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Liver and other organ damage from years of meds

Does anyone know at what point we need to start worrying about liver (and other organ degradation) as a result of the medication that we take?

I have been taking various NSAIDs (celebrex, vioxx, mobicoxx, naproxen, etc) and opiates (percocet, MS contin, dilaudid, hyrdomorphone) as well as desipramine, nortriptaline, tramadol, nucynta etc for the better part of 15 years (not all at once ;-).

Lately I have been concerned about the percocet in particular and the effect long-term use can have on the organs.

Many years ago, after my 3rd lumbar fusion, I decided it was time to get off percocet. I had been taking close to 12 tablets a day for a 4 year period with no breaks in between. I got myself down to 3 tabs and then entered an outpatient rehab program to help with the addiction and cut out the last few. I was still legitimately in pain, so I was started on buprenorphine along with my other meds - but was completely off opiates. I stayed off the until 2008 when my back got really severe again.

From 2008 until now, I take 10 - 12 percs a day (along with everything else). I was getting worried, especially about the amount of acetaminophen, so I've recently switched to oxy IR.

How do we manage, assess and protect against diseases like liver damage as a result of all the meds we take? At what point, should we start being concerned? Is it about dosage, frequency, med combos, or the sheer length of time we have been taking the meds?

Any thoughts would be appreciated.


  • dilaurodilauro ConnecticutPosts: 9,877
    My doctor has me going every 60 days for blood work. She wants to check liver and other functions and variables in my blood.

    Then there is a problem with long term usage of steroids. I have to have cataract surgery next month due to the number of steroid injections I have had in the past 10 or so years.

    What about some of the nerve medications? There are reports of weight gain as well as memory lose

    I dont think there is enough studies on this topic. What we all see are those warnings about missing dosages, what are potential side effects, etc.

    But think about this too. If the medication that you have been taking for a long time is the ONLY medication that gives you relief, BUT it can also CAUSE (ABC), what would you do? Have a long time with pain relief, or suffer through a new problem.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • May I ask if you had one Dr. who was prescribing 10-12 Percocet a day? That is a very unusual dosage as the max per day is 8.

    So, if you have been taking close to the 12 per day as you have said, for so many years, I would absolutely be concerned about possible liver damage. As well as if you have had any alcohol during that time.

    The key with chronic pain management is using dozens of different modalities to help with one's pain. Medication is just one small piece of the puzzle. And I don't know many Drs. that prescribe more than a few breakthrough medications to be taken and those are not meant to be taken every day or that defeats the entire purpose for "breakthrough" pain management.

    How many of the OxyIRs are you now taking per day? I would be questioning your Dr. if they are still prescribing so much per day as this is just not the norm and if this Dr. ever leaves, there aren't that many Drs. who would take over that type of prescription.

    So...I guess I'm just surprised on the two levels of the high dosage and then that Dr. not periodically testing your liver panels knowing you were on such high dosages....

    I moved from Percocet to OxyIr a few years ago as I started getting nausea from the acetaminophen....I use MSContin as my long acting medication.

    The other modalities to treat chronic pain are
    physical therapy
    aqua therapy
    TENS unit

    Along with a nerve medication like Lyrica, Neurontin or Cymbalta. Opiates do not work well for any type of nerve pain. So most PMs will add this to the mix to help lower your pain.

    Same thing with a muscle relaxer like Flexeril, Robaxin, Skelaxin or Baclofen. Opiates don't work for this type of pain specifically either.

    The benefit of adding these type of meds is that your reliance on opiates will be much less. If someone is reaching for an opiate to do all the work of lowering one's pain...then this will have their tolerance so low to pain as well as having to keep raising the dosages. I haven't raised my dosage in over 3 years.

    There is also an antidrepressant which is effective for many of those with chronic pain as it helps not only with the emotions but with some of the pain.

    So...it's really about finding the best possible comprehensive program to treat your pain and every single thing you use will take down the pain a tiny notch to get it to a 5 or so.
  • Thanks Ron and LoveTT

    Yes, it's the same doctor. He is actually my GP (been with me for 25 years), however, my PMD is aware of the dosages. It's not that he has perscribed that amount of Percocet - the dosage is 2 tablets every 4 hours as needed. On bad days, it can get up to 12, and on average day it's at least 8. But it's every, single day for the past several years. No, I don't drink alcohol - think I've had 3 glasses of wine over the last 2 years.

