Beaver W T
Am J Med. 1984 Sep 10;77(3A):38-53. doi: 10.1016/s0002-9343(84)80101-1.
Six rationales for using combination analgesics are identified, but most combinations are formulated with two rationales in mind: enhancement of analgesia and reduction of adverse effects by combining two analgesics with different mechanisms of action. Acetaminophen and aspirin are the mainstays of oral analgesic combinations. There is substantial evidence that combining an optimal dose of acetaminophen or aspirin with an oral opioid such as codeine, hydrocodone, or oxycodone produces an additive analgesic effect greater than that obtained by doubling the dose of either constituent administered alone. There is also some evidence that the adverse effects produced by such combinations are less than would be produced by an equi-analgesic dose of a single constituent. The physician need not be confined to existing fixed-ratio combinations; he or she may extemporize to the patient's advantage by co-administering acetaminophen, aspirin, or other nonsteroidal anti-inflammatory drugs with available oral opioids and, in select situations, co-administering oral or injectable analgesics with psychoactive drugs.
确定了使用联合镇痛药的六个基本原理，但大多数联合用药方案的制定考虑了两个基本原理：通过将两种作用机制不同的镇痛药联合使用来增强镇痛效果并减少不良反应。对乙酰氨基酚和阿司匹林是口服联合镇痛药的主要成分。有大量证据表明，将最佳剂量的对乙酰氨基酚或阿司匹林与口服阿片类药物（如可待因、氢可酮或羟考酮）联合使用，所产生的相加镇痛效果大于单独将任一成分的剂量加倍时所获得的效果。也有一些证据表明，此类联合用药产生的不良反应比等效镇痛剂量的单一成分所产生的不良反应要少。医生不必局限于现有的固定比例联合用药方案；他或她可以通过将对乙酰氨基酚、阿司匹林或其他非甾体抗炎药与现有的口服阿片类药物联合给药，以及在特定情况下将口服或注射用镇痛药与精神活性药物联合给药，根据患者的情况临时配药。
