Pdawg
01-06-2006, 02:18 PM
I was wondering......
My PM doc just switched me to Tylenol 4. I never knew there was such a thing. I knew about 3.
But anyway.....I was taking Norco 10/325 x6/day and was feeling tolerant and advised my doc. He switched me to T4. Can anyone tell me is this going to be a comparable med to the Norco? He has me on 6 per day. Anyone have any wierd side effects or anything.
Just wondering
thanks in advance
pd
My PM doc just switched me to Tylenol 4. I never knew there was such a thing. I knew about 3.
But anyway.....I was taking Norco 10/325 x6/day and was feeling tolerant and advised my doc. He switched me to T4. Can anyone tell me is this going to be a comparable med to the Norco? He has me on 6 per day. Anyone have any wierd side effects or anything.
Just wondering
thanks in advance
pd
Sponsor
catnap
01-06-2006, 04:44 PM
I believe tylenol 4 is 60 mgs. codeine and 325 acetanimophen. Codeine is hard on the stomach. Metabolized in the liver to morphine.
Director
01-06-2006, 05:42 PM
Pdawg: Catnap is right. Tylenol #4 has 60 mg of codeine and 300 of Acetaminophen in it. They actually make it as Tylenol #1, 2, 3, and 4. In Canada you can buy Tylenol #1 over the counter. I believe it has 8 mg of codeine. In the US the most prescribed is Tylenol #3, that's why you hadn't heard of T-4.
To answer your question, I believe it's a step backwards, going from Norco 10/325. Now if you were taking Hydrocodone 5/325, it would be fairly close, but you were taking 10 mg of Hydro, which is quite a bit more potent than the codeine.
If anyone knows differently, please let us know.
To answer your question, I believe it's a step backwards, going from Norco 10/325. Now if you were taking Hydrocodone 5/325, it would be fairly close, but you were taking 10 mg of Hydro, which is quite a bit more potent than the codeine.
If anyone knows differently, please let us know.
Pdawg
01-06-2006, 07:26 PM
Thanks you guys
I talked with my PM doc about maybe me becoming tolerant to the Norco because I have been feeling more pain than normal. He said he wanted to stay away from the Schedule 2's because I am so young. I am 34 and dont feel that young LOL. I have have a herniated disc that is hitting a nerve and have sciatica lower back pain and spasms etc etc etc. No history of Narcotic abuse or anything like that.
My appt was at 9 this morning and around 10 I took my first Tylenol 4. At 2pm I took another and now it is 3:30. No relief, Its actually worse now than it was yesterday with the Norco. I am completely out of my Norco and want to kick myself for asking for a change. Anyway Thanks for the info, Maybe this stuff will just kick in or something later tonight.
:confused:
I talked with my PM doc about maybe me becoming tolerant to the Norco because I have been feeling more pain than normal. He said he wanted to stay away from the Schedule 2's because I am so young. I am 34 and dont feel that young LOL. I have have a herniated disc that is hitting a nerve and have sciatica lower back pain and spasms etc etc etc. No history of Narcotic abuse or anything like that.
My appt was at 9 this morning and around 10 I took my first Tylenol 4. At 2pm I took another and now it is 3:30. No relief, Its actually worse now than it was yesterday with the Norco. I am completely out of my Norco and want to kick myself for asking for a change. Anyway Thanks for the info, Maybe this stuff will just kick in or something later tonight.
:confused:
catnap
01-06-2006, 10:08 PM
10 to 15 mg of hydrocodone or oxycodone
2 to 4 mg of hydromorphone
30 to 60 mg of codeine
15 to 30 mg of morphine
These starting doses are equal to each other. As you can see it takes more codeine than hydrocodone to have the same effect. So it looks like he gave you a little more when he changed you to the tylenol #4.
2 to 4 mg of hydromorphone
30 to 60 mg of codeine
15 to 30 mg of morphine
These starting doses are equal to each other. As you can see it takes more codeine than hydrocodone to have the same effect. So it looks like he gave you a little more when he changed you to the tylenol #4.
