LouiseM
10-26-2003, 05:54 PM
I just wanted to know from the lowest to the highest strength on pain killers? I am just clueless on it all?
Thanks a lot guys!!
Hope all is having a pain free day!
Thanks a lot guys!!
Hope all is having a pain free day!
Sponsor
igy76
10-26-2003, 06:30 PM
LOUISE,
Well one thing to keep in mind is that there's still not an EXACT science as to what will truly be stronger, as everyone reacts differently to every pill.
But I think probably a safe, general rule of thumb would be that things like Ultracet/Ultram and Darvocet (propoxyphene is the generic) are the weakest prescription relievers you can get, while still being technically Schedule III narcotics. The next step up would be hydrocodone, which comes in many brand names like Vicodin, Lortab, Lorcet, Norco, etc. And it all comes in varying strengths. The weakest hydrocodone pill you can get is 5/325 (5mg of hydro & 325 of tylenol - although now that I think about it, I'm not 100% sure hydro comes in that exact strength - otherwise the weakest combo would be 5/500. There are several differnt combo amts, 10/325, 7.5/750, 10/500, 10/650... you get the idea :)
The next level up would be oxycodone, which also comes in varying brand names (Percocet, Percodan, OxyIR, Roxicodone, etc). Oxy is a Sched. II drug (stuff that's Sched I is only like heroin, cocaine, etc). And just like with the hydro, oxycodone comes in all the same varying strength combos.
Keep in mind all the examples I just gave you are all SHORT ACTING MEDS. Currently, that I know of, hydrocodone comes in no LONG ACTING FORM. When you're RX'd a LA med, there's no tylenol, because it's with the understanding that you're going to be taking it for awhile. (believe it or not, most people in America who are given Vicodin, it's only for a week or so, so that amount of tylenol is negliable to them). Oxycodone DOES come in a LA form, that's what OxyContin is. You may hear a lot of people on here talking about taking OxyContin as their base med, as they use some form of Percocet or OxyIR as their "break through" med. These people are taking the same exact drug both times, they're just taking it in two different forms. (The Contin sustains an even level of the drug in your system during the day - well, supposedly ;) and the regular oxycodone product gives them an immediate boost for acute pain a few times a day.) There are other LA meds that don't contain oxycodone, but it's up for debate which ones are stronger than others exactly. Like I said, it just depends what works for you. MSContin is a LA morphine product. I'm sorry, I feel like there are other LA pills that I'm forgetting right now. There ARE two other meds I can tell you about, but they're kind of different. For one there's Methadone, which is also what I'm on. Technically, this isn't a LA med in the same formulation as the OxyContin or MSContin is. It doesn't release an amount of its power after you take it, then slowly do that again at the 8 or so hour mark, like those other two do. Especially in my experience, it seems to work actually more like a short acting med, it just happens to work on you for a long time. Does that make sense? :)
The other one I was thinking about is the Duragesic, or Fentynal Patch. I've never used it, but is one of, if not the most potent opiate reliever RX'd. It's simply a patch you put on (like the 'quit smoking' patch, if you're familiar), and over the course of 48-72 hours it delivers you a steady constant dose of fentynal. You have to be in some serious pain for you doc to give you these. There are of course varying strengths.
Okay like I said, I decided to reply here because I wanted to, and thought, that I could help you, but now that I'm writing I feel like I'm forgetting others. But hopefully at least that'll give you a general idea of the sort of 'ladder' of painkillers there are. Good luck
Well one thing to keep in mind is that there's still not an EXACT science as to what will truly be stronger, as everyone reacts differently to every pill.
