>At the pharmacy of the hospital where I work. occasionally I see 1.5 to 3
>regular strength vicodin/lortabs (500mg APAP/5mg hydrocodone bitartrate)
>used as the equivalency for 1 to 2 Vicodan ES (500mg APAP/7.5mg hydrocodone
>bitartrate).

Vicodin ES has _750mg_ APAP/7.5mg hydrocodone.  Therefore, this dose
is equivalent to 1.5 times the regular strength Vicodin.

Ian Wendt

: Greetings….
: Been taking lots of vicodin to deal with spinal-stenosis and other
: chronic soft tissue and nerve damage.

: How much and how long can i take this stuff without hurting myself?

: Any alternatives in the opiate family of medications?

: Thanks!

: —
: LZ/Nightline BBS 510-834-0837

I, too, have had to take Vicodin ES and Vicodin over prolonged periods in
order to get relief from sciatic nerve pain caused by scar tissue
from a crushed disk fifteen years ago and, later, surgery which bound up the
root nerves to both legs.

One of my concerns, and my doctor’s, was the possibility of liver damage
from the APAP. At one point last year I was taking 6gms. per day and we
began a search for an alternative after an abnormal liver panel.

There are several possibilities that are safer than the Vicodin or
Vicodin ES preparations.

One that works is Lortab 10′s. 500mg. APAP/10mg. Hydrocodone Bitartrate.
Another that we found is a cold preparation called Hycodan. It
contains 5mg. of Hydrocodone Bitartrate and a low dose of Homoatropine.

If you can tolerate the drying effect of the beladonna type drug on your
sinuses, the toxicity is better tolerated by the body and does tend to
extend the effect of the narcotic by slowing down excretion of the narcotic.
I don’t recommend taking more of this drug than you are prescribed as
belladonna (deadly nightshade) and similar drugs in this class are very
poisonous if abused. Death from this type of drug is not a pleasant way
to die.

A couple people I know have had good results with either Duramorph or
Fentanyl transdermal skin patches. This is a Schedule II drug and
requires a triplicate from your doctor which can be hard to get him to
agree to write. Mine doctor won’t. On the plus side, the patches
last for 3 days and give an even amount of pain killer to the body so you
don’t slide in and out of pain and/or a drugged state constantly.

Another possibility has been mentioned in another thread in this group.
Stadol (Butorphanol) is a potent narcotic that had been used as a
presurgical analgesic. It comes in a nasal spray form and is not a
scheduled substance. I don’t have any information on the long-term
effects of using such a preparation on the nasal mucosa or it’s addictive
potential. It does require more frequent administration. Every two hours as
opposed to one or two tablets of a Hydrocodone preparation every four to six
hours. I can’t speak from experience about this drug as the Vicodin ES is
working for now.

Another alternate is Talwin HCL (Pentazocine Hydrochloride). It, too, is
not a controlled drug (or wasn’t last time I looked it up, it may be
Schdule IV now). It can have bizarre side-effects such as hallucinations and
severe nausea and vomiting. It seems to depend on the individual. The first
time I took it I became very sick and hallucinated. It did have almost as good
an analgesic effect as Hydrocodone, but the side-effects were
intolerable. Several years later, I tried it again, and didn’t experience
any of the side effects and was able to tolerate it well. Go figure…

Another alternative is the synergist effect of Soma and Vicodin. Soma tends
to have a neuresthenic (nerve anesthetic) effect on some people. I’m one of
those types, and the combined effect of one Vicodin and one Soma is more
than the effect of two Vicodin ES. Unfortunately, Soma (Carisoprodol) can
have a damaging effect on the nervous system over a long time according to a
Dentist/Chemist friend of mine, so rotating off of it is a good idea
periodically. Apparently it can, he believes, cause the nerve impulses to
arch across the nerve ganglions producing severe pain and crippling. This
becomes permenent. There is a disease that does this. The name escapes me
now. It’s also addictive. Something most doctors don’t seem to recognize
readily. The withdrawal is something I don’t want to have to go through
again anytime soon. Migraine headache continously for over a month.

Some things that enhance the effect of narcotics are the antihistamine
class of drugs. Vistaril is often mixed as an injection with Morphine or
Demerol to enhance it’s effect and reduce nausea. The same or similar
effects can be produced with other drugs in the same class. I discovered
this by accident when I was given Seldane for a cold a few years ago.
Other drugs that might work and that are over-the-counter preparations are
Chloropheniramine Maleate, Bromopheniramine and Benadryl. If your
going to use these to cut down on the amount of narcotic required, I’d
suggest following the directions on the label closely. More is not better
with this type of drug and anaphylatic shock can take hold with an overdose.

Although, drugs are an "easy" way to control your pain, I’d suggest regular
exercise and proper diet/weight control as one of the best long-term
methods of pain control for chronic conditions like ours. Without them
and a willingness to stop the drugs, if and when they are not needed, an
early death is likely. Unless damage occurs to the liver, recovery from
imbalances in liver enzymes reverse themselves and disappear completely
when APAP dosage is stopped.

