolactin-dependent tumors.
  • Haloperidol Specific: Parkinson’s disease, depression, hematopoietic disorders, organic brain disease, hyperthyroidism, pregnancy, lactation.
  • Side Effects: Extrapyramidal symptoms (e.g., Parkinsonism, akathisia, dyskinesias), dry mouth, urination issues, constipation, CNS effects, cardiovascular events, blood count changes, lowered seizure threshold.

Anticonvulsants

  • Examples:
  • Carbamazepine (e.g., Tegretal): 600–1200 mg/day.
  • Gabapentin (e.g., Neurontin): 600–1800 mg/day.
  • Indication: Neuropathic pain.
  • Contraindications:
  • Carbamazepine:
    • Absolute: AV block, MAO inhibitors, lithium use, bone marrow depression.
    • Relative: Liver/kidney damage, pregnancy, lactation, children under 6 years.
  • Gabapentin:
    • Absolute: Children under 12 years, acute pancreatitis, lactation.
    • Relative: Pregnancy.
  • Side Effects:
  • Carbamazepine: Allergic skin reactions, drowsiness, leukopenia, thrombopenia, liver enzyme increase, nausea, vomiting, diplopia.
  • Gabapentin: Fatigue, dizziness, ataxia, tremor, edema, weight gain, leukopenia.

Muscle Relaxants

  • Example: Tetrazepam (e.g., Musaril) 50–200 mg/day.
  • Indication: Back pain (muscle hypertonus).
  • Contraindications:
  • Absolute: Decompensated respiratory insufficiency, pregnancy.
  • Relative: Myasthenia gravis, CNS-active substance intoxication, liver damage, sleep apnea, drug dependence.
  • Side Effects: Fatigue, skin reactions, confusion, paradoxical effects in elderly patients.
  • Note: Avoid long-term use due to dependency potential.

Corticosteroids

  • Example: Dexamethasone (e.g., Fortecortin) 3–4 × 2–4 mg/day.
  • Effect: Indirect analgesic effect through anti-inflammatory properties.
  • Indications: Tumor pain, nerve compression pain, capsular pain.
  • Contraindications (Long-Term Use):
  • Absolute: GI ulcers, infections, glaucoma.
  • Relative: Ulcer history, diabetes, concurrent NSAID use, hypertension, osteoporosis, psychosis, pregnancy, lactation, children.
  • Side Effects: Adrenal suppression, Cushing syndrome, hyperglycemia, osteoporosis, infection risk, hypertension, thrombosis, mood changes, hematological changes.
  • Note: Taper slowly to avoid withdrawal.

Calcitonin

  • Example: Karil 100 IU/day.
  • Indications: Osteoporosis, phantom pain (initial phase).
  • Contraindications: Hypocalcemia, allergies, children, lactation.
  • Side Effects: Nausea, vomiting, flushing, hypotension, headache, joint pain.

Bisphosphonates

  • Example: Alendronate (e.g., Fosamax) 70 mg/week, taken 30 minutes before meals.
  • Indications: Osteoporosis (Stage III), osteolytic metastases, Paget’s disease.
  • Contraindications:
  • Absolute: Esophageal obstruction, acute GI inflammation, pregnancy, lactation.
  • Relative: Severe renal insufficiency, children.
  • Side Effects: Esophagitis, GI ulcers, abdominal pain, nausea, vomiting.

Clonidine

  • Example: Catapresan 75–150 µg/day intrathecal or 150–300 µg/day epidural.
  • Indication: Neuropathic pain.
  • Contraindications:
  • Absolute: Sick sinus syndrome, AV block II°/III°, bradycardia <50 bpm, depression, lactation.
  • Relative: Renal insufficiency, peripheral arterial disease, Raynaud’s syndrome, cerebrovascular insufficiency, peripheral neuropathy, constipation.
  • Side Effects: Bradycardia, nausea, vomiting, hypotension, sedation, dry mouth and eyes.