But I think probably a safe, general rule of thumb would be that things like Ultracet/Ultram and Darvocet (propoxyphene is the generic) are the weakest prescription relievers you can get, while still being technically Schedule III narcotics. The next step up would be hydrocodone, which comes in many brand names like Vicodin, Lortab, Lorcet, Norco, etc. And it all comes in varying strengths. The weakest hydrocodone pill you can get is 5/325 (5mg of hydro & 325 of tylenol - although now that I think about it, I'm not 100% sure hydro comes in that exact strength - otherwise the weakest combo would be 5/500. There are several differnt combo amts, 10/325, 7.5/750, 10/500, 10/650... you get the idea :)
The next level up would be oxycodone, which also comes in varying brand names (Percocet, Percodan, OxyIR, Roxicodone, etc). Oxy is a Sched. II drug (stuff that's Sched I is only like heroin, cocaine, etc). And just like with the hydro, oxycodone comes in all the same varying strength combos.
Keep in mind all the examples I just gave you are all SHORT ACTING MEDS. Currently, that I know of, hydrocodone comes in no LONG ACTING FORM. When you're RX'd a LA med, there's no tylenol, because it's with the understanding that you're going to be taking it for awhile. (believe it or not, most people in America who are given Vicodin, it's only for a week or so, so that amount of tylenol is negliable to them). Oxycodone DOES come in a LA form, that's what OxyContin is. You may hear a lot of people on here talking about taking OxyContin as their base med, as they use some form of Percocet or OxyIR as their "break through" med. These people are taking the same exact drug both times, they're just taking it in two different forms. (The Contin sustains an even level of the drug in your system during the day - well, supposedly ;) and the regular oxycodone product gives them an immediate boost for acute pain a few times a day.) There are other LA meds that don't contain oxycodone, but it's up for debate which ones are stronger than others exactly. Like I said, it just depends what works for you. MSContin is a LA morphine product. I'm sorry, I feel like there are other LA pills that I'm forgetting right now. There ARE two other meds I can tell you about, but they're kind of different. For one there's Methadone, which is also what I'm on. Technically, this isn't a LA med in the same formulation as the OxyContin or MSContin is. It doesn't release an amount of its power after you take it, then slowly do that again at the 8 or so hour mark, like those other two do. Especially in my experience, it seems to work actually more like a short acting med, it just happens to work on you for a long time. Does that make sense? :)
The other one I was thinking about is the Duragesic, or Fentynal Patch. I've never used it, but is one of, if not the most potent opiate reliever RX'd. It's simply a patch you put on (like the 'quit smoking' patch, if you're familiar), and over the course of 48-72 hours it delivers you a steady constant dose of fentynal. You have to be in some serious pain for you doc to give you these. There are of course varying strengths.
Okay like I said, I decided to reply here because I wanted to, and thought, that I could help you, but now that I'm writing I feel like I'm forgetting others. But hopefully at least that'll give you a general idea of the sort of 'ladder' of painkillers there are. Good luck
wirry1422
10-26-2003, 07:37 PM
Sorry to correct again, but cocaine is actually schedule II as it does have some legit medical uses.
wirry1422
10-26-2003, 08:06 PM
From weakest to strongest, in my opinion, here is a brief list (oral meds taken orally only with exception of the patch).
Non-prescription- Tylenol (Acetomenophen), Aspirin, Naproxen, Ibuprofin.
Prescription Narcotics (not including NSAID's like Vioxx, or other non-narcotics used as presciption pain relievers such as elavil or neurontin):
Propoxyphene- Brand name darvocet, darvon compound, comes with APAP and/or caffeine, propoxyphene is not stronger than 60% of codeine, and in studies is equal to extra strength aspirin; overall very weak. Schedule IV.
Tramadol- This med either comes alone (Utram) or with tylenol (Ultracet). It is technically not a narcotic, but rather a completely synthetic drug which acts just like a narcotic,(so for all practical intents and purposes it is a narcotic) but a weak one which I would consider as being slightly less potent than codeine. Schedule IV
Codeine- Comes in pure codeine tablets, or in Tylenol #3 and #4. approximately 10% to 15% as strong as oral morphine. Usually first line of choice for doctor's starting someone on narcotics for the first time. Is noticeably stronger than any over-the-counter pain meds. Schedule III
Hydrocodone- Comes only compounded with tylenol or ibuprofin (vicoprofen). Approximately 4 to 5 times as strong as codeine. Probably the strongest med still in schedule III. Only slightly weaker than oral morphine. Comes in various dose combinations with tylenol. Schedule III (in most states).
