They are dihydrocodeine (e.g. DF118®), tilidine (Valoron®) and tramadol (Tramal®). They are effective against moderate pain, and in adequate doses also against more severe pain. They can be taken orally, which is an advantage over the high efficacy opioids, which are most efficient if injected.
The side effects are as mentioned in the introduction on opioids.
Tramadol causes less sedation and respiratory depression. None of these agents should be taken together with other central nervous system depressants like sleeping tablets, sedatives, or even alcohol.
Don't ignore chest pain
Breast lumps & breast pain
Arthritis Foundation of South Africa
Multiple Sclerosis South Africa
The South African Society of Physiotherapy