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Narcotics without Acetaminophen

Hi

I was wondering if and what medications work well for pain without the acetaminophen? I am seeing my Dr next month and would like to consider a different medication other than Norco. I worry about long term use and my liver. But all meds are filtered through the liver right? I should mention I have a very weak stomach, and NSAID or Advil are not an option for me without the risk of ulcers or stomach pain. My Dr. and I worked for about eight months to find meds I could tolerate. So I have about five meds I am on which each help differently. I am only taking one Narcotic- Norco 10-325 (3x per day)

Thanks in advance
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Comments

  • Hi. I take an extended release med & Oxycodone (no Tylenol) as my breakthrough med. I have a compounded topical cream that contains numbing, muscle relaxing & nerve meds. My body couldn't tolerate any of the nerve meds & I had a health scare last year which made me septic, damaging some of my internal organs. The compounding pharmacy can put a huge variety of meds into creams. It could be worth talking to your doc about.
    Osteoarthritis & DDD.
  • Hi i'm sorry to hear about your health scare! Can I ask what cream? I use Voltaren Gel as an anti-inflammatory with lidocaine patches too. I've also have been using icy hot & bio freeze. Anything! Thanks for your help.
  • We refer to mine as Ketamine cream because it's the first ingredient on the list. It's 'name' is this very hard to decider list of letters & numbers that represent the medications & doses that have been compounded in mine. Mine has ketamine & lidocaine to numb, muscle relaxants (eg Baclofen) & nerve meds (eg Gabapentin) & some other stuff. I have quite a variety of issues so my 'recipie' will probably be a bit different from yours.

    It's prescription & very expensive. Some insurance companies seem support compounding pharmacies & some don't to my knowledge. I'd advise anyone to phone the pharmacy direct if you're having financial issues. I know of some great support from them. I've never had to pay for mine.

    In my experience it's a very different medicine from the things (I've also tried) on your list ;-)
    Osteoarthritis & DDD.
  • Thanks English Girl for all your suggestions!
  • Robin Longstride said:
    Hi

    I was wondering if and what medications work well for pain without the acetaminophen? I am seeing my Dr next month and would like to consider a different medication other than Norco. I worry about long term use and my liver. But all meds are filtered through the liver right? I should mention I have a very weak stomach, and NSAID or Advil are not an option for me without the risk of ulcers or stomach pain. My Dr. and I worked for about eight months to find meds I could tolerate. So I have about five meds I am on which each help differently. I am only taking one Narcotic- Norco 10-325 (3x per day)

    Thanks in advance
    The main reason for adding acetaminophen to opioids is to allow doctors to monitor patients for abuse by checking their liver function via blood tests. Schedule numbers are assigned to drugs according to effectiveness and potential for abuse, with higher numbers being safer. Higher Schedule numbered drugs also have relaxed restrictions on prescription methods and refills. Almost every opioid is available without acetaminophen but that often decreases the Schedule number. Until recently, Norco was Schedule III and hydrocodone without acetaminophen was Schedule II. Now, they are both Schedule II.

    There are two Schedule IV opioids without acetaminophen:

    1. Tramadol - Oral tramadol doesn't work in many patients.
    2. Pentazocine/Naloxone (generic Talwin NX) - Not subsidized by most insurance.

    For me, Pentazocine/Naloxone is very effective and I have never seen a bad user review.
    Steve
  • Thanks Steve. I'm not sure about your first statement. To be honest that sounds a bit 'conspiracy' to me. They wouldn't intentionally poison us with Tylenol just to check for abuse. Would they? Many docs never check liver function & addicts arent known for considering their liver health first. I thought that acetaminophen helped the narcotics get into our brains? I know it's also to stop abuse, snorting, injecting etc. isn't it? I'm confused! I thought they reduced the amount of acetaminophen with Hydrocodone because 325 was the effective dose? Ugh!

    My doc is very anti acetaminophen. He thinks the maximum daily shouldn't go above 2000 for regular use. Wow! In the past I had a prescription for 12x 10mg hydro/acetaminophen a day!!! That was one of the reasons I stopped all meds for nearly a year back then. My old PM would only prescribe that & it just kept going up. It terrified me.
    Now I only take 'straight' narcotics, morphine ER & Oxycodone. I change the ER when I get tolerant rather than increasing dose. I cycle through all the regular ones. Methadone has been discussed but I'm hesitant to take that jump. (bias, long half-life, surgery care concerns etc). I really don't like having to take strong meds everyday. I use every other modality that works even a little but I just can't function in my life without narcotic therapy. I've tried! I really wanted the all natural approach but after being lectured on the damage unmanaged pain causes & realizing that I simply couldn't cope I changed my mind.