Pdawg
01-08-2006, 03:47 AM
Thanks Catnap.
Im just miffed why I am not getting at least close to the same relief from the tylenol 4 at 6/day as I was from the Norco 10/325 at 6 per day.
I think my pain level has increased as well as my tolerance to these pain killers. I dont expect to be pain free, but I do expect that a Pain Managment doc will at least make me semi comfortable when I tell him I am starting to become in agony.
He did state that I am young and he is worried of starting me on Schedule 2 drugs because I will build tolerance then there will be no pain killers left to treat any pain in the future. At this point I am thinking, lets treat todays pain today and worry about future pain later on. This thinking of mine all stems to this question. Does once someone build tolerance to a Med will that make them tolerant for life, even after discontinuing medication therapy? like years later?
My hopes and dreams are to move on with my life get surgical intervention and just move on from this. I have basically been on the couch for six months with this disc herniation. It sucks. Just cut me open. Workers comp i guess is why everything takes so long.........
Thanks for listening to my ramblings.
Like I said before, I know there are alot of you out there with way more pain than me. Hopefully you all are getting the care you deserve.
Pd :confused: :confused:
Im just miffed why I am not getting at least close to the same relief from the tylenol 4 at 6/day as I was from the Norco 10/325 at 6 per day.
I think my pain level has increased as well as my tolerance to these pain killers. I dont expect to be pain free, but I do expect that a Pain Managment doc will at least make me semi comfortable when I tell him I am starting to become in agony.
He did state that I am young and he is worried of starting me on Schedule 2 drugs because I will build tolerance then there will be no pain killers left to treat any pain in the future. At this point I am thinking, lets treat todays pain today and worry about future pain later on. This thinking of mine all stems to this question. Does once someone build tolerance to a Med will that make them tolerant for life, even after discontinuing medication therapy? like years later?
My hopes and dreams are to move on with my life get surgical intervention and just move on from this. I have basically been on the couch for six months with this disc herniation. It sucks. Just cut me open. Workers comp i guess is why everything takes so long.........
Thanks for listening to my ramblings.
Like I said before, I know there are alot of you out there with way more pain than me. Hopefully you all are getting the care you deserve.
Pd :confused: :confused:
catnap
01-08-2006, 11:50 AM
pdawg,
I found some more info about codeine you might be interested in. I only remembered part of what I had read about it.
Codeine is both a direct analgesic, weakly binding mu receptors, and a prodrug. It is converted into morphine in the liver. Patients deficient in a converting enzyme, CYP2D6 (10% of the population) or those taking inhibitors of this enzyme, (examples are quinidine, cimetidine and fluoxetine), may not achieve analgesia because of an inability to convert codeine to morphine.
Could be you are in that 10% population or taking one of the drugs that interfers with the codeine.
Does that help?
Carol
I found some more info about codeine you might be interested in. I only remembered part of what I had read about it.
Codeine is both a direct analgesic, weakly binding mu receptors, and a prodrug. It is converted into morphine in the liver. Patients deficient in a converting enzyme, CYP2D6 (10% of the population) or those taking inhibitors of this enzyme, (examples are quinidine, cimetidine and fluoxetine), may not achieve analgesia because of an inability to convert codeine to morphine.
Could be you are in that 10% population or taking one of the drugs that interfers with the codeine.
Does that help?
Carol
Shoreline
01-08-2006, 03:02 PM
Hey dawg, I made some corrections to the numbers on codiene, It was supposed to be 400 mgs a day is the max dose, not 40.But very few pure opiates have ceilings when you factor tolewrance into the picture. Other than codeine and demerol, there is no real ceilng on morpihine, Oxycodone, fentanyl or methadone. The side effects usually prevent increasing a dose before a problem like respirtory suppreson is reached.
Codeine and demi can cause seizures after prolonged use and that's why they aren't widely used in treating CP. Canada does have Codeine Contin, but the limt in dosing is clearly spelled out.