Morphine (oral)- Oral morphine comes only by itself (no APAP combos) and also comes in long acting form (mscontin) This Medication is schedule II and is a very strong pain reliever. Schedule II.
Oxycodone- Comes with tylenol (percocet) with aspirin (percodan) or alone (oxy ir, long acting oxycontin). Oxycodone is approximately 50% more powerful than oral morphine and works very well in most chronic pain patients. Schedule II.
Methadone- Is a long acting narcotic, which builds up in the system over time. Only comes by itself, no tylenol etc. Is 3-4 times as potent as oral morphine. Doctors usually use this meds if oxycodone is not adequate to control severe pain. Schedule II.
Hydromorphone- Is a short acting narcotic (currently long acting form available only in canada.) Is extremely powerful, approximately 8-10 times as strong as oral morphine. Usually given for advanced chronic pain patients in extreme pain, who are tolerant to the other medications. Strongest oral med available. Brand name, Diluadid. Schedule II.
Fentanyl- Not available in pill form, only skin patch or injection. This is by far the most powerful narcotic known to man. Fentanyl is measured in micro-grams (1/1000th of a milligram), not milligrams. This med is given only as a last resort for chronic extreme pain patients and especially for terminal cancer patients. The brand name of this med is Duragesic which is a skin patch which comes in strength from 25 mcg to 100 mcg per hour released into the blood stream directly through the skin. Also available as a lolipop called Actiq for breakthrough pain in strengths from 200 mcg to 1600 mcg (probably enough to kill most opiate naive people very quickly). Fentanyl is 100 times as strong as morphine, so respect Fentanyl! Schedule II.
And that's about it for the non-injection and oral meds, in order of potency. When talking about IV meds things are totally different as some meds are not made in injectable form while others increase in potency relative to others so this is only for oral meds (again with the exception of the patch) and of course is completely subjective to my opinion, others' may have differing experiences/opinions.
[This message has been edited by wirry1422 (edited 10-27-2003).]
Non-prescription- Tylenol (Acetomenophen), Aspirin, Naproxen, Ibuprofin.
Prescription Narcotics (not including NSAID's like Vioxx, or other non-narcotics used as presciption pain relievers such as elavil or neurontin):
Propoxyphene- Brand name darvocet, darvon compound, comes with APAP and/or caffeine, propoxyphene is not stronger than 60% of codeine, and in studies is equal to extra strength aspirin; overall very weak. Schedule IV.
Tramadol- This med either comes alone (Utram) or with tylenol (Ultracet). It is technically not a narcotic, but rather a completely synthetic drug which acts just like a narcotic,(so for all practical intents and purposes it is a narcotic) but a weak one which I would consider as being slightly less potent than codeine. Schedule IV
Codeine- Comes in pure codeine tablets, or in Tylenol #3 and #4. approximately 10% to 15% as strong as oral morphine. Usually first line of choice for doctor's starting someone on narcotics for the first time. Is noticeably stronger than any over-the-counter pain meds. Schedule III
Hydrocodone- Comes only compounded with tylenol or ibuprofin (vicoprofen). Approximately 4 to 5 times as strong as codeine. Probably the strongest med still in schedule III. Only slightly weaker than oral morphine. Comes in various dose combinations with tylenol. Schedule III (in most states).
Morphine (oral)- Oral morphine comes only by itself (no APAP combos) and also comes in long acting form (mscontin) This Medication is schedule II and is a very strong pain reliever. Schedule II.
Oxycodone- Comes with tylenol (percocet) with aspirin (percodan) or alone (oxy ir, long acting oxycontin). Oxycodone is approximately 50% more powerful than oral morphine and works very well in most chronic pain patients. Schedule II.
Methadone- Is a long acting narcotic, which builds up in the system over time. Only comes by itself, no tylenol etc. Is 3-4 times as potent as oral morphine. Doctors usually use this meds if oxycodone is not adequate to control severe pain. Schedule II.