I was able to stop the narcotic and be relatively pain-free for a seven month
period this year. Unfortunately, I wound up out of work in a layoff and got
depressed and started overeating. So I’m in physical therapy and a weight
reduction class with the intent of getting off the drugs again.

One component of chronic pain is depression and alot of other pain
patients that I know have had excellent results with the antidepressant
type drugs. I seem to be allergic to them across three classes of
antidepressants so that isn’t an option for me.

Included in that group are Prozac, Zoloft, and Wellbutrin, being the
newer drugs on the market. Lithum Carbonate, Desipramine, and Elavil are
some of the older drugs.

Good luck, I know it’s difficult to manage, but you can if you will only try
to rise above the pain and enjoy your life in spite of the pain.

Regards,
Mike
—

>At the pharmacy of the hospital where I work. occasionally I see 1.5 to 3
>regular strength vicodin/lortabs (500mg APAP/5mg hydrocodone bitartrate)
>used as the equivalency for 1 to 2 Vicodan ES (500mg APAP/7.5mg hydrocodone
>bitartrate).  To me, this is clearly not equivalent, but even when I have
>questioned it on the pink copy of the triplicate MAR (that is the one that
>is sent back to the Pharmacy with corrections made on the 24 hour checks),
>I don’t think anything has been done about it.

I don’t have a reference handy, but I think that Vicodin ES contains 7.5mg
of hydrocodone and 750mg APAP (same as 1.5 regular Vicodins).  On the other
hand, Lortab 7s contain 7.5mg hydrocodone and just 500mg APAP.  The fact that
the two chemicals seem to be commercially *joined-at-the-hip*, is yet another
side-effect of the "War-on-Drugs" (i.e. hydrocodone could be available w/o
APAP if the US government wasn’t so scared of everyone mainlining it!).

– laure…@fx.net

>You should be cautious about taking more than 5 grams (5000mg)
>of acetaminophen in a 24 hour period (that’s 10 regular Vicodin tablets).

To my knowledge the recommended maximum APAP dose is 4 grams in 24
hours.  At this level, liver enzyme abnormalities begin to appear.

Ian Wendt

: In <33vhju$…@fx.net> laure…@fx.net (Laurence Josserand) wrotes:

: >You should be cautious about taking more than 5 grams (5000mg)
: >of acetaminophen in a 24 hour period (that’s 10 regular Vicodin tablets).

: To my knowledge the recommended maximum APAP dose is 4 grams in 24
: hours.  At this level, liver enzyme abnormalities begin to appear.

Speaking of which, I have an interesting question.  Actually, I am trying
to seek verification of something more than asking a question, but here
goes….

At the pharmacy of the hospital where I work. occasionally I see 1.5 to 3
regular strength vicodin/lortabs (500mg APAP/5mg hydrocodone bitartrate)
used as the equivalency for 1 to 2 Vicodan ES (500mg APAP/7.5mg hydrocodone
bitartrate).  To me, this is clearly not equivalent, but even when I have
questioned it on the pink copy of the triplicate MAR (that is the one that
is sent back to the Pharmacy with corrections made on the 24 hour checks),
I don’t think anything has been done about it.

First of all, am I correct?

Second, does anyone have any suggestions as to how to try to correct the
situation, because I am worried about people getting too much APAP.  And I
have seen the full 3 Lortab Regular Strength tabs given!!!  Not for more
than a dose in a full days time, but for someone who is having a fair bit
of pain after surgery and is trying to stay away from injectable
medicines, they could easily get an overdose of tylenol.

Any insight would be greatly appreciated.

–
Elisa H. Casey
ehc5…@gold.acns.fsu.edu
My thoughts are mine; no one else wants them!!

>Talwin (pentazocine) may be roughly equivalent, and it’s Schedule IV.

Be careful with this drug. I had a terrible (psycho??) reaction
to it.  Not an experience I want to repeat.  I reckon some people
can not take it.  They react violently to it.  I was one of
them.
M. Gottesman

Vicodin contains hydrocodone which carries the usual opiate addiction concerns.
But perhaps more dangerous is the acetaminophen (Tylenol), which in very large
quantities (or even moderate+ quantities over long periods) can cause serious
liver damage.  You should be cautious about taking more than 5 grams (5000mg)
of acetaminophen in a 24 hour period (that’s 10 regular Vicodin tablets).
You could ask your doctor, but I’ve always found most MDs to be strangely
unconcerned about the well-known risks of acetaminophen poisoning.

>Any alternatives in the opiate family of medications?

Actually, hydrocodone is arguably the strongest opiate below the Schedule II
stuff (morphine, etc. – which is very restricted and your doctor may not be
willing to go for).  I’m not sure if hydrocodone is available with aspirin?
Darvon (propoxephene) would probably be a step down, as would plain codeine.
Talwin (pentazocine) may be roughly equivalent, and it’s Schedule IV.
Percodan (oxycodone/aspirin) would be a step up, but it’s on Schedule II.

– laure…@fx.net