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Posted 4/13/2011 3:04 AM (GMT 0)
I am new to this forum and I have a question about my pain medication. I have Crohn's Disease and Crohn's related arthritis. I am 40 years old and have had both of my hips replaced, a colon resection, and ankle surgery. I was on Remicade for many years but due to several factors my rheumy now has me on Cimiza and Lortabs to help the arthritis. My rheumy prescribes me Lortabs 7.5-500. His instructions are to take 2 every 6 hours as needed. Most days I take them as directed. But recently I had a friend to tell me that I am taking to many a day. If I don't take them as he recommends, I am miserable. If I do take them as he prescribes, I am able to function and I feel as if my quality of life has been restored. I hurt every single day. And I have for years. But now I am feeling guilty and second guessing my prescription. And input would be greatly appreciated :)
Posted 4/13/2011 4:16 AM (GMT 0)
Hi Harley....

Welcome to the board.... sorry you are dealing w/ pain issues and other health stuff.

Re: your medication question - my concern is not the amount of narcotics you are using, if that's what your doctor is prescribing.  It's the amount of acetaminophen and the effects on your liver that I would be more concerned about. 

I believe the max dose of acetaminophen per day is 4000mg.  So, by taking 2 lortab 7.5/500 every 6 hours - you are at the max dose per day.  (Am I doing the math right???  I'm sorry - I'm wiped out right now).  Personally, I would be concerned w/ using that much each day (acetaminophen).  Also, there are many other things that have acetaminophen in them - cold medicines; etc etc.

Have you considered seeing a pain management doctor?  One option is using a longer acting opiod that doesn't have acetaminophen in it.  There are many options; and then using the Lortab occasionally for breakthrough. 

Take care.... --Tina

 

Posted 4/13/2011 5:57 AM (GMT 0)
Hi Harley, and welcome to a wonderful place, though I'm sorry for the pain that has brought you here; no one likes to hurt.

I agree strongly with Tina, and I know that is one of the big reasons my Pain Management doctor pulled me off my Loritab and switched me to Percoset /without/ the acetaminophen. Long term acetaminophen use and damage it causes to the liver has been a big topic of late in alot of the medical journals, and unforunately it's far to easy to take to much of it. It's mainly used as an anti-inflamatory, so in my case with what I have it's kinda pointless. For anti-inflamatory control I use ice packs or Bio-freeze spray as the excessive heat during the summer months do cause great aggrivation to my condition, and as a result, swelling.

Is your friend a doctor? Perhaps they are concerned of the addictive nature of narcotics. I know my Pain Management doctor doesn't like to perscribe them, but he also understands that sometimes the pain one is in requires the "big guns". If you don't need the anti-inflamatory I'd talk to your doctor about your concerns for liver damage and see what other options you have. What about something like Celebrex or Lyrica? Also there are also extended release meds you could take, with something stronger strictly for break-through pain management.

Unless your friend is a doctor I would not second guess your perscribing doctor, especially since they do seem to help you. These are all questions to definately ask on your next visit; never be affraid to voice your concerns or questions.

I hope this has helped answer your question. If you have any others don't be affraid to ask those of us here, and certainly talk to your doctor about your concerns as well.

Posted 4/13/2011 11:59 AM (GMT 0)
Tylenol (acetominphen) is NOT an anti inflamitory-nor is it used as such.
It is simply a pain medication-it is sometimes added to narcotics formulas to prevent over use.

I do agree though that the tylenol is what you should be concerned about talk to your doctor about switching to something less liver toxic.
Posted 4/13/2011 1:27 PM (GMT 0)
 

 Sjkly, is correct, and I wanted to point out that Percocet does have the acetominphen in it. Could you have possibly meant Oxycodone IR instead? Or Oxycontin? ER

   Also the law has changed or the FDA rulling is, that the Percocet will no longer come in a 500 strength but will now be 325. Example;7.5 325 and so on. Not 7.5 500's

 Almost forgot!  "Welcome Harley" it's one of my favorite names! smilewinkgrin   

       

       SE wink

Posted 4/13/2011 2:17 PM (GMT 0)
My apologies, and thank you for the correction both Screaming Eagle, and esspecially Sjkly for catching my mistake. I was always led to beleve that's what that was for in conjunction with the pain relief of the Loritab when I was still on that perscription. After taking a brief jaunt over to WebMD I am obviously thinking Ibuprophen. Boy don't I feel like an idiot now. See, this is the sort of thing that makes me worry about constant chronic narcotic use. There was a time I never woulda made that mistake. I'm horribly sorry, Harley.

SE, the Percoset I take is Oxycodone. So no acetominphen.

Posted 4/13/2011 2:22 PM (GMT 0)
 

     Rhaevin, I have been on Percocets for several years, and I can tell you that Percocet has acetominphen in it for sure. Thus... the 7.5/325   so my question to you..... what does the /325 stand for if its not acetominphen? wink

      Look it up please. There is also Oxycodone in its pure form and is called just that...and is a IR .... Then There is Oxycontin and is an extended release form of Oxcodone.

