Discussions that mention tylenol

Pain Management board


Dave,
I have a question for you.........what I am guessing about taking hydrocodone is this...........the limit they set on your dose, is due to the tylenol in it, am I correct??? I mean how many mg's of hydro can you take a day like for safety my dentist wants me to stay at no more than 1500 of tylenol so I have to stay at 5 Norcos a day, however, how much hydro could one take if it didn't have tylenol in it.

See what I am getting at is this...........why not skip this junk all together, EVENTUALLY, and just take a LA pain med that does not have a tylenol/ibuprofen base? I guess since it has taken me years to get on a pain management schedule I am not even looking for anything different now.......I am just curious as to why a dr lets your pain med limit be based on tylenol intake and not based on your pain level??

As always, thanks for your help and support,
Karen
Hi Karen

I will jump in here and if I am wrong, I am sure someone will correct me. Hydro does not come in a pure form - as in it is not out there without the tylenol. I think a compounding pharmacy could make it with minimal tylenol in it. I also believe there is no ceiling dose of hydro, as long as you titrate up slowly and safely. There are plenty of short acting meds out there without the tylenol - like oxycodone - the active ingrediant in percodan and percocet. The issue with these are you are into a Class II narcotic and subjects the doctor to closer scrutiny and also cannot be called in. You have to go and pick up a paper script each time. I believe they can only write the script for a month supply at a time too. I finally got off the hydro because after a year, it was no longer working too well. You could ask your doc for the Norco 10/325 which gives you higher dose of hydro and less tylenol. Anyways, that is what I believe to be correct. If I am wrong, someone, please correct me!!

Amy
Hi Karen, Atti is totally right about hydro, It's not hydrocodone that is particlurly weak, But they restrain the amount of hydro you can take at one time by putting the apap in it, It also makes it very hard to turn Hydro products into an injectable drug with apap in it. The tylenol is why hydro products are still a class 111 med although the DEA would like to see it become a class 11 med because it is widely abused.

AS far as how much apap is too much. The max dose of tylenol the manufacturer recomends and most docs go by these numbers is 1000mgs per dose or 2 extra strenght tylenol "500mgs " at a time. Or 4000mgs per day. 4 doses of 1000mgs is the absolute max.

When it comes to continued use or prolonged use like with CP patients the safest thing to due is cut that number in half and avoid having to run liver panels on your blood work every 6 moths to see if the med he is is prescribing is poisenng you with "apap," Tylenol or with motrin and hydro combinations.

The only opiate that has a ceiling is demerol, too much demerol can build up a metabolite that is harmful to your kidneys and can cause seizure, It's not a daily amount it's a time frame in which it takes to build up enough of one of demi's metaobolites. But Amy is right they make pure oxy pills in 5mg,15mg,30mg and liquid oxy called Oxyfast or Oxydose with a metered dropper in strengths of 20mg per ml and 5mg per ml. All of these non apap opiates are also available in generic, so cost can be controlled.

Oxy is actually stronger than morphine by about 50%, but morphine is the gold standard to which other meds are compared in strength. Oral versions of short acting morphine are available in 15 and 30 mg, Oral verson of SA Dilaududid are available in 1mg, 2mg 4mg and now 8mg, But SA meds are short acting, So you still need These "stronger" meds prescribed properly "every 4 hours" so you don't have the ups and downs.

I've seen the same Phylosophy applied to long acting meds where the doc thinks a higher dose will make OxyContin last longer. 20 mgs twice a day isn't covering the pain so they go to 40 mgs twice a day rather than 20 mgs 3 times a day. Your daily intake of oxy would be lower and you would have smoother coverage. Larger twice a day doing just creates more in your system for the same amount of time. It doesn't make a 4 hour med last 6 or an 8 hour med last 12 by increasing the dose. Howevr Purdue has stood very strong about OxyContin being a 12 hour med and doesn't want docs prescribing it more frequently, It's Purdue pharmas' effort to seperate themselve's from any trouble that may arise if the doc isn't followng the manufacturerers prescribing instructions and prescribing more than twice a day dosing of oxycontin.

Ideally LA meds are created to assure a constant serum level. I have attained a constant level with Kadian, a 12-24 hour version of LA morphine , I can create a smooth dose with methadone, and the patches can create relatively steady serum levels if you don't make someone wait to the last second of 72 hours to change a patch. Doubling the strength of patches won't make them last longer either if they only last 48 hours for you.

But like Amy said, a compounding pharmacist can create a long or short acting version of Hydrocodone using pure hydrocodone. If he wanted a stronger short acting version He could create a caplet that has 100mgs of hydro and 15 mgs of apap if the doc just wanted something in there to discourage IV use or abuse.

Keeping you under 2000mgs of apap a day is safe though, he shouldn't have to do liver function tests or worry about liver damage using half the daily recomended dose of apap. You shouldn't have to suffer because of fear of apap poisening when there are so many short acting choices and long acting choices that don't contian any apap or any other NSAID.

Four doses a day of short acting meds is too infrequent. Whether he doubled the strenght or not. You still need to be redosed every 3-4 hours or your pain winds up beyond the present doses ability to bring it back down. That's basic stuff and if you doc every had a dental procedure and even minor surgery he would know waiting untill the 6th hour is rediculous.

You could get technical and find the half life of each m,ed and ask how does a med with a half lifeof 2.4 hours possibly last 6 hours. At 2,4 half is left in your ststem, at 4.8 1/4 is left in your system at 6 hours 1/8 of the initial dose is in your sytem and well beyond a single dose of your meds ablity to bring the pain back under control.

Every nmanufactuer has a web site where the fullprescribing instructions with all the results of th clinical trials is available, you can literally leeatn more about the meds than the doc. Too many docs base their knowledge of meds on the information a pharmacuetical rep passes along with pens, coffee mugs, callanders and wall clocks. It doesn't mean it's acurate info, but comes with nice perks.LOL

Take care, Dave
Amy,
Hey, glad you jumped in, please do, you have great ideas and experience and we have alot of the same problems. It is nice to "know"somebody with chronic pain from tmj......not something you run into with friends and neighbors, ya know? My hubby has all kinds of "live" support with the pitformis syndrome, it is like every other person we run into has had it or some form of it........when I say I am suffering from tmj, people give you that stare. My husband is obvious because he is 34 and walks with a cane. I am "normal" to the eye, so nobody knows where to look to see this so called tmj.

I guess I can ask my dentist for the Norco 10. He said I could take up to 4 pills a day or an extra here or there, he was not saying my pain was not that bad, he just wanted me to watch the tylenol. Hey, at this point, I am just so thankful that somebody is treating me for pain I don't want to complain.........or sound ungreatful. I took percocet in the beginning and really don't know that it worked any better than the hydro, it made me a little nauseous.

Thanks so much for the info........right now if I can get some good relief from the short acting meds I am ok with them. I just am wondering if after some time they are not going to work anymore and then are you stuck in the tylenol rut, you know?

Karen
Dave,

You must have been posting your reply the sametime I was posting.......

Thanks again for the info.....

That is what I figured, they were really worried about controlling my tylenol intake, not the hydro intake.

See, even though I do only take 4 doses a day, I do take it in 4 hour increments. So, if I take one at say 8am then noon the 4pm then I take one at 6.......there is my 4. I don't take any meds for pain after 6 because I have to take meds at night to sleep.

Thanks again for all your info..........being new at this is much easier with having a place to come and ask all these questions from people who actually care about what you are having to take. Even if you ask the pharmacist, they just give you blanket info.

Take care,
Karen