FDA Panel Votes to Eliminate Vicodin and Percocet

i heard that tonight as well...
that they'll end up removing the acetaminophen from the percs and vicodin.
it's too bad that some folks choose to ignore the use of their God-given brains.

leslie

have seen 2 recent deaths of patients purposely overdosing themselves with tylenol...their liver was toast......what will happen is they will take the tylenol out of these drugs....they usually are available in a plain form as well...my understanding for these combinations in pain medications was for the synergistic effect....or in other words...BETTER pain relief

Part of it is that people drop 60 IQ points when they get sick -- I know I do.

Let's say I have a cold. I can't breathe thru my nose, I grab the Nyquil. Can't find the stupid little cup, feel too crappy to go to the kitchen, so I just take a swig out of the bottle. Little bit later, I feel feverish, so I take a couple of extra strength tylenol to bring down my fever. In the middle of the night, still can't sleep, feel horrible, so I grab a Tylenol PM. And since crap happens in herds, I'd probably have cramps and wolf down a couple of Pamprin. So, in my mythical example, how much acetaminophen did I just take?

2 pamprin max -- 500 mg
A good swallow of Nyquil -- well, a tablespoon is 500mg, so I'd guess 1000mg, maybe 1500.
2 extra strength "aspirin free pain reliever" gels for my fever -- 1000 mg
2 tylenol PMs -- another 1000mg.

So there you have it. In the course of one sleepless snot ridden/cramp ridden night, a person can easily ingest 4000mg of acetaminophen within 8 hours. We've just hit the magic 4 gram cut off. And since the average dose that can cause liver failure is 24 grams, if they've got anything else going on (like arthritis, recent surgery, etc.), it would be very easy for them to accidentally overdose.

The easiest thing I can see (rather than making them sign for it, or taking it off the market) is put the active ingredients in as large of a print as the product name. Without my glasses, I can't read the ingredient lists; you get some LOM or LOL with vision problems, they may hear about the problems, but think it's Tylenol, not acetaminophen that's the issue, not even be able to read the ingredient list on other OTCs containing acetaminophen and self medicate themselves right into the grave.

Hydrocodone and oxycodone are both available without the added acetominophen, and no one I'm aware of is talking about taking those medications off the market -- it's just the risk of people inadvertantly ODing on acetaminophen that is the problem. And, really, if you're taking a narcotic for pain, isn't the acetaminophen added in just "spitting in the ocean," as the saying goes?

I read the article.
Acetaminophen is the culprit. I got that.
I guess maybe I misunderstood or misread the part where it was mentioned that the Government wanted to have Vicodin and Percocet eliminated because of the acetaminophen IN those prescribed drugs?
"Government experts say prescription drugs like Vicodin and Percocet that combine a popular painkiller with stronger narcotics should be eliminated"

I am reading this as: they want Vicodin and Percocet pulled because they have acetaminophen in them.
I was told that one reason acetaminophen was added to Vicodin/Percocet was to deter the abuse from injecting and snorting them.

Well, we already have Percocet without acetaminophen on the market....it is called Oxycontin. We all know how eager MDs are to write those scripts out.

And Hydrocodone (which is in Vicodin) is not available in pure form in the United States due to a separate regulation, and is always sold with an NSAID, acetaminophen, antihistamine, expectorant, or homatropine. The cough preparation Codiclear DH is the purest US hydrocodone item, containing guaifenesin and small amounts of ethanol as active ingredients. In Germany and elsewhere, hydrocodone is available as single-active-ingredient tablets as Dicodid (by analogy to the original manufacturer's other products Dilaudid and Dinarkon and others) available in 5- and 10-mg strengths.

Can a mod please change the title of the thread to, "FDA Panel votes to eliminate Vicodin and Percocet?

I realize it is a small difference, but changes the meaing of the title entirely, since a panel's recommendations are not binding, and the FDA itself has not ruled on the issue.

Done.

Thanks for pointing that out, Jolie. It does change things quite a bit.

Either a drug is available for sale and use in the U.S. or it isn't. The FDA does not establish rules stating that a drug can be used in the hospital setting only. If the FDA panel's recommendation is accepted, these combination drugs will no longer be available for use in the U.S.

I agree that what is needed is a massive public and professional education campaign regarding acetaminophen content and maximum safe daily dosages. I believe it is unwise and unnecessary to remove combnation drugs from the market, as they provide safe and highly effective pain relief to millions of patients.

The purpose of combination drugs is to obtain the unique benefits of both classes of drugs while reducing the necessary dosages of both. Without mixing with acetaminophen, a higher dose of narcotic will be necessary. That is hardly without risk, either.

AGREED! A lot of patients do not know that Vicodin and Percocet contain acetaminophen in them. If they're taking that + actual Tylenol on top of that, they're more prone to overdose. Lol my patient's husband was telling me about this today during clinical saying that the FDA was going to pull this really strong pain killer off the market because of overdose...I asked him what it was and he replied "acetaminophen" - it made me smile, bceause you know, acetaminophen is just Tylenol lol. He kept asking if the Zosyn that I hung had "acetaminophen" in it...

Personally, I like the idea of separating the drugs from each other. I know that acetaminophen and hydrocodone (or oxycodone) taken together work very well for moderate pain, but this can be accomplished by taking the medications separately. Even in the hospital setting, it is easy to find yourself getting close to that 4gm acetaminophen limit if you have a patient who , for example, takes both percocet and tylenol.

So, using this example, having tylenol and immediate release oxycodone ordered could be a lot more useful and allows more wiggle room for finding the right combo for pain control.