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  • questions on ultracet and a few others

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    Old 05-11-2004, 12:31 PM   #1
    Angel77
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    Question questions on ultracet and a few others

    Hi, I have been having problems with chronic pain for more than 10yrs now and last week my doc started me on some samples of ultracet. I couldn't believe it! The pain was completely gone in my hips, knees and most of my neck by the second dose. But, now that I've researched it on the net it says that it isn't recommended for more than five days use.

    I don't understand why and if it's also different with chronic pain. It's the only thing I have found that takes the pain away, doesn't make me drowsy or hyper. Now I am starting to hurt again and can't stand the thought of it going right back. I have never not known a day with out some level of pain, let alone no pain.

    It also says to steer away from it if you're on stimulants, tricyclics, certain anti-depressants, etc. I'm on all of those. I have narcolepsy, depression, brain injury, misaligned pevlis, sacroiliac joint dysfunction, poss of fibro, etc. and I'm on...
    Dexadrine 15mg 5xDay (75mg..high dose)
    Strattera 18mg (working up to 40-60mg a day)
    Wellbutrin XL 300mg
    Synthroid 150mcg
    doxepin 50mg
    Maxalt 10mg (as needed, not often)
    Utlracet 37.5 tramadol/325 acetominephin (for 5 days)

    What is the reasoning for not mixing, or is it just not recommended for the normal population and is different for people w/ chronic illness?

    Any help would be great. I also seem to metabolize drugs oddly. Lortab will take migraines away w/ no side effect, percocet make me have the warm fuzzies (I stay away from those, I like warm fuzzies and don't need help complicating matters!LOL), soma put me out the first time but after than seems to make no difference at all, demerol isn't much help, etc. Am I weird, or is this normal?
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    Old 05-11-2004, 05:15 PM   #2
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    Re: questions on ultracet and a few others

    Hey Angel, I hadn't seen the recent warning about nottaking it for more than 5 days, where do=id you see that. When something major like that changes the FDA will issue a block box warning which is just the most urgent warning they want docs to pay attn too. Haven't seen the change.

    The only limitations of Utram or Utracet I knew of are400 mgs is a day is max daly dose, if you xceed that you risk seiaure.

    The reason why you have to becareful with antiD's is that Ultram is an oddball drug. It was marketed as non narcotic, non addictivbeve , almost the miracle cure for CP when docs didn't wwant o prescribe opiates of Hydrocodone.

    It turns out Ultram does have opiate properties, can cause physical dependence. Acts like an SSRI antidpressant and increases serritonin reuptake, so when you DC Ultram abruptly it's lke stoppng opiates and Paxil at the same time. Withdrawal is extremely unpleaseant.
    Let me look for a recent black box warning. BRB
    Dave

     
    Old 05-11-2004, 05:38 PM   #3
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    Re: questions on ultracet and a few others

    Hey Angel, The toxilogical study subbmited to the FDA was a 3 month study in which minimal evedince of toxic findings were found. Where did you see you can't take it longer than 5 days. Or is that your docs way of preventing physical dependnece?
    Good luck, Dave

     
    Old 05-11-2004, 07:08 PM   #4
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    Re: questions on ultracet and a few others

    My wife went to the doc for pain either from sinus infection or a recent dentist trip. She told him aspirin worked great except it didn't last all night. He gave her Ultracet! So either he is an idiot or he thinks it's very safe.

    farmboy

     
    Old 05-11-2004, 08:38 PM   #5
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    Re: questions on ultracet and a few others

    I read it on ultracet's web-site. I don't know that it forbid taking it more than five days at a time, but I think it was something to the effect of not recommended or not FDA approved. They have the web site listed on the board as a sponsor. I believe it was Ultracet.com.

    I'm not sure. Please let me know. Also, did anyone else have a great response and not have any problems w/ drowsiness or fuzzies? Thanks for the help.
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    Old 05-12-2004, 07:50 AM   #6
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    Re: questions on ultracet and a few others

