Abdominal Pain Medications
Must-Know Information On Various Types of Stomach Pain Medicines

Abdominal pain medication: It is important to know which medicine to use for your abdominal pain relief, when to use it and common side effects associated with such medicine.

Are you looking for what is the best over the counter medicine for stomach pain or for a prescription medicine that would work?

Abdominal pain can come on when you least expect it - suddenly, after a meal, during your sleep, as period cramps or you could even be suffering with pain for many many months or years. 

Nobody should suffer with pain and struggle to find relief for it. 

The rule of thumb in medicine is that if you have pain in your abdomen that lasts for more than one hour, you should seek medical advice for such pain. If you feel dizzy or unwell at anytime with pain in your abdomen, you should speak with your healthcare provider even sooner. 

Taking a hot bath, or using a warm compress or hot water bottle are practical things you could do first if you are having stomach pain.

If the pain does not get better within the hour or if it is worsening, you could take some acetaminophen (Paracetamol or Tylenol) and get some rest. If it is worsening, it is time to call the doctor. 

As you would expect, there is no single medicine that can be taken to cure all types of abdominal pain. We would discuss the various types of abdominal or stomach pain medications available - whether it is just pain alone, stomach pain and bloating, stomach pain and diarrhea or constipation, period pain, pain from endometriosis or even unknown causes of stomach pain. 

Abdominal Pain Medicine To Use For Different Conditions

22 year old woman taking stomach pain medicine for periods (menstrual cramps).

The following are the types of medicines that are used to treat different causes of pain in the tummy. We would discuss:

• the different classes
• examples of such medicines and how they work
• which conditions they can be used for
• who should not use them, and
  
• common side effects. 

Acetaminophen 

Acetaminophen is a very important painkiller used in the treatment of mild to moderate abdominal pain from all causes. 

It is classified as a simple analgesia and fever-relieving medication with no significant anti inflammatory effect. 

It is sold in many countries by different names, including Tylenol, Paracetamol and Panadol. 

The exact way this medication works is unknown. 

It is used as abdominal pain medication for:

• Gallbladder pain
• Kidney stone
• Menstrual pain
• Pain from constipation
• Pain due to food poisoning
• Pain from bloating 
• Cystitis 
• Abdominal muscle pain
• And more. 

This is perhaps one of the safest painkillers out there. So it can be used by almost anyone e=unless you have specific allergy to acetaminophen or have significant liver damage or have severe alcohol liver disease. 

Common side effects would include:

• Nausea and vomiting
• Itching 
• liver toxicity in large dose - 8 tabs of 500 mg tablet is considered the maximum dose of this medication that should be taken, if you do not have any liver or kidney problem and are not at risk of for any of these conditions. 

Anti Inflammatory Medications  

Anti-inflammatory medications are the most commonly used pain killers for abdominal pain after acetaminophen (Paracetamol, Tylenol, Panadol etc). They are also referred to as Non-Steroidal Anti Inflammatory Drugs (NSAIDs). 

Examples of anti-inflammatory medicines are:

• Aspirin
• Ibuprofen (Motrin, Advil, Midol). 
• Diclofenac (Voltaren, Cambia, Cataflam, Zipsor, Zorvolex)
• ketorolac (Toradol)
• Piroxicam (Feldene)
• Naproxen (Aleve, Naprosyn, Anaprox, Flanax)
• Ketoprofen (Orudis, Oruvail, Actron)
• Mefenamic acid (Ponstan, Ponstel)

They work by reducing pain and swelling in the body. 

The typical dose of anti-inflammatory painkillers to use for your abdominal pain would be 200 to 400 mg of ibuprofen up to three times daily, or 50 mg of diclofenac tablet up to three times daily, or 10 mg of ketorolac up to three times daily, or 20 mg tablet of Piroxicam once daily, or Ketoprofen 50 mg up to four times daily, or 500 mg of Naproxen twice daily or 500 mg of mefenamic acid up to three times daily. 

Aspirin is best avoided for any type of abdominal pain because of the high risk of internal bleeding (from your stomach or duodenum or even bleeding into your brain) at the dose needed for pain control - 300 mg of aspirin three times daily).