Hydromorphone- Is a short acting narcotic (currently long acting form available only in canada.) Is extremely powerful, approximately 8-10 times as strong as oral morphine. Usually given for advanced chronic pain patients in extreme pain, who are tolerant to the other medications. Strongest oral med available. Brand name, Diluadid. Schedule II.
Fentanyl- Not available in pill form, only skin patch or injection. This is by far the most powerful narcotic known to man. Fentanyl is measured in micro-grams (1/1000th of a milligram), not milligrams. This med is given only as a last resort for chronic extreme pain patients and especially for terminal cancer patients. The brand name of this med is Duragesic which is a skin patch which comes in strength from 25 mcg to 100 mcg per hour released into the blood stream directly through the skin. Also available as a lolipop called Actiq for breakthrough pain in strengths from 200 mcg to 1600 mcg (probably enough to kill most opiate naive people very quickly). Fentanyl is 100 times as strong as morphine, so respect Fentanyl! Schedule II.
And that's about it for the non-injection and oral meds, in order of potency. When talking about IV meds things are totally different as some meds are not made in injectable form while others increase in potency relative to others so this is only for oral meds (again with the exception of the patch) and of course is completely subjective to my opinion, others' may have differing experiences/opinions.
[This message has been edited by wirry1422 (edited 10-27-2003).]
Shoreline
10-27-2003, 04:25 PM
Hey Guys, Everyone did a great job expalining the meds, I thought I would just explain the scheduling system as some are not clear.
meds that have been considered by the DEA controlled drug act of '72 have been scheduled into 5 catagories. Drugs deemed to have no medical value like Heroin are considered schedule 1 or illegal narcotics like ecstacy or LSD. I never really thought of cocaine as being a scedule 11 drug as nobody is ever going to prescribe it.
Cocaine is used in liquid form in the surgical arena like Rhino plasty for it's vascular constricting ability along with numbing action. Marijauna at one time would have been considered a drug with no medical value but with marinol and states that have legalized MJ I suppose it would be a schedule 11.
The lower the number the higher the abuse potential. Schedule 11's have to have a written script each time it's dispensed and no refills are allowed.
C-11's are the stronger opiates and the free form opiates that could be diverted for IV use.Amphetamines and the older diet meds are included in this more likely to be abused group
C-111 are the meds that have some potential for abuse like the meds with Hydrocodone and tylenol.Vicodin, Lortab etc.
C-1V meds are usually meds like valium, mild tranquilizers,librium and such
C-V medication does not always require a written prescription, such as antibiotics and Robotussin with a minute amount of codeine can be obtained simply by signing a log.Same with Insulin
Hope this helps. And I would agree with the order of potency Wirry suggested, although methadone is vastly underestimated in potency and may be as potent as Dilaudid. Dilaudid is 7-8 times more potent than morphine on most charts where more recent articles about methadone have suggested it has the widest reponse of all meds ranging from 3x more potent than morphine to 10 times more potent.
So whether Dilaudid is more potent than methadone is certainly debatable. Not arguable but debatable. LOL ;)
Fentanyl is by far the most potent opiate prescribed today in the states, there are other variations of Fentanyl used in the surgical arena, Suffentanyl, Affentanyl,and Carfentanyl. For the interested chemist.
Take care, Shore
meds that have been considered by the DEA controlled drug act of '72 have been scheduled into 5 catagories. Drugs deemed to have no medical value like Heroin are considered schedule 1 or illegal narcotics like ecstacy or LSD. I never really thought of cocaine as being a scedule 11 drug as nobody is ever going to prescribe it.
Cocaine is used in liquid form in the surgical arena like Rhino plasty for it's vascular constricting ability along with numbing action. Marijauna at one time would have been considered a drug with no medical value but with marinol and states that have legalized MJ I suppose it would be a schedule 11.
The lower the number the higher the abuse potential. Schedule 11's have to have a written script each time it's dispensed and no refills are allowed.
C-11's are the stronger opiates and the free form opiates that could be diverted for IV use.Amphetamines and the older diet meds are included in this more likely to be abused group
C-111 are the meds that have some potential for abuse like the meds with Hydrocodone and tylenol.Vicodin, Lortab etc.
