Diclofenac Codeine

Also analyzed acebutolol, acetaminophen, alprazolam, amphetamine, atenolol, betaxolol, brotizolam, caffeine, camazepam, captopril, chloroquine, clobazam, clomipramine, cloth-iapine, clotiazepam, cloxazolam, cocaine, codeine, diclofenac, dihydralazine, dihydrocodeine, dihydroergotamine, diphenhydramine, domperidone, doxepin, droperidol, ergota-mine, ethyl loflazepate, fenethylline, fluoxetine, flupentixol, flurazepam, furosemide, gliclazide, hydrochlorothiazide, hydroxyzine, ibuprofen, imipramine, ketazolam, loprazo-1am, lorazepam, lormetazepam, maprotUine, medazepam, mepyramine, methadone, methaqualone, methyldopa, methylphenidate, metoclopramide, metoprolol, mexiletine, mianserin, midazolam, minoxidil, morphine, nadolol, nitrazepam, oxprenolol, papaverine, pentazocine, phenprocoumon, phenylbutazone, pipamperone, piritramide, practolol, pra-zepam, prazosin, promazine, promethazine, propoxyphene, propranolol, prothipendyl, quinine, sotalol, sulpride, thioridazine, trazodone, triazolam, trimipramine, tripelennamine, lyramine, verapeunil, yohimbine... 

Noninterfering acetaminophen, amphotericin B, brotizolam, ceftazidime, ciprofloxacin, codeine, diclofenac, didanosine, domperidone, fluoxetine, foscarnet, gangiclovir, methadone, metoclopramide, mianserin, nystatin, pyrimethamine, ranitidine, sulfamethoxazole, temazepam, trimethoprim, zidovudine... 

The opioid analgesics, such os codeine, tramadol and fentanyl may cause drowsiness. Sumatriptan, which is a serotonin agonist, also tends to cause drowsiness. Modern non-steroidal anti-inflammatory drugs, such as diclofenac, do not cause drowsiness. 

Alternative products to diclofenac include naproxen and mefenamic acid, both of which are non-steroidal anti-inflammatory drugs. Co-codamol is a mixture of the opioid analgesic codeine and paracetamol and it does not possess the anti-inflammatory component. It may be used in pain management either where NSAIDs are contraindicated or in patients who are intolerant to the effects of NSAIDs. 

Other examples of analgesics or their metabolites that have been found in the environment include 4-aminoantiyrine, aminophenazone, codeine, fenoprofen, hydrocodone, indometacine, ketoprofen, mefenamic acid, naproxen, propyphenazone diclofenac, ibuprofen, phenazone, gentisic acid and N-methylphenacetin. Many studies have identified these compounds in various locations around the world and in different water resources (e.g., Heberer et al. 1997, 2001a, 2001b Ternes 2001 Stumpf et al. 1999 Ahrer et al. 2001 Sedlak and Pinkston 2001 Holm et al. 1995 Ahel and Jelicic 2001 Sacher et al. 2001). 

Diclofenac has been identified as one of the major pharmaceuticals in the waters in Berlin (Germany) at median concentrations of 0.47 pgL (Ternes et al., 2002 Ferrari et al., 2003). Other analgesics such as naproxen, phenazone, codeine, indome-tacin, fenoprofen, ketoprofen, phenylbutazone, and propyphenazone have also been detected in sewage and surface water (Heberer and Adam, 2005 Boyd et al., 2005), although data about their occurrence in the environment are not extensive. The data presented in Figure 2.5 are not exhaustive but are rather intended to show the great diversity in concentrations of some of the key PPCPs in wastewater. 

This chapter concentrates on some drug choices in acute rather than chronic pain, but the same principles can be used to determine the appropriateness of other types of analgesic. The drugs considered in this section are paracetamol, non-steroidal anti-inflammatories (NSAIDs specifically diclofenac, ibuprofen, indometacin, naproxen, sulindac and tenoxicam) and opioids (codeine, dihydrocodeine, morphine, pethidine and tramadol). Unless otherwise stated, all pharmacokinetic data originate from standard reference sources [1-5] and apply to adults only. 

Codeine Hydrochloride Dequalinium Acetate Fluorometholone Hexamethonium Bromide Riboflavine Stilbazium Iodide Mianserin Hydrochloride Tacrine Hydrochloride Diclofenac Sodium Vinblastine Sulphate Cyclizine Hydrochloride Amiloride Hydrochloride Protoveratrine B Meclofenamate Sodium 5-Methyltryptamine Hydrochloride Dicoumarol Mebendazole Pipradrol Hydrochloride Carbenoxolone Flucytosine Phanquone Phenytoin... 