    At the end of the day it's the lesser of 'evils' for me. We do what we need to!
    Osteoarthritis & DDD.
  • I believe the reason they lowered the acetominophen in prescription opiates was because of the high doses of acetominophen in OTC products, and cold and flu meds ,plus the risk of liver damage, in consumers taking prescribed meds that also contained tylenol products. Hydrocodone and oxycodone products used to contain 500 mg or 750 mg of tylenol, along with the opiate, and taken 6 times a day,along with a cold or flu med, or more tylenol containing products could cause serious damage.
    For people who take a medication with tylenol on a regular basis, and use other OTC meds, they reduced the total amount of tylenol to 2 grams (2000 mg.) Per day as the suggested level.
    For others who don't take tylenol containing products regularly, I believe the total daily dose is 3 grams (3000 mg).
    I have never heard of the claim that they added tylenol to be able to test for abuse or misuse.


  • EnglishGirl said:
    Thanks Steve. I'm not sure about your first statement. To be honest that sounds a bit 'conspiracy' to me. They wouldn't intentionally poison us with Tylenol just to check for abuse. Would they?
    At least, you understand that they are intentionally poisoning you.
    EnglishGirl said:
    Many docs never check liver function & addicts arent known for considering their liver health first.
    Everybody on statins or fibrates is supposed to take liver tests. I believe that liver tests are also a common part of Medicare Wellness Exams. At least, I get them with my Wellness exam. If liver function suddenly tests bad, an opioid prescribing doctor should be able to connect the dots. What a coincidence!
    EnglishGirl said:
    I thought that acetaminophen helped the narcotics get into our brains?
    No.
    EnglishGirl said:
    I know it's also to stop abuse, snorting, injecting etc. isn't it? I'm confused!
    No, because Naloxone does that better without poisoning you. But, with Naloxone, liver tests can't be used to monitor patients for oral abuse.
    EnglishGirl said:
    We do what we need to!
    I told you what to do in my first post. First try Tramadol because it is inexpensive, and, if that doesn't work well for you, as it likely won't, try the more expensive pentazocine/naloxone. If pentazozine/naloxone doesn't work well for you, I'll be very surprised.
    Steve
  • Steve. I don't think that they're 'intentionally poisoning us'. There are far more effective ways of testing for abuse of meds. There are many other things that can also effect liver function. Pill counts & random urine tests are common tools for a suspicious doc to use. Sandi's explanation makes more sense to me.... Fortunately I've never had problems with addiction & my docs have never been concerned with my narcotic use (other than not wanting to take them in the past but I'm over that now).

    To be honest I've never even heard of Pentazozine & Naloxone. I thought I'd tried most meds over the years. I did a quick search & it says Naloxone is an abuse deterrent. Why would I want to take that? I currently take Morphine ER & Oxycodone (no acetaminophen) for breakthrough. I change my ER when I become tolerant. It works for me.
    Can I ask why you believe Pentazozine & Naloxone are a better option? This is clearly something you've researched. I'm interested in others views.
    Osteoarthritis & DDD.
  • Pentazocine/Nalaxone is the bottom of the barrel of narcotics. It has the least analgesic effect compared to other opiates and it does not scale. You can not take it in high dosages or you will fill sick. It was designed for people with low pain and are at risk of addiction.

    If you find it works for you great but I personally would not waste time with it. There are plenty of opiate charts publicly available that a person can learn from and I am surprised that Spine-health doesn't have them on the site to prevent bad recommendations such as Pentozocine.
  • Thank you Wolfpack. I'd never even heard of it & it's a confusing one to search on because of the deterrent med & there seems to be an old version that was withdrawn which confused me further. I like knowing what members are talking about!