Codeine is roughly 1/10th the strength of morphine, less euphoric than hydro or morphine because it produces little Kappa receptor activity and at best your getting something half the strength of the 10 mg norco, and that's being really generous. It sounds more like you on a taper. Is this post op pain or chronic?
There was a thread last week or two weeks ago about CP in young people. You might want t bring it back to life. It seems we have lots of young folks being told the same line.
If you stop for years you tolerance will reset and you could have surgery and the norco will work fine for post op pain. There are some docs that believe n medication holidays, meaning discontinue the norco for a month or two and use T4's and then when he switches you back to Norco in 2 months it will work better. Unfortuantely that only works for a couple months before your right back to the same level of tolerance. IMO. I'm not sure the two improved months when it's reintruduced is worth the 2 bad months when you went without or with squat. But every PM doc has their own POV and physlophy about using opiates, BT meds, dosing, his own comfort level and understanding of tolerance, dependnece and the value of opiates.
Good luck, Dave
Codeine and demi can cause seizures after prolonged use and that's why they aren't widely used in treating CP. Canada does have Codeine Contin, but the limt in dosing is clearly spelled out.
Codeine is roughly 1/10th the strength of morphine, less euphoric than hydro or morphine because it produces little Kappa receptor activity and at best your getting something half the strength of the 10 mg norco, and that's being really generous. It sounds more like you on a taper. Is this post op pain or chronic?
There was a thread last week or two weeks ago about CP in young people. You might want t bring it back to life. It seems we have lots of young folks being told the same line.
If you stop for years you tolerance will reset and you could have surgery and the norco will work fine for post op pain. There are some docs that believe n medication holidays, meaning discontinue the norco for a month or two and use T4's and then when he switches you back to Norco in 2 months it will work better. Unfortuantely that only works for a couple months before your right back to the same level of tolerance. IMO. I'm not sure the two improved months when it's reintruduced is worth the 2 bad months when you went without or with squat. But every PM doc has their own POV and physlophy about using opiates, BT meds, dosing, his own comfort level and understanding of tolerance, dependnece and the value of opiates.
Good luck, Dave
Pdawg
01-08-2006, 04:48 PM
Hi again. Thanks you two
Catnap: I am taking Paroxetine(paxil) I wonder if that has that same inhibitor as the Fluoxetine (Prozac). I know that those SSRI's are fairly close in make up. hmmmm got me wondering.
Shoreline: My pain started about 7 months ago (herniated disc) and have been on hydrocodne 5/500 7.5/500 and then the Norco 10/325 (The Norco seemed to help me the best and for the longest). I went in on friday to the PM doc because of the increase in Pain. I asked him if maybe I was becoming tolerant then the next thing I knew he gave me a script for Tylenol 4. I have had two epidurals with no pain relief and I am thinking surgery is my best option.
So basically he prescribed me less? Im fired up.
Thank you both. You are awesome.
Catnap: I am taking Paroxetine(paxil) I wonder if that has that same inhibitor as the Fluoxetine (Prozac). I know that those SSRI's are fairly close in make up. hmmmm got me wondering.
Shoreline: My pain started about 7 months ago (herniated disc) and have been on hydrocodne 5/500 7.5/500 and then the Norco 10/325 (The Norco seemed to help me the best and for the longest). I went in on friday to the PM doc because of the increase in Pain. I asked him if maybe I was becoming tolerant then the next thing I knew he gave me a script for Tylenol 4. I have had two epidurals with no pain relief and I am thinking surgery is my best option.
So basically he prescribed me less? Im fired up.
Thank you both. You are awesome.
Pdawg
01-08-2006, 05:14 PM
I just called a Pharmacist at the local drug store and he confirmed to me that the T4 is less potent than the Norco. He seemed a bit leary to answer my question. He must of thought I was some Junkie with two pills in my hand and was calling him to figure out which one to take. LOL
catnap
01-08-2006, 05:36 PM
10 to 15 mg of hydrocodone or oxycodone
30 to 60 mg of codeine
These starting doses are equal to each other. As you can see it takes more codeine than hydrocodone to have the same effect. So it looks like he gave you a little more when he changed you to the tylenol #4.
