The main focus of today’s post is to review the most popular prescription painkillers in the UK. I previously reviewed the popularity of different drugs in the UK, which may interest you: Top 15 most prescribed drugs in the UK & most popular antidepressants in the UK.
The most popular prescription painkillers (UK) will be ranked according to the volume of prescriptions issued in the last 12 months by GPs in the UK. Prescribing data was extracted from Openprescribing.net, a website that processes information from the NHS in England, making information on prescribed drugs more accessible. I will make a short comment on each prescription to understand the context better.
Most Popular Prescription Painkillers The UK
The list below includes the 19 most prescribed painkillers in the UK. The latest available data provided a 12-month prescription volume (Nov ’19—Oct ’20).
The volume of prescriptions: 17,453,897
Cost to NHS: £66,522,927
Paracetamol is one of the most commonly prescribed drugs in the UK. Paracetamol is the most popular prescription painkiller in the UK, despite its availability over the counter.
In 2017 NHS published 10 point efficiency plan, which was included in the NHS Five Year Forward View with efforts to reduce prescribing of drugs available over the counter. This strategy has not been very effective in terms of Paracetamol definition.
The decrease in Paracetamol prescribing between 2017 and 2020 (same periods) was only 7% (18788491 prescriptions in 2017 vs. 17,453,897).
Paracetamol can be purchased in shops and supermarkets (quantity limited to two-pack of 16 tablets) or from the pharmacy with a maximum legal amount sold for up to 100 tablets or capsules.
The volume of prescriptions: 14,991,500
Cost to NHS: £76,211,293
Co-codamol contain a combination of codeine and paracetamol. Lowes strength of Co-codamol is available over the counter (8mg of Codeine & 500 mg of Paracetamol). A higher strength of Co-codamol, including Co-codamol 15/500 (Codeine/Paracetamol) and 30/500, are Prescription-Only Medicines (POM).
When looking at prescribing statistics for Co-codamol in recent years, there has not been much change in the volume of prescriptions issued. A 4% decrease in Co-codamol prescriptions can be observed between 2016 and 2019 (15.6mln in 2016 vs. 15.0mln in 2019).
Some people may find a combination of Codeine and Paracetamol as a better painkiller but, at the expense of side effects, familiar with Codeine and Codeine-containing products.
The volume of prescriptions: 6,725,949
Cost to NHS: £44,745,495
Naproxen is the most common prescription painkiller out of the drug class called Non-Steroidal Anti-Inflammatory drugs (NSAIDs).
NSAIDs are used to help manage pain and inflammation.
Naproxen is a prescription-only medication.
Naproxen is considered a first-line when NSAIDs are prescribed to manage a patient’s conditions due to its excellent and low side effects (NICE BNF, 2021).
However, there are many Naproxen alternative drugs too that you can consider.
The volume of prescriptions: 5,920,790
Cost to NHS: £24,080,122
Tramadol is the first sole opioid drug on the list of most popular prescription painkillers in the UK.
Tramadol is classified in the UK as a controlled drug (Schedule 3) and is used to manage moderate to severe pain.
The most popular form of Tramadol is Tramadol 50mg capsules; however, Tramadol also comes in the form of tablets of various strengths ranging from 50mg to 200mg of Tramadol per tablet/capsule.
5. Morphine Sulphate
The volume of prescriptions: 5,147,622
Cost to NHS: 32,292,636
Morphine (Morphine Sulphate) is another opiate drug among the most popular painkillers in the UK. Morphine comes in a variety of forms and strengths.
The lower strength of Morphine, which is available as an oral solution (Morphine Sulphate 10mg/5ml), is classified as a controlled drug schedule 5.
Higher-strength of morphine drugs, which is available as tablets, capsules, and injections, is classified as a controlled drug schedule 2, with more stringent requirements for the supply and legal prescription requirements, such as the expiry date of the prescription.
It is also impossible to get an emergency prescription or supply for controlled drugs in the UK.