    At the end of the day I trust my doc to take care of me. We talk openly about everything. I've got a good one ;-)
    Osteoarthritis & DDD.
  • WolfpackSVB said:

    Item 1: is incorrect and is certainly not how most places check for abuse.
    Whether most places check for abuse this way is irrelevant. The fact is that liver function tests can reveal acetaminophen abuse.
    WolfpackSVB said:

    Item 2: Try taking it immediately after surgery and see how well it does for you. Then scale up to knock out the pain and see how you feel.
    Is this what you did or are you just pretending to talk from experience? In 1978, I was given pentazocine by injection after surgery and it worked fine.
    WolfpackSVB said:

    Please stop with the Pentazocine. It is a dangerous drug for people with serious pain and it probably shouldn't even be on the market when a Tylenol alone would do just as well.
    So, according to you, the Schedule IV ranking of pentazocine/naloxone given to it by the DEA is a farce. Have you or have you not tried pentazocine /naloxone?
    Steve
  • EnglishGirl said:
    To be honest I've never even heard of Pentazozine & Naloxone. ...
    Can I ask why you believe Pentazozine & Naloxone are a better option?
    Google:

    "talwin nx" reviews

    Read the user reviews in the top link. Do you think that they are lying?

    The DEA has given pentazocine/naloxone a Schedule IV rating with regard to effectiveness and potential for abuse. Either you believe that the DEA knows what it is doing or not.
    EnglishGirl said:
    I did a quick search & it says Naloxone is an abuse deterrent. Why would I want to take that?
    You shouldn't care one way or the other about Naloxone because oral ingestion of Naloxone has no effect Naloxone is there to prevent abuse by injection.
    Steve
  • I’m sorry that you got caught up in the anti-drug craze all I can say is good luck with Pentozocine, Darwin will take care of who is right and who is wrong.

    For those of us that choose to read I would suggest researching opioid conversion charts. It is difficult to find Pentazocine because the medical field has moved away from it but you can still find it if you search. It is right there at the bottom of the analgesia “pain reduction” charts and right at the top for toxicity, especially the elderly. It also has a ceiling effect on pain reduction so no dice on that.

    The key to understanding the charts and opioids themselves is in learning how they are metabolized and what their byproducts are. For all practical purposes you should only be concerned with Oral and not IV preparations since it is unlikely that you will be self-administering injections.

    It would be nice if Spine-Health published a chart so people can make up their own minds. I can only say that I intend to steer clear of the Tramadols and the Pentazocines of the world. I would instead take a better and cleaner opiate and if the pain is not that great then drop to a Tylenol or none at all.

    Cheers
  • Google:

    "talwin nx" reviews

    and read the user reviews in the top link. Do you suppose that many of those people are lying?
    Steve
  • WolfpackSVB said:

    I’m sorry that you got caught up in the anti-drug craze all I can say is good luck with Pentozocine, Darwin will take care of who is right and who is wrong.

    For those of us that choose to read I would suggest researching opioid conversion charts. It is difficult to find Pentazocine because the medical field has moved away from it but you can still find it if you search. It is right there at the bottom of the analgesia “pain reduction” charts and right at the top for toxicity, especially the elderly. It also has a ceiling effect on pain reduction so no dice on that.

    The key to understanding the charts and opioids themselves is in learning how they are metabolized and what their byproducts are. For all practical purposes you should only be concerned with Oral and not IV preparations since it is unlikely that you will be self-administering injections.

    It would be nice if Spine-Health published a chart so people can make up their own minds. I can only say that I intend to steer clear of the Tramadols and the Pentazocines of the world. I would instead take a better and cleaner opiate and if the pain is not that great then drop to a Tylenol or none at all.

    Cheers
    In other words, you haven't tried it and you believe that the DEA's Schedule IV assignment to pentazocine/naloxone is a farce. Since you like to read, please, do me a favor. Try to find reported cases of death from oral ingestion of pentazocine. I was only able to find two reported cases, both suicides. Now, please, repeat for oxycodone.
    Steve
  • EnglishGirlEEnglishGirl Posts: 1,825
    edited 07/17/2015 - 1:01 PM
    The reviews are in 'usefulness' order. There are many negatives on page 2. In my experience all medications have positives (or they're not allowed) & negatives. We're all different & different meds have different results & side effects. At the end of the day our doctors are there to advise us.

    The tone of this conversation is getting a bit unpleasant now ;-(
    Osteoarthritis & DDD.
  • I'm sorry the last post wasn't there when I hit save!
    Osteoarthritis & DDD.
  • The new formula of Hyrodocone does not have any acetaminophen. The brand names are Hysingla ER and Zohydro ER for instance. Hysingla ER has approved abuse-deterrent labeling. These are extended-release medications. Morphine, Oxycodone, Hydromorphone, are some other opiates without acetaminophen.
    At least there are some choices out there for us!!
  • Good evening and Happy Weekend,

    While no chart is perfect and they can be difficult to read I have listed a few links. My own personal opinion is that the level of pain should guide which medicine you take and that you should have no concern of what society or others think. You might notice that the great Pentazocine is not listed on many because it is being phased out. If you do some searches on Analgesia, Opioid Conversion, or Opioid Metabolism you can find plenty of material to make a sound decision and the good thing is it can be done without the Wolfpack and ARuzinsky involved.