If you go by what the chart says 15 mg. hydrocodone is equal to 60 mgs. codeine and you were getting 10 mgs. hydrocodone and now getting 60 mgs. codeine, then it appears to be slightly higher. The other changed was 325 mgs. acetimenophen decreasing to 300 mgs. so that making the tylenol #4 less potent. My mistake, sorry. I was just looking at the opiate number.
I haven't read anything on paxil in a long time. It might be a factor to consider. Docs are pretty good about looking at all of your meds and knowing about reactions, but once it was overlooked that I was taking tagament which had an impact of one of my pain meds.
Sorry bout that mistake,
Carol :confused:
30 to 60 mg of codeine
These starting doses are equal to each other. As you can see it takes more codeine than hydrocodone to have the same effect. So it looks like he gave you a little more when he changed you to the tylenol #4.
If you go by what the chart says 15 mg. hydrocodone is equal to 60 mgs. codeine and you were getting 10 mgs. hydrocodone and now getting 60 mgs. codeine, then it appears to be slightly higher. The other changed was 325 mgs. acetimenophen decreasing to 300 mgs. so that making the tylenol #4 less potent. My mistake, sorry. I was just looking at the opiate number.
I haven't read anything on paxil in a long time. It might be a factor to consider. Docs are pretty good about looking at all of your meds and knowing about reactions, but once it was overlooked that I was taking tagament which had an impact of one of my pain meds.
Sorry bout that mistake,
Carol :confused:
Director
01-08-2006, 05:36 PM
Pdawg: I think what you really need to do is somehow convince your doc to prescribe a Schedule II for you. There are a lot of them and you really don't have to worry about prescribing them at your age. There's no ceiling (as Shore pointed out) to them, so there's always plenty of room to go up, if need be.
I would suggest, at the very least, he try you on Oxycodone. Maybe Percoset or just plain Oxy. That would be the next logical step in pain relief.
I would suggest, at the very least, he try you on Oxycodone. Maybe Percoset or just plain Oxy. That would be the next logical step in pain relief.
Pdawg
01-08-2006, 06:08 PM
No worries Catnap :) I am just thankful for your and everyones help.
Director: I guess I am just going to have to ask for a sched 2. I think I am in enough pain for it. I am in the most pain that I have ever been in my life. I think that warrants it. I guess for me, is the part of asking him directly for a med by name. I worked as a Firefighter Paramedic . The local Junkies knew we carried Morphine Sulphate and Valium so whenever we would get a call out to one of these guys and they asked for MS or Valium by name we would question it. So I have seen alot of drug abuse and hoped I would never need to use opiates due to the fact i have seen first hand how bad some people get.( Im just a big chicken i guess) But I am dependant on them now for pain control so I might as well get some more for pain relief before I go nuts over here.
Well, there is my life story.
Thanks again everyone!
Director: I guess I am just going to have to ask for a sched 2. I think I am in enough pain for it. I am in the most pain that I have ever been in my life. I think that warrants it. I guess for me, is the part of asking him directly for a med by name. I worked as a Firefighter Paramedic . The local Junkies knew we carried Morphine Sulphate and Valium so whenever we would get a call out to one of these guys and they asked for MS or Valium by name we would question it. So I have seen alot of drug abuse and hoped I would never need to use opiates due to the fact i have seen first hand how bad some people get.( Im just a big chicken i guess) But I am dependant on them now for pain control so I might as well get some more for pain relief before I go nuts over here.
Well, there is my life story.
Thanks again everyone!
Chaswick
01-08-2006, 06:52 PM
I'd question whether the 25mgs. of acet. makes any difference at all.
According to the convertor that I think you showed me Dave, 10mg. of hydrocodone is equal to 66.67mg of codeine. Looking at it that way it would seem they were close to the smae??