Some common brands of Morphine dispensed in the UK include:
- MST Continus tablets
- Zomorph capsules
- Morphgesic tablets
Morphine can be used to manage acute and chronic pain. A higher strength of Morphine is used for severe pain and pain management in palliative care (care of terminally ill people).
6. Codeine Phosphate
Volume of prescriptions: 4,968,331
Cost to NHS: £16,786,970
Codeine is another opiate used in pain management. There is a slight increase in Codeine prescribing in the UK. A growth of 6.6% in prescriptions for Codeine was observed between 2016 and 2019 (4654533 prescriptions in 2016 vs. 4960647 in 2019).
The use of Codeine in pain management is somewhat controversial, especially when used to treat chronic pain. Little evidence exists to support the effectiveness of opioids in chronic pain.
Only a small number of people may benefit from opioid use for pain relief. This applies not only to Codeine but to other Opiates, for example, Tramadol (NICE, 2019).
Ongoing, long-term use of opioids usually leads to dependence and tolerance (ibid), meaning a drug does not work as it did when the treatment was initiated.
Prescription-only Codeine is available in the form of tablets:
- Codeine phosphate 15mg tablets
- Codeine phosphate 30mg tablets
- Codeine phosphate 60mg tablets
7. Topical Ibuprofen (Ibuprofen gel)
Volume of prescriptions: 3,455,112
Cost to the NHS: £11,376,569
See the Ibuprofen section below for comments on topical Ibuprofen prescribing.
The volume of prescriptions: 2,368,482
Cost to NHS: £ 42,607,181
Buprenorphine is another opioid analgesic classified as a controlled drug schedule 3. Buprenorphine is prescribed for moderate to severe pain not relieved by other drugs, including other opioids and non-opioid medications.
Buprenorphine comes in the form of:
- sublingual tablets (tablet is placed under the tongue)
- oral lyophilisate,
- solution for injection
- prolonged-release solution for injection and,
- transdermal patch
Patches tend to be the most common form of Buprenorphine prescribed in the community. Buprenorphine patches are not suitable for the management of acute pain.
Buprenorphine can also be used in the treatment of opioid dependence. Sublingual tablets and oral lyophilizes are usually used for this indication.
9. Oxycodone Hydrochloride
Volume of prescriptions: 1,804,713
Cost to NHS: £38,136,061
Oxycodone is a controlled drug schedule 2 used to treat moderate to severe pain, for example, postoperative pain, and manage pain in palliative care. Oxycodone comes in different forms, including tablets, capsules, and solutions for injections.
Volume of prescriptions: 1,646,753
Cost to NHS: £8,998,097
Co-dydramol contains two active ingredients – Paracetamol and Dihydrocodeine. Although Co-dydramol comes in three different strengths, the vast majority of prescriptions are issued for Co- dydramol 10mg/500mg (each tablet contains 10mg of dihydrocodeine and 500mg of Paracetamol). Other strengths of co-dydramol:
- Co-Dydramol 20/500 mg tablets
- Co-Dydramol 30/500 mg Tablets
Lower strength Co-dydramol, which contains 7.5mg of dihydrocodeine and 500mg of Paracetamol per tablet, can be purchased from the pharmacy. ‘Over the counter’ Co- dydramol is sold as a Paramol tablets product.
Dihydrocodeine produces a similar analgesic effect to Codeine.
Co-dyramol prescribing is in decline, which is visible in the graph below.
11. Dihydrocodeine Tartrate
Volume of prescriptions: 1,504,990
Cost to NHS: £ 6,599,771
Dihydrocodeine is another opioid analgesic that is related to Codeine. Dihydrocodeine is only available on prescription. Dihydrocodeine comes only in the form of 30mg tablets.
- the volume of prescriptions: 1,332,513
- Cost to NHS: £5,841,065
Topical Ibuprofen (Ibuprofen gel):
- the volume of prescriptions: 3,455,112
- Cost to the NHS: £11,376,569
Ibuprofen is the second most prescribed NSAID in the UK, after Naproxen. Like Other pain relievers, Ibuprofen can be purchased over the counter, including the two most common forms of Ibuprofen, 2,00mg, and 400mg tablets. Ibuprofen 400mg is a pharmacy-only medicine and therefore is not available for customers’ self-selection, for example, in supermarkets.