Minotti V, De Angelis V, Righetti E, Celani MG, Rossetti R, Lupatelli M, Tonato M, Pisati R, Monza G, Fumi G, Del Favero A. Double-blind evaluation of short-term analgesic efficacy of orally administered diclofenac, diclofenac plus codeine, and diclofenac plus imipramine in chronic cancer pain. Pain 1998 74 (2-3) 133-7. 

Analgesic/ Anti-inflammatory Non-prescription treatment of colds, allergies, pain Prescription treatment of chronic pain, arthritis, migraines, etc. ASA (aspirin), ibuprofen, indomethacin, acetaminophen Naproxen, diclofenac, propyphenazone, codeine 33, 40, 55, 61, 62... 

Also analyzed acebutolol, acepromazine, acetaminophen, acetazolamide, acetophenazine, albuterol, amitriptyline, amobarbital, amoxapine, antipsrrine, atenolol, atropine, azata-dine, baclofen, benzocaine, bromocriptine, brompheniramine, brotizolam, bupivacaine, buspirone, butabarbital, butalbital, caffeine, carbamazepine, cetirizine, chlorqyclizine, chlordiazepoxide, chlormezanone, chloroquine, chlorpheniramine, chlorpromazine, chlorpropamide, chlorprothixene, chlorthalidone, chlorzoxazone, cimetidine, cisapride, clomipramine, clonazepam, clonidine, clozapine, cocaine, codeine, colchicine, qyclizine, (yclo-benzaprine, dantrolene, desipramine, diazepam, diclofenac, diflunisal, diltiazem, diphenhydramine, diphenidol, dipheno late, dipyridamole, disopyramide, dobutamine, doxapram, doxepin, droperidol, encainide, ethidium bromide, ethopropazine, fenoprofen, fentanyl, flavoxate, fluoxetine, fluphenazine, flurazepam, flurbiprofen, fluvoxamine, fii-rosemide, glutethimide, glyburide, guaifenesin, haloperidol, homatropine, hydralazine, hydrochlorothiazide, hydrocodone, hydromorphone, hydro g chloroquine, hydroxyzine, ibuprofen, imipramine, indomethacin, ketoconazole, ketoprofen, ketorolac, labetalol, le-vorphanol, lidocaine, loratadine, lorazepam, lovastatin, loxapine, mazindol, mefenamic acid, meperidine, mephenytoin, mepivacaine, mesoridazine, metaproterenol, methadone, methdilazine, methocarbamol, methotrexate, methotrimeprazine, methoxamine, methyl-dopa, methylphenidate, metoclopramide, metolazone, metoprolol, metronidazole, midazolam, moclobemide, morphine, nadolol, nalbuphine, naloxone, naphazoline, naproxen, nifedipine, nizatidine, norepinephrine, nortriptyline, oxazepam, oxycodone, oxymetazo-line, paroxetine, pemoline, pentazocine, pentobarbital, pentoxifylline, perphenazine, pheniramine, phenobarbital, phenol, phenolphthalein, phentolamine, phenylbutazone, phenyltoloxamine, phenytoin, pimozide, pindolol, piroxicam, pramoxine, prazepam, prazosin, probenecid, procainamide, procaine, prochlorperazine, procyclidine, promazine, promethazine, propafenone, propantheline, propiomazine, propofol, propranolol, protriptyline, quazepam, quinidine, quinine, racemethorphan, ranitidine, remoxipride, risperidone, salicylic acid, scopolamine, secobarbital, sertraline, sotalol, spironolactone, sulfinpyrazone, sulindac, temazepam, terbutaline, terfenadine, tetracaine, theophylline, thiethyl-perazine, thiopental, thioridazine, thiothixene, timolol, tocainide, tolbutamide, tolmetin, trazodone, triamterene, triazolam, trifluoperazine, triflupromazine, trimeprazine, trimethoprim, trimipramine, verapamil, warfarin, xylometazoline, yohimbine, zopiclone... 

Also analyzed acebutolol, acepromazine, acetaminophen, acetazolamide, acetophenazine, albuterol, alprazolam, amitriptyline, amobarbital, amoxapine, antip3rrine, atropine, aza-tadine, baclofen, benzocaine, bromocriptine, brompheniramine, brotizolam, bupivacaine, buspirone, butabarbital, butalbital, caffeine, carbamazepine, cetirizine, chlorQrclizine, chlordiazepoxide, chlormezanone, cliloroquine, chlorpheniramine, chlorpromazine, chlorpropamide, chlorprothixene, chlorthalidone, chlorzoxazone, cimetidine, cisapride, clomipramine, clonazeptun, clonidine, clozapine, cocaine, codeine, colchicine, cgrclizine, cy-clobenzaprine, dantrolene, desipramine, diazepam, diclofenac, diflunisal, diltiazem. 

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