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Old 10-11-2004, 03:45 PM   #1
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Question Help! contraindicated??? Tramadol/percocet?

Hi all~
I have been taking Ultram for pain caused by a pinched nerve, and am actually in the process of having diagnostics to find the underlying cause of my pain and numbness. In any event, I was at my dentist today because of a root fracture and infection (and pain!) I will be getting a surgical procedure later this week to remove the fractured roots. For the meantime, the dentist has prescribed percocet which I took about 1 and 1/2 hour ago. I usually have great pain relief from percocet within 45 minutes or so and this time nothing! My teeth pain is still at an 8! Just wondering if those opiate receptors are too filled with Ultram to allow the percocet to get in and work? Is it possible the percocet won't work until the Ultram is out of my body? I took 2 Ultrams at around 11:30 AM, and took the percocet around 5:00 PM.
Any thoughts or info would be welcomed.
Thank you!

 
Old 10-11-2004, 05:17 PM   #2
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Re: Help! contraindicated??? Tramadol/percocet?

Hopefully, shoreline will see this and respond. My guess is that the ultram should have been out of your system by the time you took the percoset. I have never found pain medicine helpful for that kind of tooth pain, though. It just takes the edge off.

Carol
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Old 10-12-2004, 06:25 AM   #3
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Re: Help! contraindicated??? Tramadol/percocet?

Thanks for replying Carol~ Though I did get some relief from the percocet after a while, I would still be interested in hearing about this if anyone knows. Are they both fighting for the same receptors? After last nights experience, my guesstimate would be that perhaps they are and that taking them too close together would not give the best pain relief. In any event, I don't plan on taking any of the Ultram while my teeth are acting up in case I need to take the percocet. I'm calling the dental surgeon this morning (ugh!) to get this taken care of!

 
Old 10-12-2004, 08:39 AM   #4
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Re: Help! contraindicated??? Tramadol/percocet?

Hi Ellen, After my last surgery I was prescribed both ultam and Percocet to be used together or alternating. Ultram is not an opiate recptor antagonist, meaning it doesn't block receptors or purge receptors.

Tooth pain is basically nerve pain, If you have an infection, getting the infection under control will probably give you more relief that the pain meds. Nerve pain doesn't respond quite the same way to opiates but the only possibly dangerous contra- indication would be if your taking an antidepressant with ultram.

If you typed it into a drug interaction checker tit will warn of increased CNS depression, But nomore so that Taking a muscle relaxer with an opiate or taking a benzo for anxiety, restless leg or anti siezure meds for nerve pain. THey all have CNS depression qualities but if you aproached your present dose and are somehwat acomadated to your meds it shouldn''t do anything more than possibly cause additional drowsiness. However percocet is a pro opiate meanng it has stimulating effects that will likely over ride the CNSdepression. Obviously iif you feel your having a difficult time with breathing this needs to be reported so safe adjustments can be made to your regemin.

Althogugh Ultram is not a true opiate in the sense it's chemical structure is not modeled after opiate derivatives like Thybaine , It does have some opiate like properties and it does bind to the MU receptor which is the reasn i relieves pain.

It also has some antidepressant properties and effects serritonin levels. Ultram should not be stopped abruptly, you may experience withdrawal even while still taking percocet.

I stopped the ultram before stopping the opiates post surgcically and experienced 2 weeks of withdrawal very similar to opiate withdrawal, with the added treat of feeling like my brain had been rewired the wrong way. Much the way discontinuing antidepressants causes strange withdrawal symptoms.

When Ultram first came out it was touted as the safe alternative to addictive opiates. It turns out it causes the same physical dependence that opiates will cause with repeated use.

If your taking an antidepressant I would be more concerned about the interactions between Tramadol and any SSRI, particularly Paxil. If you take an an antiD for pain or one of the many off label uses of antiD's like treating nerve pain, contact the doc prescribing the antiD and confirm with him that the combination is safe. Soundsd like you have a typical neurologist treating your nerve pain that doesn't believe in using opiates ,so once the tooth is under contro you may find you get better relief for the hand problem from percocet.

Even if ultram was a pure opiate agonsit, pure opiates don't prevent other opiaites from finding opiate receptors to bind to. You have opiate receptors throughout your body, not just the spinal cord and brain. Basicaly you could never take enough opiates to fill every receptor. Often combining opiates will provide relief a single opiate can't. Different opiates bind to diferent receptos so your just covering a wider range of opiate receptors and recieving the benefit of doing so.