  • I'm sorry for the people that have misused and even died from taking too many opiates but I'm not in the camp that places the blame on the medicine. I also am not of the belief that I or others should shoulder the burden of taking a less potent analgesic that does more damage to my body than others do so that society can be appeased. The simple fact is that the level of pain and a person's own tolerance for a given medicine should drive the treatment.

    Oxycodone is one the greatest medicines ever created. Couple a long acting Oxycodone with a short acting Norco and you can have a person formerly in pain fully functioning in society. Someone that is able to work, to enjoy their family, go to the gym and have an all around good time. You can not reach the people that are in significant pain with Tramadol or Pentazocine. This is not my opinion the analgesic charts are available for everyone to read. I'm sorry to tell you this but Pentazocine is for low end pain and is being phased out.

    To the original poster you might need to find a good PM to cycle you through different meds until you find the right mix but one of the best combinations available is a long acting Oxycodone with a short acting Hydrocodone. If those don't work for you then try opiates that have different byproducts until you find the ones that your body metabolizes well. There are three main divisions in the opiates. They were created for a number of reasons but the most important is to make sure that pain relief exists for all people.

    Best wishes
  • aruzinsky said:

    Item 1 The main reason for adding acetaminophen to opioids is to allow doctors to monitor patients for abuse by checking their liver function via blood tests.

    Item 2 For me, Pentazocine/Naloxone is very effective and I have never seen a bad user review.
    Item 1: is incorrect and is certainly not how most places check for abuse. The abuse topic isn't even brought up with my PM and I take a schedule II opiate that has zero additives. I do however, take urine tests, do pill counts, and have sit down discussions where they are trying to figure out if I continue to need opiates or not. They also try to catch a person in a lie and I am glad that do these things, it filters out the drug seekers.

    Item 2: Try taking it immediately after surgery and see how well it does for you. Then scale up to knock out the pain and see how you feel.

    Please stop with the Pentazocine. It is a dangerous drug for people with serious pain and it probably shouldn't even be on the market when a Tylenol alone would do just as well.

    Best of luck
  • WolfpackSVB said:
    You can not take it in high dosages or you will fill sick.
    For me, 150 mg of pentazocine feels exactly the same as 20 mg of methadone, except shorter duration. The worst side effect of both is that they cause a muscle in my ear to spasm, vibrating my eardrum. Do you regard 20 mg of methadone to have a strong analgesic effect?
    WolfpackSVB said:
    If you find it works for you great but I personally would not waste time with it.
    Therein lies the crux of your argument. I am saying that pentazocine is worth a try and you are saying that even trying it is a waste of time. Your stance is irrational. The worst that can happen from trying it is that a small amount of time and money are lost and a short period of pain is gained.

    You have ignored two important variables in your argument:

    1. acquired resistance
    2. withdrawal symptoms

    The best that can happen from trying pentazocine is that you will be spared pain, withdrawal symptoms, and acquired resistance. You will become more appreciative of these variables, if and when you stop taking your opioids. Then you may wish you that had tried pentazocine.
    WolfpackSVB said:
    There are plenty of opiate charts publicly available that a person can learn from and I am surprised that Spine-health doesn't have them on the site to prevent bad recommendations such as Pentozocine.
    Those charts are suspect because they are not papers published in peer reviewed scientific journals. Your usage of "bad recommendations" is a logical fallacy called "begging the question."
    Steve
  • NursesAREangels :-). Great recommendations for the OP. I also have prescription compounded topical meds. For anyone who has liver fears or weakness already that's an alternative to traditional meds.
    Osteoarthritis & DDD.
  • amcneeseaamcneese va beachPosts: 1
    The main reason they add acetaminophen to opioids is that they have found it works better in combination.  Pain levels are reported lower,  in addition, patients are better able to operate ADLs on the medication.  Checking liver enzymes typically is to test the function of the organ, not to see if abuse has occurred.  But I'm sure it happens.
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