    When I raised my concerns - particularly around the medication - he said he wasn't worried that my total acetaminophin intake was still ok. Regardless, I asked for the switch to Oxy IR. I've only been on it about 2 weeks. I take 15mg also, every 4 hours, so total tablets consumed hasn't changed. We talked today about increasing to 20mg because it's not strong enough.

    In addition, I take Nucynta 100mg twice daily, Naproxen 500mg twice daily and nortriptaline 50mg per day. (I had been on both Lyrica and Cymbalta, I didn't tolerate either. For me, the best nerve med was Desipramine. I will be going back on it this month. Needed to give my body a break.) Was also on Cipralex for years for depression, but stopped when pregnant with my second child in 2009. The thing is, I'm trying to eliminate meds, not increase my cocktail...

    I know all the modalities available to me. I have been dealing with chronic back pain for 15 years. I have various steroid injections and blocks, every 3 months or so, have had 2 RFAs, have a Tens machine at home, lie on an ice pack, am restarting physio next week (but mainly for my coccydynia). Massage and acupuncture are not options for me.

    But, back to the main issue - I guess I should be talking to my GP about regular blood tests to screen for liver disease?

    Thanks for the support and advice,
  • jlrfryejjlrfrye ohioPosts: 1,110
    My Pcp runs blood work every 6 months to make sure the meds are not affecting my liver and kidneys. Are you getting at least yearly blood work?
  • Thanks for more information....I still have to say it's a very unusual dosage....All the prescriptions I have ever gotten have read one to two tablets every 4-6 hours but they always put a max of 8 daily....

    So...I wasn't trying to judge or look down upon this as it's between you and your Dr...just stating that in the 11 years I've been in PM....I've never seen or read about a prescription for 12 a day...

    But back to your question...yes....he should be, and should have been testing your liver panels yearly.
  • Just to address something Lovetotravel posted, and something that is still repeated quite often on chronic pain-related forums, regarding the efficacy of opioid drugs in treating neuropathic pain (i.e. nerve pain):

    While it may be true that, on the whole, other types of pain respond better to opioid therapy, the myth that they are of no use for treating neuropathic pain has been dispelled. This notion was the result of flawed trials that have since been discredited. Many recent pain management texts have stressed this -- the following are just a couple of exerpts:

    "The traditional idea that these drugs are not useful in the management of neuropathic pain has now been disproven. Randomized controlled and open label studies of these drugs delivered by a number of routes have shown them to have efficacy in a number of neuropathic pain states. They are at least as effective as other classes of drugs used to treat neuropathic (and central) pain."
    Source - Pain: Chronic Pain Syndromes (Elsevier, 2004)

    "The place of opioids in the management of neuropathic pain has been controversial until relatively recently. Clinical observations in the 1970s and 1980s of patients with nociceptive and neuropathic pain diagnoses who were given single doses of opioids suggested that neuropathic pain was resistant to opioids. These studies were often small, non-randomized, and uncontrolled, though their conclusions were readily taken up by some clinicians. By the 1990s, observational and controlled studies began to emerge that demonstrated dose responsiveness to opioids in patients with neuropathic pain. Although patients with nociceptive pain experienced greater pain relief, it was clear that neuropathic pain appears to confer reduced sensitivity to opioids, rather than resistance. Over the past ten years, much more consistent evidence has emerged to support the use of opioids as a class (as well as individual drugs) in the treatment of neuropathic pain."
    Souce - Neuropathic Pain (Oxford Pain Management Library, Oxford University Press, 2010)

    I agree it's not a good idea to rely on compound analgesics that include APAP (acetaminophen/paracetamol) over the long-term. I don't know any chronic pain patients who routinely receive these for breakthrough pain. They are supposed to be used for the short-term treatment of acute pain. Also, NSAIDs can cause considerable gastrointestinal problems. I was on them for years before my spine surgery and can no longer take them due to GI problems. There are also some cardiac-related concerns with this class of drug.

