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Opioids darvon - N vs. tramadol

sleepy

sleepy

Bluelighter
Joined
Dec 4, 2007
Messages
222
i hope it's okay to post this question in OD rather than BD... i have quite a bit of pharm knowledge, and am seeking advice from people smarter than myself......


so, i have chronic pain. i used to be on #180, 4 mg dilaudid/mo., plus a small bit of methadone at night..... i've since had successful spinal surgeries, but my hip replacement, about 12 yrs old at this point, and my neck w/four disc fusion and no C5 vertabre is degenerating and causing me a great deal of difficulty/misery. i used to be an IV drug user, and have Hep C. i was 13 yrs clean, and relapsed after my broken neck went undiagnosed for about a month.... i'm getting ready to revisit a pain management doctor, but would like to avoid narcotic pain meds w/highest risk of abuse... but i also have to avoid meds that are hard on my liver, so even strong NSAIDs are advised against. i don't want to take this medication daily, just on bad days. i'm wondering what people think about Ultram vs. Darvon -N, for my situation. i know there is a lot of controversy about the effectiveness of Darvon at all..... but also that Ultram is hit and miss.... btw, i'm also have ADHD and take 20 mg/2x/day of Adderall, which i don't abuse, but obviously, i assume, would lower my seizure threshold, though i have no family or personal history of seizures, i work out regularly, so my heart/blood pressure, etc are in good shape.... suggestions?

thank you knowledgable BLers! i appreciate any input -

g
 
sleepy said:
i hope it's okay to post this question in OD rather than BD... i have quite a bit of pharm knowledge, and am seeking advice from people smarter than myself......


so, i have chronic pain. i used to be on #180, 4 mg dilaudid/mo., plus a small bit of methadone at night..... i've since had successful spinal surgeries, but my hip replacement, about 12 yrs old at this point, and my neck w/four disc fusion and no C5 vertabre is degenerating and causing me a great deal of difficulty/misery. i used to be an IV drug user, and have Hep C. i was 13 yrs clean, and relapsed after my broken neck went undiagnosed for about a month.... i'm getting ready to revisit a pain management doctor, but would like to avoid narcotic pain meds w/highest risk of abuse... but i also have to avoid meds that are hard on my liver, so even strong NSAIDs are advised against. i don't want to take this medication daily, just on bad days. i'm wondering what people think about Ultram vs. Darvon -N, for my situation. i know there is a lot of controversy about the effectiveness of Darvon at all..... but also that Ultram is hit and miss.... btw, i'm also have ADHD and take 20 mg/2x/day of Adderall, which i don't abuse, but obviously, i assume, would lower my seizure threshold, though i have no family or personal history of seizures, i work out regularly, so my heart/blood pressure, etc are in good shape.... suggestions?

thank you knowledgable BLers! i appreciate any input -

g
Click to expand...

Just in the past 10 years reseach has found darvon to be extremley hard on your heart...as far as I'm concerned the jury is still out on the tramadol too...
 
so what does one do, if they have severe pain, but a tendency to enjoy opiates a bit too much for their own good???? are there other, opiate type meds that ARE safe, but w/a low abuse potential??
 
tapentadol?? i dunno what else to tell you, IMO darvon and tramadol are some of the most useless and dangerous members of the extended opioid family
 
Mixing Darvon with Adderall is extremely dangerous, mixing it with tramadol is also dangerous.

I'd say go with other option, neither of those drugs is safe to mix with your ADHD medication.
 
It is my belief that Darvon and Darvon-N and Darvocet have been taken off the market for about over a year now.
 
okay.... i get the picture. i'll see what the doctor says. i hadn't thought of tapentadol, but seeing that it's a CII makes me think it'll be, or is at least considered, as addictive/high abuse potential as any of the others... but i'll see what the doctor says. thanks all!
 
I use to take Darvocet & it was okay for pain but didnt do anything for recreation & if it was still around, I would say that would be the best way to go............but since its off the market, I would go with hydrocodone.
 