   I'm guessing that your bottle is labled oxycodone and it is a generic form of Percocet. Trust me, if it is percocet is has acetominphen in it.

         It can be confusing and threw me for a loop for quite some time. If your bottle says Oxycodone and does not have the 325 or the 500 at the end of the numbers, then you are on pure Oxycodone, and is not considered Percocet. wink   

         Rhaevin to clarify, my Percocet bottle also says Oxycodone and is 7.5/325 it is still Percocet even though the bottle does not say this. If your bottle says Oxycodone and does not have the /325 or /500 number behind it, then it is Oxycodone in it's pure form and NOT Percocet.

     Oh lord! if....I'm wrong here....that CROW is going to taste awful! shakehead   

 SE wink

Posted 4/13/2011 4:20 PM (GMT 0)
Hi all,

To clarify - yes, percocet DOES indeed have acetaminophen in it.  Often it will say "oxycodone" (because that's the narcotic) - but IF it's percocet - it does have acetaminophen in it.  Whatever # is to the right of the "slash" (like 5/350) is the amount of acet. in it.

There is definitely instant-release oxycodone (called oxycodone IR) - w/ no acetaminophen in it.  But this is not percocet - thought it contains the same opiod as percocet.

Point of all of this is - acetaminophen makes me really nervous re: liver damage.  I think Harley would be smart to ask for something (like the oxycodone IR or whatever) that could be used w/out all that acet. in it.  Harley, I hope you can get into a PM doc and figure a better approach to handling your pain.

Take care all -Tina

Posted 4/13/2011 5:03 PM (GMT 0)
Hi Harley and welcome to the chronic pain forum. I have nothing to add, I see the others have covered the percocet situation well enough. I have crohns & UC so I know what you are talking about along those lines. Its even worse because with the IBD you cannot have any type of anti-inflammatory because of this. I have heard some folks with crohns were able to tolerate Celebrex and I do know that it is back on the market. You may want to talk about this with your rheummy, as this is the only anti-inflamm that I am aware we can possibly take.

I too was on Remicade infusions for 3 1/2 yrs until I developed antibodies to it and Lupus. I did the infusions every 4 weeks as this was what worked the best when it worked. I am on Humira shots now and wish I had been on them a long time ago. How do you like Cimzia and does it work well for you? By chance did high doses of steroids cause your hip problems?

Anyway, I just wanted to pop on tell you welcome aboard.
Posted 4/14/2011 2:53 AM (GMT 0)
A huge thanks to all of you that responded. smilewinkgrin Momto8kids, no one has ever mentioned a PM doctor to me. I'm not really sure that I know what one is. My doctor keeps a check on my liver enzymes each month due to the use of Lortab and Methotrexate. So far all of my blood work has been fine. Rhaevin, I was on lyrica briefly and I felt "drunk" everyday....and the nice state troopers here in South Carolina frown upon DUI I quit taking it. smilewinkgrin Screaming Eagle....Harley is one of my favs also....before my husband passed away we had a HD Dynawide glide :) Straydog, I was on Humira for a few weeks. My body rejected it and I had reactions each time I had an injection. So far the Cimzia seems to be ok.....no bad side effects....I would like to try Remicade again but even with my insurance it will cost me about $600.00 per infusion. For now I will stay on the Cimzia. High doses of steroids were a God send at the time. But the long term effects have been rough. Yes my hip problems were most likely caused from long term steroid use. My teeth and bones both became brittle. I have had extensive dental work. I gain so much weight. I still have the round face and fluffy belly.....neither seem to be going anywhere :) I refuse to take any more prednisone and so far my doctors have respected this. Sjkly, you bring up a good point. My doctor and I do need to discuss less liver damaging meds. Again, I want to thank all of you for responding and for making this site so welcoming!!
Posted 4/14/2011 5:38 AM (GMT 0)
Harley, it's good to hear from you! I'm sorry the Lyrica didn't work for you. Hopefully you've got some good ideas to talk to your doctor about.

Screaming Eagle, see, this is where I get confused. The doctor says "I'm going to put you on percocet", but the bottle says Oxycodone, and no, there is no addition after my 15mg. So yes, pure Oxycodone I would imagine then since it's not got the other non-narcotic in there. So why then does my PM call it percocet??

Posted 4/14/2011 2:39 PM (GMT 0)
 

    Hello Harley!

         Well my username comes from the Harley I have sitting in my garage! shakehead

              I have not been on that bad boy in over 18mo! Its a 2008 Screaming Eagle Road King, and I loved ridding it. Right now, I'm thinking about hopping on it to see if my back can handle it.

     I hope all the information helped you here, and please do stay active with us if you can. We always enjoy and welcome new members.