    Drugs by themselves are only part of the picture - although certainly an important part - when it comes to dealing with chronic pain. The various modalities mentioned in some of the earlier posts can all be useful - it's a matter of finding the right balance for each individual.
  • 12 years ago I was on a med called digoxin for control of an irregular heart beat. I had been on it for almost two years and went to see the Dr for a upper respitory infection. I was seeing a new Dr as being in the Navy at the time you never saw the same one. The Dr looked at my record and asked me "where's your dig levels?' I said "what's a dig level?" He lost it and explained to me that once I was on digoxin they were supposed to do quarterly blood tests to measure the level in my blood to prevent toxic levels. Thank goodness my body didn't build up the level to much.
    I now look at all my meds and discuss the side effects with the Dr. Both my Primary and Rhuematologist check my blood for kidney and liver functions to ensure that all the stuff I'm taking doesn't have adverse effects. I currently take 10 different meds and use a compounded cream that contains 5 more. That's alot for anybody's organs to try and filter.
    We have to be our own advocates when it comes to meds and potential side effects. It may cost an additional co-pay for the test but the peace of mind is worth it.
    laminectomy c4/c5 2008, ACDF c4-c7 Jan 20 2014 sched
  • JohnJJohn Posts: 964
    edited 09/07/2012 - 2:25 AM
    I have been taking Omeprazole from the start to give some GI protection from NSAIDs and varied medication overall for twenty five years, it is always important to be vigilant, with a recent haemoglobin count of 7 then went for an endoscopy and colonoscopy to check for some internal bleed, all is OK.

    It is an important lesson that the accumulative impact volume medication can impart and better to be pro-active than with hindsight.

    Take care, John.
  • I went into my pcp doc office to pick up some paper work and insisted that they do blood work on the spot to check liver and kidney functions. I said that given my history and on-going use of meds I wanted to e screened at least every 6 months. They agreed. It was as easy as that.

    I'm just pissed that I had to bring this concern to my doc as opposed to him being proactive in my care and long term health. Oh well, at least we're doing the right thing now.

    Cross your fingers for me that it's not too little too late...
  • For six years I have used percoset 10/325 (oxy) norco 10/325 (hydocodon also same as Vicodin) Tramadol 50mg
    Soma 350 and IBpro 800 4 times a day. My blood test are due every three months for liver and kidney.
    Percs and norco have acetaminophin and it is not suggested to take act and IB to gather but I have to. I have cut IB down to 600 when needed to save one problem. Another problem is that they snuck in a lower limit on acetamin on us with out much news of the change. This was brought up when a high school cheerleader started taking acetaminophin for pain from cheerleading practice for muscle pain. She was under the impression it was safe because it was OTC. At that time the limit was 4000 mg per day. She died of liver failure fairly quick and there was nothing that could be done. This was one case I saw but there were more.On the FDA web site they now have a limit of 325 mg per prescription Med and a limit of 3000 mg of over the counter use and I found both a limit of 3000 mg and 4000 mg per day on persciption meds which is right?

    I found some Vicodin with 850 mg apap which now looks crazy. So to be safe if you are using 3000 to 4000 I would be getting it check every three months min. Another issue I came across is SOMA and Vicodin can have a chemical change that isn't the best for us and another reason to be getting a test. Now I know most of you will know this but I am writing in case some body doesn't know. A bottle of lets say norco comes with a label that says
    Hydrocodon 10/325 apap (apap) isn't always there means 10 mg of hydrocodon and 325 mg of ametaminophin
    Now I only placed this here because on another board their meds expert was telling people people they could take 4000 mg of hydrocodon per day with 10s that would be 400 tablets a day. It took weeks to have them change it.
    Always verify information that is online from a good source that doesn't sell anything and is a trustworthy site like te FDA.

    Now just for fun isn't it a small laugh when your talking to some one and it comes up that you are taking norco 10s and they say they are in more pain then you and have to take Vicodin extra strength. Vicodin ES are 7.5 75% of a norco 10. And yes norco and Vicodin are both made of hydrcodon so they are the same with a differant name.
    Or better yet when Vicodin makes them sick but norco doesn't LOL

    OK just my thoughts, verify it and stay on top of the blood test just to be safe

  • Hi
    With everything doctors have to do today and see so many people a day we have to learn what we need and be very proactive in our care or the care of family. My Dad was declared brain dead in a ICU and they said we had to shut everything down. Thank god he was so sick that he could not have been a organ donor. My arguments with the doctors was that he reacted to me and was still there. The eeg I belve was the test showing him brain dead its the one used for donors. Any way they called in a shrink for me because I was mistaken that he wasn't brain dead. While they were telling me how wrong and wish full I was I yelled and said Dad look at me and he did I then said dad look over the other side and see my friend that was with me and he did. Then I got to ask the shrnk who was nuts and needed help LOL
    Then they said even if he lived which they said was impossible he would be a vegatable. Well he spent three months there and came home. Weeks later he was back working construction with me and he could still do as much as I could. So we have to stay informed and on top of everything it can make a difference and knock a few doctors with big egos down a notch. I could write a book on mistakes made in that ICU but I wouldn't because we did had some really good people that tried all they could.
    OK got off topic but your post brought back memories
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