Prescription alternative to's panadeine forte (not for abuse purposes)

Hi All,

After many years of using of safely using (aka abusing) codeine based over the counter drugs and the occasional box of Panadeine Forte I unfortunately will be in the need of some powerful painkillers (dental related issues).

That said I have had to use them for many legitimate needs and as a chugs of responsibility and extremely careful and infrequent with my use.

I have however developed a fearsome tolerance that doesn't seem to dissipate even after many months of no use, and have several qualms about eating Panadeine Forte (5-8 in one hit) in order to receive the expected and required pain relief (dental surgery in question = very awful pain), especially with concerns about my poor ole liver is going when it chews over 3grams of paracetamol at a time.

That said I am equally aware of the medical professions instant disregard and absolute bitterness, and hatred for patients that are users of opiates.

I have known someone rather close to me who was to have treatment for hep c withdrawn (temporarily) because they were honest and admitted to smoking cannabis on a regular basis (not excessively though). The nurse in absolute shock horror demanded that he see a drug counselor, this despite the fact that he as a condition to the treatment was already seeing one, ontop of the one he was already seeing (centrelink issues).

Thus I do not want to explain to the medical practitioner that I seem to have a tolerance to codiene as this will create issues, and I equally don't want to be proscribed Panadeine Forte.

I could put it the medical practitioner that I am allergic to paracetamol however I am unaware of the opiate based alternatives that do not contain this NSAIDs. I am sure a medical practitioner would seem it strange that if I was allergic to paracetamol but was unaware of the alternatives (since a only a very small minority are afflicted by this allergy). I do want to avoid suspicions

Therefore I beset you all, what prescribed narcotics are available for strong to extreme pain, which do not have paracetamol, or any other NSAID in them?

You'll be EXTREMELEY lucky to get anything stronger than panadeine forte. There's no other effective pain killers for the sort of pain you'll be in except for the opiates. The only thing i can suggest is Tramadol and do CWE on codeine tablets.And there's nothing to stop you going to see a few doctors in a week to get more fortes.Nitrous oxide works well for pain. I'd drink a little vodka and CWE juice every 3 or 4 hours, smoke a bit of weed (if u smoke) and try to keep your mind of it with movies and games.

thanks. indeed I do potentiate codeine with many of those suggestions (though I really don't smoke anymore). CWE is a bit of pain and again I'd rather not risk the paracetamol that comes through.

Tramadol sounds interesting though. Its sounds like the one of the few prescription alternatives available.

That said can you get prescription codeine without the paracetamol content?

It is available but doctors and dentists like the para combo because it's supposed to help with pain too. Tramadol isn't to bad, bit rough on the guts. It does help though, and most doctors are happy to dish it out.

I wouldnt smoke if you've had dental surgery, can lead to bad stuff.

Just ask a doc. tell them the panadeine forte's aren't enough and you cant sleep, you have a low pain threshold. The worst he will do is not give you anything, just dont come of as a junkie looking for a fix.

Therefore I beset you all, what prescribed narcotics are available for strong to extreme pain, which do not have paracetamol, or any other NSAID in them?

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The thing is, regardless of how painful it might be, your doctor is unlikely to prescribe anything above tramadol. And there's a mile of red tape to go through to get pure codeine. Indeed, the drug is not normally stocked at pharmacies and must be picked up the day it is delivered. At least that's what my wife's mum had to do a few years ago. But her pain was arguably worse - half the flesh on her lower leg had been eaten away by a very nasty infection which also resulted in severe osteomyelitis.

Tramadol is a shit drug IMO, but then again I'm not big on opioids. While it might sound like rubbish, I never take things for toothache, and other than N2O, which has become less and less available at dentists, I have no analgesics or locals for toothwork - That includes pulling of upper wisdom teeth some years ago. I find cloves or clove oil do a wonderful job, but you have to apply it regularly.

