Hey Pikka, clue us in if you know something we don't. As far as I know no opiate alone will cause any liver damage, If your liver is already compromised you could have problems and if you take meds that use the same route of elimination you could develop toxic levels of some drugs and destroy any theraputic value of other drugs.
That's why it's important to use one pharmacy, one doc and make ssure every doc knows what your taking before excepting a new med. If you have several meds using the same route of eliminaton, serum levels can rise to unsafe levels, the Cytochrome P450 Inhibitors like tagament can either reduce or increase the serum level of several drugs including opiates making them dangerous, alcohol and opiate or alcohol and benzo's are dangerous. But if your not overloading the ability of the P450 cytochrome enzyme it can effectvely break down and excreete any amount of opiate unless you using other drugs that take the same route of elimination using the same enzyme. Cold meds, stomache meds and nausea meds can cause problems due to this same enzyme.
But the only reason to combine many of these meds is simply to obtain a better high, if your doing this and it damages someones liver, I wouldn't blame it on the "evil" opiates. It was the combination and drug interctions that created a problem, not any single drug alone.
If you ran across something or had an interaction, do tell.The article would be nice to see because we have all been told misinformation by doctors simply because they don't want to prescribe. I had one surgeon tell me it's against the law to prescribe more than 40 Class 11 meds at one time, BS, I had a Nurse practioneer tell me it was against the law to increase a pump more frequently than ronce a month after the first month, more BS. Just like we have been told partial fills on C-2 are illegal, more BS from the pharmacist.
Demerol is the only opioid med that has an actual limit as to how much your kidneys can break down, you You can buld up a metabolite which causes seizures from the way it's broken down inthe kidneys.
OxyC uses the P450, Morphine uses the P450, and many otrher drugs use the same cytochrome and if you overload this one enzymes abilty to break down meds down you will have consequences and sometimes lethal consequences. But pure opiates alone, as much as I have researched don't damage the liver.
Can you explain or show us the info you ran across. Some people will develop liver problems regardless of what they take just as non smokers can develop lung cancer, so lets not scare folks unless you absolutely know something.
Codeine is unique in that you can only metabolize 400mgs of Codeine per day, any more is just wasted because the liver can't break it down and turn it into it's metabolites, one of which is morphine. So you loose any additional pain relieving effects by exceeding that dose.
Thanks Dave
I apologize everyone, as to Shorelines reply, i worded that incorrectly. I should have said pain therapy.
Okay, here is my story:
I work at an Animal Sanctuary. I was working with animal's until that familiar day, we all know, all to well. The next day after the incident, I had a very painfull ache and pain in my testical's, and my back was out. I made an appointment with my GP, and he diagnoosed me with Epyditimys (sp). la-la-la-lalalalala..... After dealig with the crohonic pain for about 9mths, and the only two Urologists within a 200mile radius, I searched for my own UR, because my GP said there weren't anymore around (huh). So after finally seeing the third, he diagnosed me with; Prostitus/CPPS, and said i could easily cure it with the proper diet. 4mths, nothing. So i fanaly found out there was a PM close to me. Yeah!
During this whole past year, I did all of the antibiotics, all of the NSAID's, Accupuncture, stretching and therapy.
Pain Management Doc, a gift from God (or your deity of choice). I have tried Oxy-contin and the Duregesic Patch
I am know taking:
MS-Contin, 115mg. 3xdaily
Neuronton, 600mg. 3xdaily
Percocet, 10/325mg. 5xdaily (PRN)
Compazine, 10mg. 4xdaily (PRN)
Provigil, (my bad, i forgot mg's) 2xdaily (PRN)
My PM rx's everything but Cymbalta, for depression.
So my question is of the the /apap/ and all adjunctive therapies, what toll do these take? I know everyone uses something different, I just wanted to open a topic for anyone concerned.
Also, if you can help. My current dose of MS-Contin, isn't really taking care of all my pain, i am still at a 6 with my current dose, my breakthrough cuts me down to about a four, wich is pretty good for me, but it only lasts about an 1 1/2. Any suggestions on BT's my doc says all there really is for that is Lortab and Percocet, with or without apap.
I probably missed a lot of what i wanted to say, but thanks.
Hey Keb, It's the apap in the hydrocodone products that cause liver problems and most decent PM docs avoid them.
The average person shouldn't take more than 1000mgs in a single dose or 400omgs a day, If you use apap daily for months you have to cut that in half.
I wouldn't say your morphine dose was high, I was taking 600mgs of kadian a day, the 24 hour versoion of MSC. 200mgs 3 times a day. Because my base dose of LA morphine was high I need a proportionate amount of BT to make a dent, they usuallly shoot for a 20-30% increase for BT or rescue pain.
At 300 mgs a aday, that means 2 30mg MSIR "60mgs", 1and 1/2 or 2 30mg Roxicodone a day 45-60 mgs of oxy , both are available in generic. Or you could use 4-8 mgs of dilauadid. 8mgs of dilauadid, 60mgs of msir or 45-60mgs of oxycodone for BT is propertionate to your dose and all about the same strength. Some meds work better for different problems though.
You can get pure oxy in 5mg, 15mg 30 mg, morphine in 15m and 30mg dialaudid in 4 and 8mg they make liquid versions of both for faster relief. One called Oxyfast which is 20mgs per ml there is a generic for that too. they make a weaker concentration of 5mg per ml and it comes in 30ml bottles. They make liquid morph. But based on your base dose of morphine any hydro product with tylenol is going to be like a tic tac.
You get better pain coverage by using different opiates for base and rescue, and avoid just raising your tolerance to he base med. Different opiates bind to different receptors and work differently on different pain.
Because your taking morphine, and if he's open to sugestion, I would start with the 15 or 30mg generic or name Roxicodone, they can be split in half with a pill splitter so you have control over the dose you need. I just got 120 30mg oxycodone tabs for 89 bucks, after I had the pump implanted they prescribed the 10mg percs, 40 generic cost me 96 bucks. So I get 3 times the number of mgs buying generic 30mg oxy tabs then using the generic
10 mg percs , and I don't have to worry about tylenol.
NSAIDS are harder on your kidneys and apap on your liver but both should be concerrns, not to mentoion your stomach.
If your in Canada, the products available are a little different. They Have OxyIR in 5 mg , 10mg and 20mg but the important thing is that it needs to be propertionate to your base dose. a 10mg norco would be 1/30th of your base and wouldn't be effective.
There are also adjunct meds like Nemanda worth trying, It's the latest Alzheimers med but is a potent NMDA blocker and has helped my wife quite a bit with nerve pain from a degenerative nerve disease and she isn't even up to the dose they want her on.
What works for one may not another but you have alot of choices for BT meds. If your in Canada, I can give you an apropriate list. But there are definitely stronger and better meds without apap than the hydro products and percocet in any strength.
Hope this helped some.
Take care, Dave
Sorry to hear that you are still in so much pain. As to the BT meds there is a whole world of meds out there that your dr doesn't seem to be aware of OR is unwilling to RX. MSIR (Morphine Sulphate Imeadiate releif) comes in 15mg and 30mg tablets or 20mg per 1 ML liquid dose. OxyIR is available in 5mg tablets or again as a 20mg per 1Ml liquid dose. Those would be the two most common BT meds that your dr hasn't tried/mentioned and given the amount of MScontin you are taking you would probably be looking at the MSIR 30mg or twice that 2x to 3x per day PRN.
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