C-1V meds are usually meds like valium, mild tranquilizers,librium and such
C-V medication does not always require a written prescription, such as antibiotics and Robotussin with a minute amount of codeine can be obtained simply by signing a log.Same with Insulin
Hope this helps. And I would agree with the order of potency Wirry suggested, although methadone is vastly underestimated in potency and may be as potent as Dilaudid. Dilaudid is 7-8 times more potent than morphine on most charts where more recent articles about methadone have suggested it has the widest reponse of all meds ranging from 3x more potent than morphine to 10 times more potent.
So whether Dilaudid is more potent than methadone is certainly debatable. Not arguable but debatable. LOL ;)
Fentanyl is by far the most potent opiate prescribed today in the states, there are other variations of Fentanyl used in the surgical arena, Suffentanyl, Affentanyl,and Carfentanyl. For the interested chemist.
Take care, Shore
HockeyCrystal
10-27-2003, 08:49 PM
I didn't know Dilaudid was so strong...I'm on it, and it doesn't seem to be so strong... I'm only on 2mg though...Maybe that's why. I'm hoping my doc will up my dosage a bit next time I get a refill.
Crystal
Crystal
igy76
10-27-2003, 09:28 PM
Dilaudid! That's the one I knew that I knew, but also could tell I was forgetting! And jeez, I've even had it before! Thanks Shore
Though I'll say, I was RX'd Dilaudid 4mg once, and (as is somewhere in an old post of mine) it didn't have ANY stronger affect on me than Percocet 10/325 did, in fact it seemed even a little less. And the Methadone 5mg I'm on now, the Dilauded certainly didn't feel as strong as this does.
But, as it goes (like a broken record :) we all react to them all differently!
[This message has been edited by igy76 (edited 10-27-2003).]
Though I'll say, I was RX'd Dilaudid 4mg once, and (as is somewhere in an old post of mine) it didn't have ANY stronger affect on me than Percocet 10/325 did, in fact it seemed even a little less. And the Methadone 5mg I'm on now, the Dilauded certainly didn't feel as strong as this does.
But, as it goes (like a broken record :) we all react to them all differently!
[This message has been edited by igy76 (edited 10-27-2003).]
justwandering
10-27-2003, 11:10 PM
JUST WANTED TO THROW IN TWO CENTS SHORE I AGREE ABOUT FENTANYL WHEN TAKING IT AND IT STARTS TO RUN LOW IE 3RD DAY NO MEDS WILL TAKE AWAY EVEN SLIGHT PAIN OR EVEN WITHDRAWL THE REASON I USE THE WORD WITHDRAWL IS I KNOW WHEN LEVEL STARTS TO DROP WITHDRAWL COMES FIRST THEN PAIN PS DO A SEARCH ON GOOGLE ON OTOTOXIC MEDICATIONS THESE ARE TYPES OF MEDS THAT EFFECT YOUR EARS AND YOU WOULDNT BE SURPRISED WHAT YOU FIND OUT
justwandering
10-27-2003, 11:12 PM
JUST WANTED TO THROW IN TWO CENTS SHORE I AGREE ABOUT FENTANYL WHEN TAKING IT AND IT STARTS TO RUN LOW IE 3RD DAY NO MEDS WILL TAKE AWAY EVEN SLIGHT PAIN OR EVEN WITHDRAWL THE REASON I USE THE WORD WITHDRAWL IS I KNOW WHEN LEVEL STARTS TO DROP WITHDRAWL COMES FIRST THEN PAIN PS DO A SEARCH ON GOOGLE ON OTOTOXIC MEDICATIONS THESE ARE TYPES OF MEDS THAT EFFECT YOUR EARS AND YOU WOULDNT BE SURPRISED WHAT YOU FIND OUT
HockeyCrystal
10-27-2003, 11:33 PM
I don't seem to get more relief than my percocet 10/325 either... I guess I do some, but I think that's just because of the fact that my tolerance to the percocets was off the charts. I'm taking Dilaudid 2mg, but it hardly seems to do anything for my pain. Especially since I had my injection last Monday...