Another alternative to tramol might be Dextropropoxyphene, but I'm a bit worried about recommending it to anyone without knowing them well. Your Dr might share similar concerns. Alcohol must be avoided with this drug, and it's not recommended for anyone with opiate abuse problems, suicidal thoughts etc. as OD is common and nearly always fatal. I was prescribed this once for an extreme case of hemorrhoids in the time leading up to surgery. I found it to be moderately effective - at least intitially. Dextropropoxyphene is available in Aus in three preperations; one without paracetamol

Capadex, Paradex and Di-Gesic; Dextropropoxyphene hydrochloride 32.5 mg, paracetamol 325 mg

Doloxene; Dextropropoxyphene Napsylate (2-Naphthalenesulfonic acid)

Still, if I were a dr and knew of your codeine use, I'd give you tramol over propoxyphene, simply because the risk of OD is far lower. Hope that's of some help.

Endone but it's a S8, capadex is ask good, steer clear off anything with asprin or ibofrofan as it will constrict blood cells and you'll bleed more. the other ingrediant in de-degsc/capadex is dextroprplalethine (speelilng?) is called doloene. The tablets are 100mgs. same as three capadex. The shit rocks 300+ mgs, except you only get ten, 50 if lucky.

Endone is instant release. Instant release = euphoria and pain relief for a short time. This - in somebody with a penchant for codeine - WILL lead to addiction.

Oxycontin is the same ingredient (oxycodone) but in a sustained release formulation - lasting 12 hours and not delivering quite the punch of endone. I'd recommend oxycontin, but DON'T go chewing or crushing to get the rush or you will mess with your pain, and start on the road to a serious addiction that will ruin your life as you know it. If you take it sensibly for pain only, oxycontin will work best for your dental pain. It comes in 5mgs right through to 80mgs - which is usually used only in endstage cancer. You would probably be given 10mg to take twice per day.

This is wrong of me to suggest it.. but you could say something like "when I was in the UK I was prescribed (UK equivalent to endone, if it doesn't go by that name) instant release oxycodone - but I didn't like it because it made me feel too sleepy and dizzy. I have heard there is a sustained release one called oxycon - something or other - which won't make me so dizzy and will last longer. Do you think I could try that instead of an instant release one? Also, I've been taking SOOOO much panadol lately that I'm really worried about my liver, so I'd rather avoid anything with paracetamol in it if I could.

You don't want to look as if you know too much, you don't want to look as if you're seeking a high, you want to express your concerns about paracetamol, and you need to let him know your liver has already had a good bashing, but that your pain is such that you've knowingly done this to yourself. He should take you seriously, and if he/she is a good doctor, should be more concerned about the potential for cirrosis of your liver than the potential for addiction!

It makes me mad how many medical profs will put patients at risk of permanent liver damage, just because of their opiophobia.

When working in a transplant ward I met a truckie who had just had a new liver transplanted due to his doctor undertreating his back pain.. leading to this man taking matters into his own hands - 16 panadol per day! It killed his liver and nearly cost him his life - but hey, he didn't become addicted to opiates and make that doctor look bad! Grrrr!

I believe you that you have genuine pain, but given your history you can understand why doctors may be cautious. You need to let them know that you are desperate to the point of abusing panadol to get effective pain relief.

If you do get stuck and can't get prescriptions for what you need, take nurofen plus. Two of these equal almost one panadeine forte. Combine this with painstop daytime strength. You will need 30 mls from a 100 ml bottle, so it will only give you three doses and it gives you the equivalent of two panadol. It's 3/4 as effective as panadeine forte. It's over the counter syryp for children, and is very strong on the codeine. The expense makes it not viable to take often, but good for emergencies. If you need a good sleep take the night time one, it will knock you out.

You can safely take nurafen with panadol, and the combined codeine of nurafen pluss (22 mgs) plus 30 mls of painstop (about 30 mgs) is almost equal to two panadeine forte and is available over the counter. Plus the combined NSAID with paracetamol and codeine is sure to deal effectively with your pain.

But best is to get your tooth fixed hon. And the cloves idea is great. Hold a clove against the gum and the inside of your mouth adjacent to that tooth.

Good luck!

