FDA Panel Votes to Eliminate Vicodin and Percocet - page 11

"Government experts say prescription drugs like Vicodin and Percocet that combine a popular painkiller with stronger narcotics should be eliminated because of their role in deadly overdoses. A Food... Read More

  1. by   AtomicWoman
    Quote from OBTECH01
    no vicodin or percocet, lets see I wonder now how long it will be before the overdose rate on tylenol and advil spike back up. Post-Surgical patients have to be able to go home with something other than good ol' tylenol or advil dont believe me you just be a post-op pt. This is not a good idea it is more about pt. education than anything else.
    It's highly unlikely that post-op patients will no longer be given pain meds. What is likely, however, is that their pain meds. will change to those formulations that do not contain Tylenol. If I were a doctor, I would now be very reluctant to prescribe the combo meds. that contain acetaminophen, since the word is out about their dangers. Sounds like something a lawyer would jump on right away.

    As for chronic pain, I've learned a lot about that in the process of getting my husband help for his pain. In pain management, the mantra is that chronic pain needs to be treated with long-acting opoids plus short-acting opioids for breakthrough pain. The long-acting opiods don't contain NSAIDs, and there are plenty of short-acting opioids (hyodromorphone, oxycodone IR, etc.) that don't contain NSAIDs as well. My husband's doctor refers to the short-acting meds that contain any kind of NSAID as "that crap", because they are bad for your liver (Tylenol) and/or your stomach (Motrin, aspirin).
  2. by   AtomicWoman
    Just wanted to give a citation to an article about the connection between acute liver failure (ALF) and acetaminophen:

    Larson AM, Polson J, Fontana RJ, Davern TJ, Lalani E, Hynan LS, Reisch JS, Schiodt FV, Ostapowicz G, Shakil AO, et al. (2005) Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology 42: 1364-1372.

    Just a snippet from their concluding remarks:

    "In conclusion, acetaminophen poisoning now accounts for at least 42% of U.S. acute liver failure cases seen at tertiary-care centers and one third of the deaths. Unintentional overdose is the leading form of acetaminophen hepatotoxicity in U.S. ALF subjects, but suicidal ingestions remain important as well. Susceptible patients include those with chronic pain, depression, and substance abuse, including alcohol."

    (My emphasis). The article, of course is much longer and complexly-argued, but I didn't want to put a long quotation in.
  3. by   CapeCodMermaid
    So we have this patient...she takes 12 percocet a day for horrible pain from a fracture. I asked the doc to change her to oxycontin 30 mg BID with Oxy IR for breakthrough....same pain relief...no APAP. He looked at me like I was insane. I'll be calling him again tomorrow.
  4. by   morte
    Quote from CapeCodMermaid
    So we have this patient...she takes 12 percocet a day for horrible pain from a fracture. I asked the doc to change her to oxycontin 30 mg BID with Oxy IR for breakthrough....same pain relief...no APAP. He looked at me like I was insane. I'll be calling him again tomorrow.
    how old is the patient?
  5. by   kanzi monkey
    Quote from CapeCodMermaid
    So we have this patient...she takes 12 percocet a day for horrible pain from a fracture. I asked the doc to change her to oxycontin 30 mg BID with Oxy IR for breakthrough....same pain relief...no APAP. He looked at me like I was insane. I'll be calling him again tomorrow.
    What kind of fx? Did she have surgery? How long ago was her injury? Are the 12 percs working for her? If they are, this is not technically too much acetaminophen (if they are 5/325 tabs). If she's not going to have surgery, and that dose is working for her, I wouldn't change it (unless there is risk for acetaminophen OD or liver damage w/ etoh, etc). If it WAS changed, I think oxycodone IR alone should be fine. This is assuming she's not recovering from a surgery, has a history of opiate use, or has other chronic pain issues.
  6. by   CapeCodMermaid
    64
    postop ankle fx...had horrible intractable pain in the hospital requiring IV morphine. She is petrified of being in pain again so she keeps taking the percs. Very smart woman...no substance abuse history that we are aware of. Anyway, she's going home on Friday and her pain has been managed.
  7. by   AtomicWoman
    Quote from CapeCodMermaid
    64
    postop ankle fx...had horrible intractable pain in the hospital requiring IV morphine. She is petrified of being in pain again so she keeps taking the percs. Very smart woman...no substance abuse history that we are aware of. Anyway, she's going home on Friday and her pain has been managed.
    Has she been evaluated for CRPS? I've heard of CRPS beginning quickly after surgery. Only reason I bring it up is because you said the pain had been intractable.
  8. by   DManAZRN
    WOW, why stop there? Why not "Ban" oxycontin, the newest most abused drug in pill form society has ever seen? Must have gotten a kickback from the drug companies and a certain fat radio show host....

    We hand out dilaudid like candy here. How about banning IVP narcotics on patients capable of taking PO pills?

    Oh God the logic,
    Oh the humanity....
  9. by   Pierrette
    Quote from Pierrette
    Even water is harmful if too much is ingested.
    "The parent company of a local radio station engaged in the first day of a wrongful death lawsuit after a contestant died on a morning drive program more than two years ago."

    http://www.sacramentopress.com/headl...ter_Death_Suit

    "Strange, 28, died Jan. 12, 2007 of water intoxication, or hyponatremia, after drinking more than 1.5 gallons of water while taking part in a "Hold Your Wee for a Wii" contest."

    http://www.onpointnews.com/NEWS/Radi...Own-Death.html
  10. by   sethmctenn
    The FDA created this issue by requiring narcotics in schedules III, IV, and V to have other ingredients with them that limit the total dose/day someone can take. This means that hydrocodone without tylenol or ibuprofen is actually a schedule II drug. Some compounding pharmacies do make it that way. If they reclassify it as schdule III, then I can see this working. It's wierd though that this is happening right after an attempt to remove darvocet as an option.
  11. by   CapeCodMermaid
    Darvocet is on the Beer's List and is a horrible drug. It SHOULD be taken off the market. It's not very effective and has many metabolites which are harmful to elders.
    It is a pretty pink color though.
  12. by   sethmctenn
    Digoxin, just about all the benzodiazepines, most antihistimines, and many anti-inflammatories are on the Beer's list too but many of them are used often. Every drug has potential side effects. It's up to clinicians and patients to weight the relative risks with the relative benefits.

    I like propoxyphene for me (the old darvon without tylenol). I used it when I had an injury. Ultram didn't cut it. Lortab constipated me. The darvon relieved my pain without any noticible side effects and without giving me a buzz that lots of people seek. Of course, I'm not elderly yet :-) It just seems that there aren't many options for mid level pain relief. I hate to see valid options reduced or eliminated unnecessarily. A black box warning regarding elders could certainly be another option that could have a significant effect on the number of prescriptions written.
  13. by   hypocaffeinemia
    The reason darvocet in particular is a crappy drug is because research shows that there is no pain relief above placebo (propoxyphene-only) or above the acetaminophen in it (darvocet), yet it contains many of the typical opioid side effects and risks.

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