Some Abdominal Conditions Where Anti Inflammatory Medicines Are Used

NSAIDs are used commonly for the following types of abdominal pain:

• Menstrual Cramps (Period Pain). All the above medications would be very effective to be taken for menstrual pain. It is always best to start taking your pain medication a day before your menses start and continue for another two days into your period. Taking anti-inflammatory after your period starts (on the first day or second of your menses) is almost too late because the chemicals that causes your pain have already been released and you will not get a good pain control.
• Kidney Stone Pain. All the above anti-inflammatory medications are also very effective in relieving pain from kidney stone. If you suspect that your pain is from kidney stone, be careful though with using an anti inflammatory medication, until after your doctor has done a quick blood test to establish that you do not have kidney failure. All Anti inflammatory medications can worsen kidney damage. 
• Biliary Colic or Gallbladder Pain. Biliary colic pain can be relieved by using an anti inflammatory pill. 
• Abdominal Pain Days After Surgery. If you had a cesarean section, or any abdominal surgery and have no risk of bleeding, anti-inflammatory medicines could be a very powerful painkillers on their own alone or in combination with opioids like codeine, Tylenol 3 (co-codamol), or morphine. 
• Endometriosis Pain. Do you have endometriosis? You may find the use of anti-inflammatory pills very helpful either alone or in combination with your hormone containing pills. 

Cautions And Common Side Effects of Anti Inflammatory Medicines

Anti inflammatory medications are a great resource for pain control in several parts of the body as well as abdominal pain medications. They also help in controlling fever. 

Like all medicines, they should be used with caution in certain situations and individuals. And when they are used, it is important to be familiar with common side effects that could result and recognise these so that you can stop them and seek help if necessary. 

Cautions

Please avoid taking anti-inflammatory medications if you:

• Suffer with asthma. It could make your asthma worse or trigger an attack
• Are taking a blood thinning medication like warfarin (coumadin), apixaban (eliquis), rivaroxaban (xarelto), dabigatran (pradaxa), edoxaban (savaysa), fondaparinux (arixtra) Heparin (fragmin, innohep, and lovenox). They could cause you to bleed
• Have been diagnosed with bleeding stomach or duodenal ulcer

Use with caution if you:

• Suffer with hypertension
• Have heart disease (past history of angina or heart attack, or have had a coronary bypass surgery. They could significantly increase your risk of a fatal heart attack.
• Also use with extreme caution if you have kidney disease. NSAIDs could be really hard on your kidneys. 

Side Effects

• The most common side effects with anti-inflammatory pills is the irritation of the lining of the stomach and even a stomach bleed. You can avoid this by taking this medication with food and never on an empty stomach. Another way you can minimize this side effect is by taking NSAIDs with PPI (proton pump inhibitors) such as omeprazole, lansoprazole, or pantoprazole. 
• All NSAIDs causes some degree of toxicity to our liver. But this is often very negligible and short term use of this group of medication is generally safe.
• Other common side effects if NSAID could include nausea and vomiting.

Opioids

Opioid medications are a group of medicines derived from or related to morphine. 

They are another family of powerful analgesics or painkillers used for the treatment of moderate to severe pain. 

They could be a very effective abdominal pain medication, especially for acute pain. If you were to have acute appendicitis or ectopic pregnancy or rupture ovarian cyst, and go into hospital, you are almost certain to get an opioid injection. 

They are also helpful to an extend for chronic abdominal pain, but best avoided for long term use, because of their propensity for the body to get used to them and you then lose the analgesic effect. They also cause dependency or addiction. 

Examples of opioid painkillers are:

• Codeine
• Tramadol
• Oramorph
• Morphine sulphate
• Hydromorph
• Oxycodone
• Hydrocodone
• Tapentadol
• Meperidine
• Fentanyl.  And more. 

Codeine is often combined with acetaminophen in co codamol or Tylenol 3 / 4.

Abdominal Conditions Where Opioids Are Used.

Opioids are used in the relief of pain in the abdominal from all causes. The more common use of opioid painkillers in abdominal pain are for pain due to:

• Acute abdominal conditions like acute appendicitis, ectopic pregnancy, ovarian cyst rupture, twisted ovarian cyst, pelvic inflammatory disease, ulcerative colitis and crohn's disease, strangulated hernia, etc
• Chronic abdominal conditions like pain from abdominal adhesion, endometriosis, chronic pelvic pain of unknown origin, etc.
• After abdominal surgery and procedures.

Cautions And Common Side Effects of Opioids

Opioids are generally save medications, but for their side effects of causing sedation and constipation. They should be used with caution if you have gallbladder surgery because they could cause spasm of the gallbladder and bile system. 