I found that Ultram inhanced the effects of opiates , it does not block opiate reception and discontinujng Tramadol abruptly can cause major problems. You have to taper off Ultram just like you would with any opiate or any SSRI antiD, to remain comfy through the process.

Use ice, take the antibiotics and hopefully you will be getting relief by the time for surgery. The doc will check again on the progress of the infection and if the infection isn't controlled he may not be able to go ahead with the surgery that day, he may have t continue, increase or change the antibiotic before performing surgery as not to spread an infection systemically or into the bone which is extremely hard to treat.

Sporry your hurting, Tooth pain is exquisite and nothing I would wish on anyone but my mother in law.LOL
Good luck with the surgery and I hope you start getting relief. Remember there is a limt on the amount of Tramadol you can take per day, It's 400 mgs a day, exceeding this can cause seizures or seritonin syndrome.

Don't discontnue Tramadol abruptly and try to hang in there untill the antibiotics start working, usually within 48-60 hours you should notice some improvement from the antiB's, or yorur not on the right one. Ice and topical gels like ambasol would probably help more with tooth pain, and with the percocet, that's abut the best you can expect untill you have the infection under control. I kind of doubt the dentist os going to go with somethin stronger than percs for a bad tooth.

10 mg of oxycodone manages the majorerity of orthopedic post op pain once released from the hopital and things like that are in the dentist mind when prescribing. Pecocet is very apropriate for a broken tooth and and infection but not many dentist will go to something stronger . The tramadol should actually enhance the effect of the percs adding aditional releif.
Take care Dave

Last edited by Shoreline; 10-12-2004 at 09:03 AM.

 
Old 10-12-2004, 08:16 PM   #5
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Re: Help! contraindicated??? Tramadol/percocet?

Thanks Dave! I love reading your knowlegable, informative posts, you are an incredible asset to the boards and I appreciate your responding. Didn't know that I might still have w/d if I was taking percocet, so just to be safe, I took a mere half a 50mg. tab this afternoon. I never exceed 400 mg. of ultram, since yes, I am also taking an SSRI (20mg lexapro) for depression and was told (even post-operatively) that I could only take 1-50 mg. every 5 hours, rather than the usual 2- every 4-6, which I have always adhered to. When my pain is more severe as in post op, I am prescribed percocet, which has always worked pretty well for me. This tooth pain is intense and as you mentioned I'm wondering if the antibiotic I've been taking since Sat is just not working! (Trimox 250 mg 4X a day). Anyway, I am scheduled for my oral surgury tomorrow, so possibly the oral surgeon will prescribe a stronger antibiotic, in addition of course to cleaning out the infection, and fractured roots causing it.
Because I am also a recovering addict, I was one of many who has been prescribed Ultram as an alternative to the opiates only to have recently discovered (on the add/recovery board) about the nastsy withdrawal I may be in for. Because of my journey with surgeries and pain and my not being a marter (!) I feel blessed to have been able to take my prescribed pain medications responsibly using guidelines and the tools I have learned in my program of recovery. Hopefully, my tooth pain will be relieved soon.
My arm, shoulder and hand pain has not yet been diagnosed, and as soon as
I recover from this ordeal, I plan to see a Rheumatologist as my preliminary exrays (shoulder and cervical spine) have revealed: "extensive calcification of the supraspinatus tendon indicating peritendinitis calcaria, as well as considerable degenerative disc disease, dislaying considerable disc space narrowing, sclerosia and early osteophyte formation at every disc extending from C3 to C7, straightening of the normal lordosis may be related to muscle spasm." Not certain what all this means but since I have previously been diagnosed with DDD, and osteoarthritis, and "calcification" seens to show up in various part of my body whenever I have tests, I am now awaiting my RX for Bextra to arrive in the mail to replace the vioxx I have been taking for 5 years.
Until then, I will try to keep my Ultram use to a minimum (2-3 a day)since I feel it might be the better of 2 evils for me, and I still have a healthy fear of reaaddiciton to the opiates. If this does become yet another chronic condition I will have to seek the help of a nuerologist and or pm.
Again, thanks Dave, love "talking" to you. I'm sure I've given you more info than you ever needed ~ lol. Hope you are feeling well and as pain free as possible these days.
Best regards,
El

 
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