I guess they hit different receptors. II know in Canada, Tylenol 4 is considered a big time med. and rqrs. the same Rx pads as morphine.
Rds/Chas
According to the convertor that I think you showed me Dave, 10mg. of hydrocodone is equal to 66.67mg of codeine. Looking at it that way it would seem they were close to the smae??
I guess they hit different receptors. II know in Canada, Tylenol 4 is considered a big time med. and rqrs. the same Rx pads as morphine.
Rds/Chas
catnap
01-08-2006, 08:04 PM
Yes it's very close. I just don't believe you could possibly tell the difference they are so close and I agree about the tylenol difference.
Anyway, Pdawg when asked for something else and told the doc the drug was not helping much he shouldn't have given you a sidestep. Maybe he thought the codeine would work better. Hydrocodone has alway worked better for me and I have taken tons of codeine and hydrocodone. Codeine mostly when I was a kid for bad earaches. It hardly even touch the pain. But better than nothing.
I would tell the doc the hydrocodone worked better. It won't hurt to ask for something stronger. After all you have the proof of pain in the test results.
Anyway, Pdawg when asked for something else and told the doc the drug was not helping much he shouldn't have given you a sidestep. Maybe he thought the codeine would work better. Hydrocodone has alway worked better for me and I have taken tons of codeine and hydrocodone. Codeine mostly when I was a kid for bad earaches. It hardly even touch the pain. But better than nothing.
I would tell the doc the hydrocodone worked better. It won't hurt to ask for something stronger. After all you have the proof of pain in the test results.
Chaswick
01-08-2006, 08:23 PM
Funny, I've taken pretty much everything at one time or another (30 years plus of battling pain) but never ever been Rx'd Hydrocodone. I don't even know if it is on the market here in Canada. It's not like our Dr.'s are afraid of meds..
Iknow in this day and age with so much information out there esp. on the internet it is easy and makes sense to go to the Dr. and have your own knowledge base and request what you think might work.
I wonder if, in the long run, that is the best way. Or is it better to just report to your Dr. the pain relief you are getting and let him decide how to proceed.
My pain was controlled OK up until about seven yrs. ago when it went totally out of control for no reason. Two years of hell and trying different medications. I'd stay away as much as I could but every month or so I'd have to go to the Dr. for injections.
After we had tried pretty much everything, I was astonished when the Dr. said he was going to Rx morphine IM for home use. For a while I really didn't know if I thought that was a good thing. It took a while to get used to it but it has allowed me to get back to work full time and even have somewhat of a social life.
I wasn't given many guidelines to use at the start so figuring out how much to take was trial and error. And there were months that I took more than I was comfortable with. But we have kept track and the last 8 months I am taking a fair amount less than the same period the last 3 years. So that is a good thing.
Whatever you and your Dr. decide I hope you have success with it. It isn't a good life being in pain all the time.
Chas.
Iknow in this day and age with so much information out there esp. on the internet it is easy and makes sense to go to the Dr. and have your own knowledge base and request what you think might work.
I wonder if, in the long run, that is the best way. Or is it better to just report to your Dr. the pain relief you are getting and let him decide how to proceed.
My pain was controlled OK up until about seven yrs. ago when it went totally out of control for no reason. Two years of hell and trying different medications. I'd stay away as much as I could but every month or so I'd have to go to the Dr. for injections.
After we had tried pretty much everything, I was astonished when the Dr. said he was going to Rx morphine IM for home use. For a while I really didn't know if I thought that was a good thing. It took a while to get used to it but it has allowed me to get back to work full time and even have somewhat of a social life.
I wasn't given many guidelines to use at the start so figuring out how much to take was trial and error. And there were months that I took more than I was comfortable with. But we have kept track and the last 8 months I am taking a fair amount less than the same period the last 3 years. So that is a good thing.
Whatever you and your Dr. decide I hope you have success with it. It isn't a good life being in pain all the time.
Chas.