They should also be used with caution just before delivery in a pregnant women because they have could cause drowsiness and breathing problem within the first few hours of a baby being born, if sufficient quantity gets to the baby through the placenta. 

Side Effects:

• A few people are allergic to opioids. Completely avoid, if thet is you. 
• Constipation. This is the most encountered side effects, especially for codeine and it's derivatives and certainly seen too for all other opioids. 
• Nausea and vomiting. If you are given morphine intravenously, you are more likely to experience nausea and may even vomit. We often administer an anti sickness or anti nausea medication at the same time. Oral opioids could also cause nausea and vomiting. 

Anti-Spasmodic

Antispasmodics are medications that help with abdominal pain relief by relaxing the gut muscles. 

Examples of antispasmodics are:

• Mebeverine (colospasmin, colofac, duspatalin, caborin, colese)
• Hyoscine butylbromide - Scopolamine in the US (Buscopan, Gascopan, Buscapina)
  
• Pinaverium bromide (Dicetel)
  
• Alverine
  
• Dicyclomine Hydrochloride
  
• Peppermint  oil 

This group of medicines are widely used either on their own or in combination with other medicines for treating many causes of abdominal pain including:

• Irritable bowel syndrome
• Intestinal gas or wind 
• Gallbladder pain
• Stomach and duodenal ulcers
• Abdominal adhesions
• Symptomatic relief of stomach pain of unknown cause.

Mebeverine is commonly used in the UK for the treatment of irritable bowel syndrome. It is not available in some countries like Canada, where the main stay for treating spasms associated with irritable bowel syndrome is by using Dicyclomine Hydrochloride or Pinaverium bromide. 

Antacids

Heartburn from GERD (gastroesophageal reflux disease), peptic ulcers (stomach or duodenal ulcers) are very common causes of abdominal pain and discomfort.

Antacids are easily amongst the top over the counter abdominal pain medications purchased worldwide.  They work by neutralizing acid in the stomach. They often provide quick relief from the pain of heartburn and indigestion.

They mainly contain:

• Sodium bicarbonate
• Calcium bicarbonate
• Magnesium hydroxide
• Aluminium hydroxide
• Bismuth
• Sucralfate.

Examples of antacids include:

• Gaviscon
• Tums
• Gastrocote
• Gavilast
• Eno
• Pepto Bismol
• Remegel
• Rennie
• Woodward Gripe Water
• Bismuth
• Sucralfate.

The following are typical conditions for which antacids are taken:

• Heartburn
• Indigestion
• Bloating

Antacids only provides symptomatic relief. They should be used on a very short term basis. If your symptoms persists for more than 3 days, seek medical advice for a more definitive approach to what is causing your abdominal pain or discomfort. 

Side effects of antacids include:

• They could cause diarrhea (the magnesium containing ones) or
• Constipation
• Interact with other drugs if taken at the same time, reducing the absorption of such drugs. Do not take an antacid same time as your iron tablet, tetracycline and some other medicines - if you are taking any medication and need to take an antacid as well, as your pharmacist if there is the potential for interaction.

H2-Blockers

H2-blockers and antacids were the mainstay for the treatment of peptic ulcers and  GERD before the arrival of medications we call PPIs - proton pump inhibitors. 

H2-blockers are still used today, but to a lesser degree. 

They are a group of medications that help reduce the production of acid by our stomach. They do so by antagonizing the type 2 histamine receptors in the stomach. 

They are relative safe to take with very few side effects. They can be obtained over the counter. 

Examples of H2-Receptor antagonists or H2-blockers are:

• Ranitidine
• Cimetidine
• Nizatidine
• Famotidine

H2-blockers are used in the treatment of the following conditions:

• Gastroesophageal reflux disease (GERD)
• Peptic ulcer diseases (stomach and duodenal ulcers)
• Non-ulcer dyspepsia
• Stress gastritis
• Zollinger–Ellison syndrome.
  

Common Side Effects of H2-Blockers include:

• H2-blockers, as mentioned are an extremely safe medication as a group. 
• It is reported that less than 3 % of users will notice any side effect
• The most common side effects with this group of stomach pain medicines are things like nausea, headache, fatigue, muscle pain and constipation
• Cimetidine specifically, can cause breast tissue enlargement (gynecomastia) in men as well as milk production and discharge in men and non-nursing women.