Prescribing statistics for Ibuprofen are categorized according to intended use:
- Ibuprofen is used in rheumatic diseases and gout (oral Ibuprofen), and
- Ibuprofen is used in soft-tissue disorders and topical pain relief (Ibuprofen gel)
A considerable decrease in Ibuprofen prescribing can be observed in the first category (rheumatic diseases and gout), with a slight decline in topical Ibuprofen in the UK. Ibuprofen gel, 5%, and 10% are also available over the counter. Despite this, a high level of prescribing for topical Ibuprofen is observed in England, with little change in prescribing in recent years.
The volume of prescriptions: 973,464
Cost to NHS: 35,732,365
Fentanyl is the most potent opioid analgesic available on prescription. Fentanyl is classified as a controlled drug schedule 2. Fentanyl is about 50-100 times more potent than Morphine (Vardanyan & Hruby, 2014).
Fentanyl is usually reserved for pain management, which is not controlled by strong opioid analgesics and breakthrough pain experienced caused by cancer.
14. Diclofenac Sodium
The volume of prescriptions: 487,922
Cost to NHS: 3,103,167
Diclofenac sodium is the third most commonly used NSAID on the UK’s most popular prescription painkillers list. Diclofenac is frequently prescribed to treat acute gout pain and inflammation in rheumatic disease.
15. Nefopam Hydrochloride
The volume of prescriptions: 277,908
Cost to NHS: £3,852,728
Nefopam is rarely prescribed in the NHS. Nefopam is a non-opioid analgesic with a mechanism of action different from all drugs reviewed.
Although the mechanism of action is not fully understood, it is thought that Nefopam affects the reuptake of neurotransmitters, including serotonin, norepinephrine, and dopamine (Kim & Abdi, 2014).
Nefopam is licensed to relieve acute and chronic pain, dental pain, cancer pain, and musculoskeletal pain.
The volume of prescriptions: 67,920
Cost to NHS: 993,182
Meptamizol (brand name: Meptid) is the least popular opioid analgesic on the list. The licensed use is limited to short-term management of moderate pain.
The volume of prescriptions: 57,929
Cost to NHS: £190,820
Aspirin is rarely prescribed in NHS England for the management of pain. Aspirin, usually used as a painkiller, comes in 300mg tablets.
On the opposite side, a low dose Aspirin – baby Aspirin is one of the most commonly prescribed drugs in the UK. A doctor can recommend baby Aspirin to prevent heart attack or stroke in people who had such an event.
18. Diamorphine Hydrochloride
The volume of prescriptions: 47,138
Cost to NHS: 1£,410,497
Diamorphine is another opioid analgesic classified as a controlled drug schedule 2. Diamorphine comes only in the form of ampules (for injections). Diamorphine manages acute and chronic pain, not relieved by strong opioid analgesics.
19. Diclofenac Potassium
The volume of prescriptions: 13,176
Cost to NHS: 182,362
Diclofenac Potassium (an NSAID) has similar licensed use as diclofenac sodium; however, it is rarely prescribed in the NHS.
Methadone (brand name: Physeptone tablets) is rarely prescribed in the community to treat the pain. Methadone is classified as a controlled drug schedule 2. The vast majority of methadone in the community is used to manage opioid dependence.
Most popular painkillers in the UK: summary table
|Drug||Items prescribed||Cost to NHS||Cost per item|
Data source: OpenPrescribing.net Data period: Nov ’19—Oct ’20
The total cost of the top 20 most popular prescribed painkillers has come to £419.7mln in the last 12 months. Perhaps the most controversial is the supply of Paracetamol, which is still the most commonly prescribed drug to manage the pain.
Historically Paracetamol has been sold cheaply in pharmacies and supermarkets. In recent months paracetamol prices went up; however, even when used regularly (e.g., daily), the total monthly cost is low.