Pdawg
01-08-2006, 10:54 PM
Catnap, I will do just that. I am going to call him tomorrow and just tell him exactly how I feel and that my pain and quality of life sucks. I have learned so much about all this stuff lately. I have to thank you and Director and Shoreline and everyone else for the info. I will for sure keep you updated on what happens once I finally get a hold of the doc.
Pdawg
01-08-2006, 10:58 PM
WOW Chaswick
30 years of pain. I dont know how you tolerated that !!! Im glad you have a handle on it now with the MS.
and here I am cryin over 7 months of pain. I will be quiet now. :cool:
30 years of pain. I dont know how you tolerated that !!! Im glad you have a handle on it now with the MS.
and here I am cryin over 7 months of pain. I will be quiet now. :cool:
Pdawg
01-12-2006, 02:03 PM
Called the doc on Monday with no call back. My Pain level is about an 8. Called on tuesday morning with still no call back. I didnt call yesterday beacause I was starting to feel better. This morning I woke up and the pain is back to an 8 and I have been vomiting and have had leg twitches and am sweating. Is this withdrawl? I have called the office again and left another voicemail. How long do I have to wait for at least a call back? Is this normal to not get a call back in 4 days? I have never called the office and bugged them about anything before so its not like the doc is saying oh its this guy calling again.
The switch from Norco to tylenol 4 for me has been horrible.
What can I do to feel better in the mean time?
anyone?
The switch from Norco to tylenol 4 for me has been horrible.
What can I do to feel better in the mean time?
anyone?
FairyMagick
01-12-2006, 07:58 PM
Hi
That is not acceptable that they didn't call you back. Would you be able to speak to the Nurse when you call? They should have called you back the day you called. If they don't call you back another day, you should complain to your insurance or doctors office. If you are having withdrawals I imagine that can be dangerous? Shoreline would know more about that. I'm sorry to hear your suffering.
Do you take Ibuprofen 800 with your t4's? Sometimes that can help. I take hot showers or a bath when my pain is really bad, It doesn't take the pain away but it helps.
That is not acceptable that they didn't call you back. Would you be able to speak to the Nurse when you call? They should have called you back the day you called. If they don't call you back another day, you should complain to your insurance or doctors office. If you are having withdrawals I imagine that can be dangerous? Shoreline would know more about that. I'm sorry to hear your suffering.
Do you take Ibuprofen 800 with your t4's? Sometimes that can help. I take hot showers or a bath when my pain is really bad, It doesn't take the pain away but it helps.
catnap
01-12-2006, 08:44 PM
I wouldn't think what you are experiencing is withdrawal. More than likely you are experiencing bad side effects from the codeine. The sweating and vomiting are some of the se. Have you taken your temperature to see if maybe this could be a virus?
Usually withdrawal occurs from a major decrease in the opiate or opioid. If you are vomiting to the point of not being able to keep your meds down you will begin to experience withdrawal. Then you need to go to the hospital. It will begin like a severe case of the flu. You will feel like climbing the walls, anxious, not able to keep still, pacing, severe stomach cramps, diarreah, vomiting, burning up and cold at the same time, sweaty or sweating. There is no other feeling like this.
If you begin these symptoms go to the hospital immediately. Going through withdrawal is not fatal but very uncomfortable and could last several days.
I have had problems like the doc's office not calling me back either. Just had that same problem this week. Really ticks me off.
I hope you start feeling better soon,
Carol
Usually withdrawal occurs from a major decrease in the opiate or opioid. If you are vomiting to the point of not being able to keep your meds down you will begin to experience withdrawal. Then you need to go to the hospital. It will begin like a severe case of the flu. You will feel like climbing the walls, anxious, not able to keep still, pacing, severe stomach cramps, diarreah, vomiting, burning up and cold at the same time, sweaty or sweating. There is no other feeling like this.
If you begin these symptoms go to the hospital immediately. Going through withdrawal is not fatal but very uncomfortable and could last several days.
I have had problems like the doc's office not calling me back either. Just had that same problem this week. Really ticks me off.
I hope you start feeling better soon,
Carol