Crystal
Crystal
rubindj
10-28-2003, 02:48 AM
Just wanted to correct a one or two things.
Schedule 5 drugs are controlled narcotic substances, not merely prescription substances. There are only a few of them: Buprenex, Temgesic, Cosanyl,Robitussin A-C,Cheracol,Cerose,Pediacof, Motofen, Cophene-S, Lomotil, Logen , Parepectolin, Kapectolin PG, Kaolin Pectin P.G., Centroton, Thymergix, and the generics. That's it.
All other drugs (antibiotics, insulin, anitemetics, NSAIDS, etc) are perscription drugs, but they are not controlled substances. The major difference is that controlled substances are regulated by the DEA, FDA, and State boards of Medicine and Pharmacy, whereas perscription drugs are not regulated by the DEA.
Schedule 5 drugs are controlled narcotic substances, not merely prescription substances. There are only a few of them: Buprenex, Temgesic, Cosanyl,Robitussin A-C,Cheracol,Cerose,Pediacof, Motofen, Cophene-S, Lomotil, Logen , Parepectolin, Kapectolin PG, Kaolin Pectin P.G., Centroton, Thymergix, and the generics. That's it.
All other drugs (antibiotics, insulin, anitemetics, NSAIDS, etc) are perscription drugs, but they are not controlled substances. The major difference is that controlled substances are regulated by the DEA, FDA, and State boards of Medicine and Pharmacy, whereas perscription drugs are not regulated by the DEA.
Shoreline
10-28-2003, 09:25 AM
Thanks Rub, As far as the potency of dilaudid, It's a great IV med used in PCA machines for post surgical pain. However when taken orally it has a short half life and short duration f action. I was never impressed with oral dialuadid but in the PCA after surgery Dilauadid was the only med to ever give me any relief. The difference between oral and IV can be as great as 6-10 times more potent. With a constant drip like a PCA "Patient controlled anesthesia" machine you don't have to worry about half life and duration. So many that are impressed with IV dilaudid may find that oral "D" falls a bit short.
JMO Shore
JMO Shore
LouiseM
10-28-2003, 06:13 PM
This is great everyone! Thanks for a whole lot of info!
Does the PM usually start you off slow on the list? Then, if it is not working higher the dose? Or do they go right for the injections?
The other thing, kinda off the subject. I have had back pain for yrs, I did have an MRI done about 3 yrs ago showing a bulging disc, do these get worse? Then on my last xray (about a yr ago) showed some of the lower bones kinda collapsing, does this make sense to anyone? Does the PM dr usually get another MRI done? Would this cause my sciatica pain?
Thanks again as alway everyone, you have all been wonderful!!!!
LouiseM
Does the PM usually start you off slow on the list? Then, if it is not working higher the dose? Or do they go right for the injections?
The other thing, kinda off the subject. I have had back pain for yrs, I did have an MRI done about 3 yrs ago showing a bulging disc, do these get worse? Then on my last xray (about a yr ago) showed some of the lower bones kinda collapsing, does this make sense to anyone? Does the PM dr usually get another MRI done? Would this cause my sciatica pain?
Thanks again as alway everyone, you have all been wonderful!!!!
LouiseM
igy76
10-28-2003, 07:07 PM
Yeah SHORELINE, I agree. As I said up there, the oral Dilaudid was a big disappointment for me (and at 4mg no less, compared to Crystal's 2mg), but I've gotten it via IV a few times in the ER for my kidney stones, and a good five spot gets me loving life again :) I was always content if they gave me either that or Demerol (Morphine, of course long a favorite of ER docs for extreme pain, for some reason thru the IV doesn't give me nausea but creates a very heavy, tight feeling in my chest, so much so that I don't like to get it)
wirry1422
10-31-2003, 07:52 PM
It is interesting because i have never tried dilaudid mayself, but i have known i few people who argue that the dilaudid didn't help them as much as say oxycodone, but i was simply going along with the standard conversion rate as i have never been on it myself.