Pain can affect sleep, mobility, concentration and quality of life. When pain is significant, a healthcare professional may consider prescription medicines as part of an overall treatment plan.
Some of the strongest prescription pain medicines belong to a group called opioids. These include oxycodone, oxymorphone, tramadol and codeine. While opioids can provide effective pain relief for appropriate patients, they also require careful monitoring because they can cause drowsiness, constipation, tolerance and dependence.
This guide explains some important considerations for people who have been prescribed opioid pain medicines.
Important: This article is for educational purposes only and is not a substitute for personalised medical advice. Always follow the instructions provided by your doctor, pharmacist or other qualified healthcare professional.
What are prescription opioids?
Opioids are medicines that interact with opioid receptors in the nervous system. This changes how the body perceives and responds to pain.
Different opioids have different strengths, formulations and clinical uses. Examples include:
- Oxycodone
- Oxymorphone
- Tramadol
- Codeine
A healthcare professional will consider factors such as the type and severity of pain, previous treatments, other medicines and the patient’s individual circumstances when deciding whether an opioid is appropriate.
Oxycodone and controlled pain management
Oxycodone is a strong opioid analgesic used for certain types of severe pain.
Different formulations and strengths are available. You can find additional medicine information about OxyContin 20mg and OxyContin 40mg on our website.
Oxycodone may cause drowsiness, nausea, constipation or dizziness. More serious effects can include respiratory depression.
Because the effects of opioids can vary between individuals, patients should take only the amount prescribed for them. Taking more than prescribed does not necessarily provide proportionally greater pain relief and can significantly increase the risk of harm.
Oxymorphone and opioid treatment
Oxymorphone is another opioid analgesic used for certain types of severe pain.
Our Opana 5mg medicine information page provides further information about this opioid.
Patients should never attempt to calculate an equivalent dose between different opioids themselves. Opioids differ in potency and pharmacological characteristics, so any change from one opioid to another should be managed by an appropriate healthcare professional.
Tramadol has additional drug interactions
Tramadol is used for certain types of moderate to severe pain.
You can read more about Tramadol 50mg through our medicine information resources.
In addition to its opioid activity, tramadol affects neurotransmitters including serotonin and noradrenaline. Consequently, it can interact with certain medicines, including some antidepressants.
Patients should tell their doctor or pharmacist about all medicines they currently take before starting tramadol.
Codeine and short-term pain relief
Codeine is an opioid medicine that may be prescribed or recommended for certain types of pain.
Our Codeine Phosphate 30mg page provides further information about this medicine.
Codeine can cause drowsiness, nausea and constipation. Regular use can also result in tolerance and physical dependence.
If pain continues despite treatment, patients should speak with their healthcare professional rather than repeatedly increasing their medicine themselves.
Understanding co-codamol
Co-codamol combines codeine with paracetamol and can be used for certain types of pain.
Our Co-codamol 30/500mg page provides additional information about the medicine.
One important consideration is that co-codamol already contains paracetamol. Taking additional paracetamol-containing medicines without checking first can result in taking too much paracetamol.
Always check the active ingredients of other medicines you are taking and ask a pharmacist if you are uncertain.
Why the prescribed dose matters
Prescription medicines are prescribed at doses selected for an individual’s circumstances.
Factors that can influence prescribing decisions include:
- Age
- Medical history
- Other medicines
- Kidney and liver function
- Previous exposure to opioids
- Type and severity of pain
- Duration of treatment
For this reason, information about another person’s dose should never be used to determine your own dose.
If your prescribed medicine does not appear to be controlling your symptoms adequately, speak with your prescriber rather than taking additional doses.
Opioids and drowsiness
Many opioid medicines can cause drowsiness, particularly when treatment is first started or when the dose is changed.
Patients should understand how their medicine affects them before driving, cycling or operating machinery.
If you feel sleepy, dizzy, confused or impaired, do not drive or operate machinery.
Diazepam and opioid interactions
Diazepam is not an opioid. It belongs to the benzodiazepine group of medicines.
MedTrust provides information about Bensedin Diazepam 10mg and Diazepam Actavis 10mg.