Teddles said:

Endone but it's a S8, capadex is ask good, steer clear off anything with asprin or ibofrofan as it will constrict blood cells and you'll bleed more. the other ingrediant in de-degsc/capadex is dextroprplalethine (speelilng?) is called doloene. The tablets are 100mgs. same as three capadex. The shit rocks 300+ mgs, except you only get ten, 50 if lucky.

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wrong. its 100mg of Dextropropoxyphene Napsylate, there's only 60mg of Dextropropoxyphene (so equiv to ~2x DiGesic)

Also, you wont get anything except Panadeine Forte or Digesic. No dentist is going to write you a script for OxyContin or Endone.

Iv always thought if I needed something for pain id use Rikodeine and nurofen plus togther. duno if it would work

I had my wisdom teeth out just today, under a local and I can usually take a fair bit of pain. However, the Panadine Forte I was given only really helped it for 30 mins then it got painful again, so I decided to drink 100ml of Rikodeine and that seems to have done the trick. The only bad bit was drinking that sugary syrup right after having a tooth pulled. Obviously since it's cough medicine you'll need to source it yourself rather than ask for a prescription at the dentist though.

Hiya all,

Thanks for the flush of advice and information, certainly more then I expected.

A few little things. I've been heavily heavily addicted to many things, heroin, ampthetamaines, alcholol, Tobacco, MDMA, cannabis, nitrous oxide (that was one of the more worse ones, waking up slumped over bulbs on many occasions), LSD, cocaine, food and sex. However those addictions were driven by issues that i've now resolved. It was as amazing to see, years of addiction dropping away with understanding and forgiveness.

Anyway, accordingly i'm free from the ravages of addiction, I might get high a 6-12 a year, if that). Hardly drink (and no longer to get high). As I said i'm a chugs of responsibility. No more ridding the nod express to cabra. Certainly I don't see an addiction potential anymore (to be frank I've got better things to do with my time these days then to sit around getting high).

However my years of hedonisms have certainly not me or my liver (or other major organs) any favours. As I get older I'm increasing my aversion to risk and trying to HM what I do use.

From the sounds of it Tramadol is possibly the only alternative I'll get if I decide to make an issue of it and that said dealing with Dentist and GP's for pain relief is a pain in the ass (tooth). I might just have to ride this painful experience out and simply plan better for the future.

I suspect a patch poppies will produce enough opium for the next time I need a powerful, clean, painkiller. It seems the age of easily obtained pharmaceuticals is moving away from us.

That said I would like to mention something strange that happened the other week.

In a bid to obtain some pain relief I mixed 3 Panadeine Forte (90Mg) with approx 120ml of Rikodeine, perhaps a little more. Which by my calculations is approx 228mg of Dihydrocodeine, a total dose of 318mg of codeine - lets say 350mg because I do remember drinking a bit more then 120ml.

Now I have to admit I might have gone a little overboard (considering I might do this once a month if that) but what is really strange is that in the past, similar doses of Dihydrocodeine, of 250mg plus did not cause a significant antihistamine response. Now I appreciate I might have been a bit low on that neurotransmitter however when I included the Panadeine Forte bam I was getting the whole range of symptoms, itch, nausea etc.

Now I must of missed my Cabramatta pharmacy classes about Dihydrocodeine but is it known to invoke a different antihistamine response in users, as compared with blog standard codeine, and could there be more then one enzyme at play when the codeine is metabolised?

One last thing, Rophynal? Now I do recall never feeling pain on that stuff (holy shit its powerful). Is it still being produced? I could imagine its one hell of a difficult drug to be prescribed for but it is an option i guess?

Now I must of missed my Cabramatta pharmacy classes about Dihydrocodeine but is it known to invoke a different antihistamine response in users, as compared with blog standard codeine...

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I would suggest that if preferential binding occurs with codeine to CYP2D6 it could increase histamine response. It is known that other opioid agonists can increase the toxicity of dihydrocodeine, probably due to increased dihydro binding to non-opioid receptors, which invokes a histamine response. Of course, high doses of either drug are known to cause typical opioid itching etc.