Proton Pump Inhibitors

Proton pump inhibitors (PPI or PPIs) displaced antacids and H2-blockers like Zantac and Tagamet since they were introduced to the market in the late 1980s to early 1990s. 

They are one of the most prescribed groups of medicines worldwide.

They reduce acid production in the stomach by deactivating the enzyme that helps in acid production. 

They are very effective for the treatment of peptic ulcers and a number of other conditions. 

Examples of PPIs include:

• Omeprazole (Prilosec, Losec, Miracid, Zegerid)
• Pantoprazole (Protonix, Pantoloc, Tecta)
• Rabeprazole (Patriet, AcipHex)
• Esomeprazole (Nexium)
• Lansoprazole (Prevacid)
• Dexlansoprazole (Dexilant)

The following are abdominal pain causes for which PPIs are prescribed:

• GERD
• Peptic ulcers
• Barrett Esophagus (to prevent cancer of the esophagus)
• Treatment of Helicobacter pylori infection
• In combination with NSAIDs to prevent NSAID induced stomach bleeds
• Zollinger–Ellison syndrome (ZES)
  
• Alcoholic Gastritis
• Stress Gastritis
• As a protection for the stomach if you are on long term steroids or certain medications given after a heart attack like ticagrelor or clopidogrel to reduce the risk of stomach bleed.

Side Effects of PPIs

PPI are generally safe when taken for short periods of time. The manufacturers advise that they should not be taken for more than 12 weeks. In many situations, you may need to use them for several more months or perhaps years. In such situations, be aware that long term use may come with a big price - such as :

• The risk of developing severe deep tissue or blood infections (because the acid our stomach produces suppose to help kill off bugs that causes such infections. With long term use of PPIs, you lose such protection)
• Poor absorption of nutrients
• Osteoporosis
• Pneumonia
• Memory problems.

If you take PPIs for heartburn, speak with your doctor to draw up a plan to help you identify the cause of your symptoms and deal with the cause (like losing weight, or cutting back on coffee and fruit juice or acidic drinks, or having smaller regular meals). You may then be able to get off your proton pump inhibitor and avoid these potentially serious side effects. 

Wind Medication

Trapped wind or bowel gas is a condition that causes abdominal pain for many people. 

It is usually due to excessive air swallowing or excessive production of intestinal gas. This leads to bloating and belching and flatulence. 

There are specific intestinal gas or wind medications. They act by displacing air from the gut contents and this bubbles out and are expediently released. 

Examples of wind medications include:

• Simethicone (Gas X, Gas Aide, Bicarsim, Little Tummys)
• Peppermint oil
• Antacids.

As a group, they are used in the treatment of:

• Indigestion
• Bloating
• Irritable bowel syndrome.

Side effects of wind medications depend on the type. Commonly, they cause:

• Constipation
• Heartburn
• Nausea.

Constipation Medicine

Constipation is a big and common cause of abdominal pain across all age groups, but commonly in children and in the elderly. 

Medications used to treat abdominal pain from constipation includes:

• Lactulose (Duphalac, Enulose)
• polyethylene glycol 3350 (Macrogol, Lax-a-day, Miralax, Gavilax)
• Psyllium (Metamucil, Hydrocil, Cilium)
• Methylcellulose (Citrucel)
• Polycarbophil (Fibre Lax)
• Docusate sodium
• Bisacodyl
• Senna
• Prucalopride
• Tegaserod
• Cisapride
• Lubiprostone
• Elobixibat
• Mizagliflozin
• Naronapride
• Plecanatide
• Tenapanor 
• Velusetrag
  
• Alvimopan
• Methylnaltrexone
• Linaclotide (Constella).

In chronic constipation, the diphenylmethane laxatives (bisacodyl and sodium picosulfate) taken at 10 mg tablets once daily was recently shown to be superior at 4 weeks to treat constipation, followed by Prucalopride 2 to 4 mg daily at 12 weeks than all other constipation meds.

These different medications span a large subgroup of medications generally referred to as laxatives. Each of these would have different side effects.

Generally, side effects of anti-constipation medications would include:

• Diarrhea
• Nausea
• Electrolyte imbalance.

Antibiotics

Anthelmintics

Antidiarrheal Medications

Biologics

Antidepressants

Neuromodulators

Medicines for Inflammatory Bowel Diseases

Medicines For Endometriosis

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