Diazepam can cause sedation and impaired coordination. Combining benzodiazepines with opioids can increase central nervous system depression and may increase the risk of severe sedation and respiratory depression.
Patients should therefore never combine diazepam with an opioid unless the combination has been specifically considered and prescribed by their healthcare professional.
Alcohol and opioid medicines
Alcohol can increase the sedative effects of opioid medicines.
Combining alcohol with opioids may increase drowsiness and impairment and can contribute to dangerous central nervous system depression.
Patients should follow the specific advice provided by their healthcare professional and medicine information leaflet concerning alcohol.
Tolerance and dependence
Tolerance occurs when the body becomes accustomed to a medicine and its effects may become less pronounced over time.
Physical dependence is different from addiction. A physically dependent person can experience withdrawal symptoms if certain medicines are stopped suddenly.
Opioids can cause physical dependence, particularly with regular or prolonged use. Diazepam and other benzodiazepines can also cause dependence.
If you have been taking these medicines regularly, speak with your healthcare professional before stopping treatment.
What happens if a dose is missed?
The correct response to a missed dose depends on the specific medicine and the instructions provided with it.
Patients should check their medicine’s patient information leaflet or contact their pharmacist or prescriber for advice.
Do not automatically take a double dose to compensate for a missed dose unless a healthcare professional has specifically instructed you to do so.
Recognising potentially dangerous opioid effects
Although many side effects are relatively mild, opioid medicines can occasionally cause serious problems.
Urgent medical assistance is required if a person taking an opioid:
- Is difficult or impossible to wake
- Becomes unconscious
- Has unusually slow or shallow breathing
- Becomes unresponsive
- Develops severe confusion
- Is suspected of having taken an overdose
Respiratory depression is one of the most serious risks associated with opioid medicines.
The risk can be greater when opioids are taken together with other medicines or substances that cause sedation.
Questions to ask your pharmacist or doctor
If you have been prescribed a new medicine, useful questions may include:
What is this medicine being prescribed for?
Understanding the purpose of your treatment can help you use it correctly.
How should I take it?
Ask about timing, duration and any specific instructions.
Can it interact with my other medicines?
Provide a complete list of prescription, over-the-counter and complementary medicines.
What side effects should I look out for?
Knowing which symptoms are expected and which require medical attention can improve safety.
How long should I take it?
Some medicines are intended for short-term use, while others may be prescribed for longer periods with monitoring.
Responsible use of prescription medicines
Responsible medicine use involves more than simply taking the prescribed dose.
Patients should:
- Keep medicines in a safe place.
- Never share prescription medicines.
- Follow storage instructions.
- Keep track of their medicines.
- Attend follow-up appointments where required.
- Report concerning side effects.
- Tell healthcare professionals about all medicines they use.
- Avoid making changes to treatment without professional advice.
These simple steps can help reduce preventable medication-related problems.
Frequently asked questions
Are stronger painkillers always better?
Not necessarily. The appropriate medicine depends on the individual’s condition, the type and severity of pain, previous treatments and potential risks. Stronger medicines can also carry greater risks.
Can I increase my opioid dose if my pain gets worse?
You should not increase your dose without speaking with your prescriber. Increasing an opioid dose can increase the risk of serious side effects, including respiratory depression.
Can I take more than one painkiller?
Some pain medicines can be used together in specific circumstances, but this should be determined by a healthcare professional. Patients should not combine opioids or other medicines without checking first.
Is diazepam a painkiller?
No. Diazepam is a benzodiazepine rather than an opioid painkiller. It may be prescribed for specific conditions such as anxiety, muscle spasms or certain seizure disorders.
Can prescription medicines cause withdrawal?
Yes. Some medicines, including opioids and benzodiazepines, can cause physical dependence. Suddenly stopping regular treatment can lead to withdrawal symptoms, so patients should seek professional advice before stopping.
Final thoughts
Prescription pain medicines can be an important part of medical care when used appropriately. However, medicines such as oxycodone, oxymorphone, tramadol and codeine require careful use because of their potential for adverse effects and dependence.
Likewise, medicines such as diazepam require appropriate medical supervision, particularly when used alongside other medicines that cause sedation.
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