       Rhaevin, I don't have an answer for you about you're PM, but look the information up here on the web, and check for yourself. Then the next time you can ask you're PM about it. There are plenty of medical sites that will help you understand the difference. If your on the 15mg then I will assume you're on the Oxycodone IR type and it is not called Percocet.

       I have nothing more to add, other than to advise you to do the web search on it.

           Hope you have a nice day.

   SE wink

        

Posted 4/14/2011 3:20 PM (GMT 0)
hey harley, you have some good advice here and they have said it all. just to let you know the hydrocodone/APAP 10/325 brand name is Norco with lots of generic options; Watson Pharma. holds the trade name on Norco but the same company has a generic and all i can tell different is the price. Endo Pharma. has a 10/400 they call Zydone. the 24hr. max on APAP is 4grams but if it is used chronically it is 2400mg/2.4grams and if you add meds that strain the liver it is lower ex: Cymbalta. Alcohol is something to watch with APAP also. one of the metabolites of hydrocodone is hydromorphone (Dilaudid), 15mg may be equivalant to 4-6mg and no APAP. the dilaudid may have a bit shorter active life.
Posted 4/15/2011 5:57 AM (GMT 0)
Lortab is still coming 5/500 or at minimum 500. the new law is not in effect yet. least not here in this state (MD).

even with 4000mg being the max in a 24hr period, how much do you want to push that limit? think about blowing out your liver or if you have crohn's and/or colitis tylonel is hell on your gut. And you know we will be dependent on it to function (get out bed) a a couple or a few days of the week for the rest of our entire lives since we have chronic illnesses

It can constipate you really badly. so it may make one feel better in the short (basically, lortab only works short-term anyway) but be mindful of how much you're popping in a 24hr period

Post Edited (archiestyles) : 4/15/2011 12:02:29 AM (GMT-6)

Posted 4/15/2011 7:12 AM (GMT 0)
Welcome Harley :)

Like the others have said, I'd definitely recommend a pain management doctor.

I can certainly confirm that there is oxycodone IR with nothing else added. I take Oxycontin (the extended release form of oxycodone), then use straight IR oxycodone as a top up when I get breakthrough pain. When I need to, I also use a product called Panadol Osteo. I don't know if you guys have it in the US - but it's an extended release form of paracetamol/acetominaphen. Still not something you would want to be taking long term, but it's supposedly safer. I think that the argument for including it with drugs like oxycodone (though we don't have have have the same combinations as you do - we have paracetamol/codeine, and I think that's about it), is probably for the opioid-sparing effects, maybe also for a synergistic effect. Paracetamol for me is as much use as *** on a bull, but if I take it with my oxycodone for breakthrough, I get better pain relief than taking the oxy on its own. With apologies for that little digression...
Posted 4/15/2011 2:08 PM (GMT 0)
I am so thankful for all of your responses. I have researched some of the other pain meds that you have discussed. After a quick call to my doctor he called in my refill for lortabs 7.5 mg. But I am decreasing by 2 a day. So, that's a start until I can get more information about a pain management doctor. Again thanks so much this forum is wonderful :)
Posted 4/15/2011 7:13 PM (GMT 0)
Harley, I would like to point out to you that there are two types of pain mgt drs too. One will do nothing but injections & procedures and will not write scripts. The other will do the same but will write scripts if he/she feels they are deemed necessary. Once you have an appt scheduled, I suggest calling that office and ask the receptionist if this dr also writes scripts for meds if he feels they are necessary. Tell her you know some PM drs only does injections & procedures. You will not look like a drug seeker by asking that question either. We have had some members in the past get sent to the ones that do not script meds and it was a wasted appt and time.

I hope you can find a good PM dr soon. Take care.
Posted 4/16/2011 7:19 PM (GMT 0)
if you can ask your doctor to actually refer you himself to a clinic or doctor that has a multi-disciplinary approach but understands your on meds already and normal measures are no longer controlling your pain. by your doctor getting involved it gives you a "advocate" right from the start and creditbility. i sucks to be forced to jump through so many hoops to get pain managment but an epidemic exsist in appalachiaSP? an florida and all over with "pill mills". i did not believe just how bad they are but more pain pills are on the street corner than cocaine, meth, or heroin but it has made a huge comeback for people who run out of pain pills and are starting to get the heebee geebeees.
Posted 4/17/2011 11:10 AM (GMT 0)
Thanks for the post here, It was pretty useful for me.
Posted 4/17/2011 11:24 AM (GMT 0)
Good morning Anne!

Hey we like to welcome all new members!

We feel we can do that best if you will start a new topic and introduce yourself. Just click the new topic tab at the top of the page, and tell the members a little about yourself.

SE wink
Posted 4/17/2011 4:45 PM (GMT 0)
Hello, Anne. I agree completely. These posts have all been very informative. I am also new to the Chronic Pain Forum. There is so much information on this site. And just being able to read the posts gives me a glimpse of what others are coping with every day. I am so glad that I found this site :)
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