..., and could there be more then one enzyme at play when the codeine is metabolised?

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In non-2D6 deficient people, CYP2D6 is the principle isozyme in first pass metabolism (codeine to morphine, dihydrocodeine to dihydromorphine etc). However, some dihydrocodeine will be converted to nordihydrocodeine via CYP3A4. Whether the levels formed change with co-administration, I don't know.

The next stage of metabolism, (involving relatively lower conversion rates) is O-demethylation via CYP2D6.

One last thing, Rophynal? Now I do recall never feeling pain on that stuff (holy shit its powerful). Is it still being produced? I could imagine its one hell of a difficult drug to be prescribed for but it is an option i guess?

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If I were a dr, typical of those who have a limited knowledge of off-label uses, I'd be suspicious to say the least if such a drug was requested for tooth pain

chugs said:

thanks. indeed I do potentiate codeine with many of those suggestions (though I really don't smoke anymore). CWE is a bit of pain and again I'd rather not risk the paracetamol that comes through.

Tramadol sounds interesting though. Its sounds like the one of the few prescription alternatives available.

That said can you get prescription codeine without the paracetamol content?

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I find tramadol very effective for pain. I use it for back pain and it works great and it lasts a hell of a long time. If I dose 100mg at night it keeps going well into the next day. Although the withdrawal symptoms are not as severe as the most potent opiate agonists (oxy, morph), they still can be quite annoying. If you are to use tramadol make sure you use low doses and have breaks between usage.

My friend is allergic to paracetamol (eek spelling and was recently prescribed codine for tooth pain after she explained the situation to the doctor.

Might be worth looking into

(this is in Australia btw)

Nwalmaer said:

My friend is allergic to paracetamol (eek spelling and was recently prescribed codine for tooth pain after she explained the situation to the doctor.

Might be worth looking into

(this is in Australia btw)

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I gotta say, any dr that hears "I am alergic too ..." is suspicious if the answer is used to try and get a different drug which has recreational value. So if any dr hears "I'm allergic to Paracetemol" he probably won't believe you unless he got tests to prove it. I'm telling you, the dentist will bounce you to a GP if he doesnt want to prescribe strong stuff, and the GP will bounce you back to the dentist. No one will write a script for Rohypnol, or codeine phosphate 30mg tablets (both s8 ) unless you either a elederly / trustworthy patient (ie no one under age 60) or someone with a serious condition (more serious than tooth extraction).
If you dont like paracetemol, use a CWE.

Ok my suggestion to you is get some packs of nurofen plus and do CWE for your required dose of codiene, taking 5-8 tabs of is ALOT of paracetamol and u should be nicer to your liver.

When it comes to dental problems, NSAIDs are MUCH better than paracetamol (only downside is its gotta be taken with food)

So just get some packs of nurofen plus, do a CWE for you required codiene (minus 25.6mg) then take 1-2 tabs of whole nurofen plus.

Prescription wise, i think you're looking at some S8 drugs, or a stronger NSAID such as celecoxib at the least.

Diclofenac is the best NSAID by FAR, & can be applied topically w/ very little systemic absorption. IMHO, it is the only NSAID better than ibuprofen (COX blind).

Could this be a sign of liver damage, the loss of certain isozyme?

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I wouldn't think so. Gene expression could be altered by some toxins, but on the whole, a deficiency in this cytochrome is likely to be caused by not choosing your grandparents wisely i.e. genetic factors.

It's often stated that ~ 20% of the population have a 2D6 deficiency. For these people, when metabolising most drugs and endogenous compounds, other cytochromes will take the place of 2D6.

To work out if you're deficient is not that easy for the average Joe. I believe there are some pathology labs that can do it, but it's probably very expensive. I'd assume a drug would be given and the metabolites in urine analysed. Certain compounds are 2D6 specific in regards to metabolism (in contrary to what I said above). Levels of the eliminated metabolites would provide an indication as to whether or not you're deficient.

However, I should add, that I'm not up to date with current screening techniques. There may well be a specific test for 2D6 density. Perhaps someone more in the know can comment here.