Painkiller Equivalency Chart

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All Drugs[edit]

Equianalgesic Chart[edit]

Sources.[1][2][3] Acetaminophen (paracetamol) is typically regarded as being the least effective painkiller in common use.[4]

Relative Potency Drug Names Type Legal Status
1/360 Acetaminophen Tylenol Atypical Few restrictions1
1/360 Aspirin NSAID Few restrictions
1/222 Ibuprofen Advil, Motrin, Nurofen NSAID Few restrictions
1/138 Naproxen Aleve NSAID Few restrictions
1/10 Tramadol Opioid (atypical) Controlled
1/10 Codeine Opioid Controlled; OTC in combinations
Us-flag.png Rx Only (de facto)
1/5 Dihydrocodeine Opioid Controlled; OTC in combinations
Us-flag.png Rx Only (de facto)
1/3 Tapentadol Nucynta, Palexia, Tapal Opioid Controlled
1 Hydrocodone Vicodin*, Norco* Opioid Controlled
1 Morphine Opioid Controlled
1.5 Oxycodone Oxycontin, Percodan*, Percocet* Opioid Controlled
4-5 Diamorphine2 heroin Opioid Uk-flag.png Ca-flag.png Controlled
Us-flag.png Au-flag.png Illegal
5 Hydromorphone Dilaudid Opioid Controlled
7 Oxymorphone Numorphan, Opana Opioid Controlled
8-10[5] Desomorphine3 krokodil Opioid Illegal
40 Buprenorphine Buprenex, Suboxone* Opioid (atypical) Controlled
50-100 Fentanyl Opioid Controlled

* indicates a combination product

1 maximum sale quantity is limited in some jurisdictions due to the risk of liver damage from overdose

2 prescribed only in limited circumstances

3 no longer prescribed

Unknown potencies[edit]

Cannabis[edit]

Cannabis extracts, such as tetrahydrocannabinol (THC) and cannabidiol (CBD), have substantial analgesic properties, but varying methods of administration, a lack of regulation and scientific research, and differences between individuals make the analgesic effects of these compounds difficult to quantify. The Oxford Handbook of Pain Management cites inhaled cannabis as having an analgesic effect comparable to 50 to 120 mg of codeine (5 to 12 mg of morphine).[6]

Terpenes such as myrcene, which is found in cannabis, are believed to stimulate natural endorphins through alpha receptor activation.

Non-typical opioids[edit]

Kratom, as there is no standardized extract, and as a drug which is very atypical of the opioid class, does not have a reliably established equivalency to well-studied opioids.

Loperamide, an opioid which crosses the blood-brain barrier in small amounts (which can be increased via concurrent use of p-glycoprotein inhibitors), is not officially recognized as having central nervous system effects. The drug remains hypothetically viable as a painkiller, especially in areas where access to weak opioids such as codeine is limited.

Other drugs[edit]

Turmeric is well established to have analgesic properties, and is believed to contain natural NSAID-like compounds.

Ethanol has analgesic properties, and has historically been used as a pain reliever. This use continues in informal or improvised settings, but use in medical settings has been discontinued in the developed world. Studies have shown that two standard drinks of alcohol provide analgesia comparable to 10 to 15 mg of morphine (100 mg to 150 mg of codeine)[7], but the analgesic effect quickly reaches a ceiling, making a quantitative comparison to morphine problematic and misleading.

OTC Drug Comparison[edit]

Non-combination[edit]

All products are instant-release. Opioids are not included in this chart because they are typically not available by themselves. Exceptions to this include products that include non-drug ingredients that act to limit the maximum consumption (e.g. Rikodeine), research chemicals not yet regulated, and kratom.

Drug Dose Brand names Morphine mg Equivalent Codeine mg Equivalent
Aspirin 81 mg "Baby aspirin" 0.23 mg 2.3 mg
Naproxen 200 mg Aleve (normal dose) 1.45 mg 14.5 mg
Ibuprofen 200 mg x2 Advil, Motrin 1.80 mg 18.0 mg
Aspirin 325 mg x2 1.81 mg 18.1 mg
Acetaminophen 325 mg x2 Tylenol 1.81 mg 18.1 mg
Aspirin 325 mg x3 2.71 mg 27.1 mg
Acetaminophen 500 mg x2 Tylenol Extra Strength 2.78 mg 27.8 mg
Naproxen 200 mg x2 Aleve (max dose) 2.90 mg 29.0 mg
Ibuprofen 200 mg x4 Advil, Motrin 3.60 mg 36.0 mg

Combination[edit]

Drug Dose Brand Names Morphine mg Equivalent Codeine mg Equivalent Notes
Acetaminophen / Codeine 300 mg / 8 mg x2 Ca-flag.png Tylenol 1 3.27 mg 32.7 mg Also contains 15 mg caffeine
Aspirin / Codeine 325 mg / 8 mg x2 Ca-flag.png AC&C 3.41 mg 34.1 mg Also contains 15 mg caffeine
Dihydrocodeine 19 mg Au-flag.png Rikodeine 3.8 mg 38 mg Also contains 4.4 g sorbitol
Ibuprofen / Codeine 200 mg / 12.8 mg x2 Uk-flag.png Nurofen Plus 4.36 mg 43.6 mg
Acetaminophen / Codeine 400 mg / 20 mg x2 Fr-flag.png Codoliprane 6.22 mg 62.2 mg
Acetaminophen / Codeine 500 mg / 20 mg x2 Fr-flag.png Claradol 6.78 mg 67.8 mg
Acetaminophen / Ibuprofen / Codeine 1000 mg / 400 mg / 65.6 mg "Grand Slam" OTC combo 11.14 mg 111.4 mg 2x Claradol
2x Nurofen Plus
Acetaminophen / Ibuprofen / Codeine 1200 mg / 800 mg / 111.2 mg "Grand Slam" OTC combo 18.06 mg 180.6 mg 3x Codoliprane
4x Nurofen Plus

Maxiumum Potency by Country[edit]

Following maximum dose guidelines[edit]

Country Drug(s) Morphine mg Equivalent Codeine mg Equivalent Notes
Us-flag.png United States Acetaminophen 500 mg x2
Naproxen 200 mg x2
5.68 mg 56.8 mg
Ca-flag.png Canada Acetaminophen/codeine 300mg/8mg x3
Naproxen 200mg x2
7.8 mg 78 mg
Uk-flag.png United Kingdom Acetaminophen/codeine 500mg/8mg x2
Ibuprofen/codeine 200mg/12.8mg x2
8.74 mg 87.4 mg

Reference[edit]

  1. https://www.med.unc.edu/emergmed/files/analgesicdosing.pdf
  2. https://www.nhms.org/sites/default/files/Pdfs/Opioid-Comparison-Chart-Prescriber-Letter-2012.pdf
  3. https://en.wikipedia.org/wiki/Equianalgesic
  4. http://www.vox.com/2015/8/17/9165189/best-painkiller-tylenol-aspirin-advil
  5. https://en.wikipedia.org/wiki/Desomorphine#cite_note-lifsci-7
  6. https://books.google.com/books?id=N4iZfyvHUk0C&pg=PA178&lpg=PA178&dq=cannabidiol+equianalgesic&source=bl&ots=HkmYtUFCbp&sig=O3rTzrylv2b8unwztRc4gggddno&hl=en&sa=X&ved=0ahUKEwjEmK_H2q7TAhVT0mMKHTKfD0kQ6AEIKzAB#v=onepage&q=cannabidiol%20equianalgesic&f=false
  7. http://bja.oxfordjournals.org/content/50/2/139.full.pdf