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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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13

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.
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  • 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
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  • 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.
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