    Hey Angel, This is what you read, It even had a catchy tune to go along with the pretty web site, this med can't possibly be harmful. NOT LOL
    ULTRACET is a prescription pain reliever that combines the active ingredients of two of the leading pain medications—ULTRAM® (tramadol hydrochloride), available by prescription, and acetaminophen, the nonprescription analgesic most commonly recommended by physicians.
    ULTRACET is indicated for the short-term (five days or less) management of acute pain.
    The pain relieving effects of the two ingredients in ULTRACET offers significant benefits over either component when used separately: ULTRACET begins working faster than ULTRAM and lasts longer than acetaminophen.
    ULTRACET has a positive safety profile. Unlike COX-2 NSAIDs and other nonsteroidal anti-inflammatory drugs (NSAIDs), ULTRACET does not increase the risk of stomach ulcers and gastrointestinal bleeding, impair kidney function or interact with many blood pressure medications. ULTRACET can also be prescribed in sulfa-sensitive patients. The most common adverse events seen in clinical trials of ULTRACET included constipation, somnolence (sleepiness) and increased sweating.
    ULTRACET is a centrally acting analgesic that works through several different mechanisms of action. Tramadol relieves pain by binding to mu-opioid receptors in the central nervous system. In addition, tramadol weakly inhibits re-uptake of norepinepherine and serotonin, which may aid in pain relief. The mechanism of action of acetaminophen is not fully understood.
    ULTRACET is administered in doses of two tablets every four-to-six hours as needed for pain up to a maximum of eight tablets per day. Patients should check with their physicians if they have questions regarding dosing.
    ULTRACET should not be used concomitantly with alcohol. The use of ULTRACET in patients with liver disease is not recommended.
    Cases of abuse and dependence on tramadol have been reported. Tramadol should not be used in opioid-dependent patients. Since tramadol can reinitiate physical dependence, ULTRACET is not recommended for patients with a tendency to drug abuse, a history of drug dependence, or chronically using opioids.
    Patients with a history of severe, life-threatening allergic (anaphylactoid) reactions to codeine and other opioids may be at increased risk and therefore should not receive ULTRACET.
    Seizures have been reported in patients receiving tramadol. The risk of seizures is increased with doses of tramadol above the recommended range. Tramadol increases the seizure risk in patients taking certain medications (e.g., tricyclic antidepressants, selective serotonin reuptake inhibitors, opioids) and may enhance the seizure risk in patients taking MAO inhibitors, neuroleptics, or other drugs that reduce the seizure threshold or in patients with epilepsy, those with a history of seizures, or in patients with a recognized risk for seizure (such as head trauma, metabolic disorders, alcohol and drug withdrawal, CNS infections). See WARNINGS
    ........................................ ........................................ .....................
    If you read the full prescribing instructions it explains why It's recomended for short term use, because Ortho Mcneil now recognizes due to it's MU receptor activity and SSRI like activity physical dependence can occur in as little as five days. Many PM docs use Ultram and Ultracet long term but there is the price of physical dependence, and hopefully your doc is aware that it causes dependence. When it was first marketed it was safer than a sugar pill, non opiate and no potential for abuse acording to the McNeil reps.

    They have since learned it's not true. When used long term a Titration schedule should be used as you dose is increased and as your dose is decreased. You definitely don't stop this stuff cold turkey after more than 5 days. It's not that it becomes unsafe or toxic after 5 days, just causes the same physical dependence that SSRI's cause and that other MU agonists "opiates" cause. So why not just take an opiate instead of one mixed with an SSRI to really fry your brain chemistry.JMO But docs would prefer to prescribe Ultram than Hydrocodone products because of abuse potential and the false sense they aren't really prescribing an addictive medication.
    Good luck, Dave

     
    Old 05-12-2004, 08:07 AM   #7
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    Re: questions on ultracet and a few others

    I take tramadol (generic Ultram) regularly. I did see the 5-day warning at one point but it seems to be applied inconsistently. I think it is because the drug will cause physical dependency.

    I know why you shouldn't take it with certain anti-depressants -- because it is an anti-depressant itself and I guess you can "OD" on the seratonin or something.

    Because I have both moderate occasional pain and occasional depression, this is the best drug I have found. But I know I have to be prepared for physical withdrawal.

    Also you can't take more than 400 mgs a day, tramadol has caused seizures in large dosages.

     
    Old 05-12-2004, 09:53 AM   #8
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    Re: questions on ultracet and a few others

    Mouse is correct, Oding on Serritonin is called seritonin syndrome, IT can cause Halucinations, psychossis, dramatic dep[resion. Many of the pleaseant experiences folks experience when disontinuing Paxil. Nasty stuff and no less harmful than pure opiates. If it works ,great. Follow the directions like the 400mgs aday. Follow your docs orders and don't stop this med cold turkey after 5 days.
    Take care, Dave

     
    Old 05-13-2004, 07:50 PM   #9
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    Re: questions on ultracet and a few others

    Not sure but Ultracet contains tylenol (couldn't spell the real name sorry). I don't believe ultram does. It is just 50 mg tramodol. Maybe the concern is longterm use of tylenol. Something to check into. I have been on ultram for years for leg pain and it does work quite well for my leg pain. Isn't ultracet new? Or at least fairly new maybe they don't have enough info on this medication.
    Jan

     
    Old 05-14-2004, 02:33 AM   #10
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    Re: questions on ultracet and a few others

    I also took up to 400 mg a day of Ultram (tramodol without the tylenol) for years. I had no problems reducing the dose on days that I didn't require it or stopping when I didn't require any. I don't know about interactions but the other problems are as they say 'potential' not guaranteed.

     
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