i agree about dilaudid, oxy, etc are extremely safe and the abuse potential is objective.....but my point of reference is scary sick!...buprenorphine sounds like an idea. my last experience on it was HORRIFIC, but that's because i was detoxing heroin, and the prescribed does was too low, so low i stopped taking them, as they were doing nothing except increasing the mind fuck by lowering the physical symptoms, but that was an entirely different situation. if they are used for pain, that could be an idea. but don't doctors need a special certificate to even prescribe this shit? and this certificate is total BS imho, as the doc who prescribed me the ineffectual low dose, after telling him, straight up, i was doing two grams a day easily, at least, and wide awake as fuck, i.e., not even close to "nodding," prescribed a dose that didn't make sense. and he didn't fully explain the whole concept of being in real wds before even STARTING the shit. i got the sniffles, anxiety, exhaustion, hot/cold sweats, and thought, " i should take my subs", then was blasted into full motherfucking wd's, out of my fucking mind, writhing in pain, puking, delerious... and it's not like i haven't wd'd from heavy opiates before, this, the naltrexone, made it HELL, but that wouldn't be the case today, so, i will work on being more open minded. my only fear, is that in california, at least, to even prescribe subs, as far as i can tell, requires a special certification, the kind given to "addiction specialists" who aren't necessarily pm doctors. but we'll see. i think one, in the past, said it was an option for me, but that i wouldn't get the real pain relief i needed from them... but i was in unbearable pain at the time, this time it's "bearable", just ruining my relationships, making me miss appts, i've lost my wallet twice in two weeks, i isolate, etc.... thanks again, all, for all of your thoughtful, educated input!!
 
I think Propoxyphene (Hcl and Napsylate versions), despite its well established and widely known cardiac risks, is a good tool for medical professionals and is the perfect fit for specific medical situations. It's my personal opinion that the media coverage regarding The Peaceful Pill and other how-to-commit-suicide books, which Propoxyphene (specifically Propoxyphene Hydrochloride - Darvon - not Propoxyphene Napsylate- Darvon-N) is the main actor, is what brought about the change in policy. Darvon, Darvon-N and Darvocet have been on the market for decades and have an established place in the medical pharmacopiea.

The latest news I'm aware of concerning whether it is still available in the US is this:

Xanodyne Pharmaceuticals Inc. which makes Darvon and Darvocet, the brand version of the prescription pain medication propoxyphene, has agreed to withdraw the medication from the U.S. market at the request of the U.S. Food and Drug Administration. The FDA has also informed the generic manufacturers of propoxyphene-containing products of Xanodyne’s decision and requested that they voluntarily remove their products as well.
Click to expand...

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm234350.htm

While the brand name versions of Darvon, Darvon-N and Darvocet have been voluntarily taken off the market in the US, I can't say whether or not the generic manufacturers of Propoxyphene formulations have withdrawn their products from the market. Its been a long time since I worked in a pharmacy, and I sincerely hope it has not been completely removed from medical practice in the US. If anyone has additional news since the above mid-2010 announcement where the FDA has declared Propoxyphene no longer available in any form in the US, please share it.

As others have noted, neither drug really suites your specific situation as outlined in your post. Tapentadol is a good idea; when it was being released I think there was a detailed discussion about its scheduling status in the ADD forum (I think?)- it probably should be a Schedule III rather than Schedule II narcotic.

The problem with Buprenorphine is that you have chronic pain issues and other medical problems. Buprenorphine as your primary pain medication negates the use of traditional opioid breakthrough pain meds (Tramadol being an exception though it was noted that the side effects and risks of Tramadol probably make it unsafe for your situation; IV Toradol (Ketorolac), an NSAID that given IV is great for severe pain and doesn't go through the digestive system thus avoiding liver damaging effects may be a good option whether you go on Buprenorphine or another opioid; I'm not sure whether Tapentadol can be used successfully while on Buprenorphine- I'm sure the topic has been explored on Bluelight at some time so maybe using the search function would be useful for finding this out). Like, if you were prescribed Methadone or MS-Contin or OpanaER as your primary pain management medication, something like Hydromorphone or Oxycodone or IR Morphine or IR Oxymorphone etc could be used as breakthrough meds. A lot of pain patients are on regimines like that. So it'd just be potentially (I'd guess likely) difficult to get a stable, helpful regimine if a lot of the tools in the toolbox are out the window from the start due to Bupe's partial-agonism and high affinity for receptors.

As far as less abuse liability opioids, if you're talking oral opioids, theres a number of synthetics agonist and partial-agonist of varying potency with what's considered low abuse potential but have a number of potential and likely side effects (Pentazocine, Butorphanol, etc). Drugs like Dihydrocodeine-only (IR or XR), Hydrocodone-alone formulations can be made by a compounding pharmacy/specially made for you considering the health liability NSAIDs orally have on your liver as you noted.

There are a lot of options. The abuse liability of Methadone is debatable, but if you have used it successfully as a pain management medication and did not abuse it or feel the need to abuse it, it may be a good option for chronic pain. Adjuvant medications like Orphenadrine and Phenyltoloxamine and Nefopam are often combined with opioids for 1) better pain relief (as these drugs add to the analgesia of opioids) and 2) lets the patient use less opioids to kill the same amount of pain (i.e. instead of taking 100mg Morphine, lets say you may find relief on 60mg Nefopam and 50mg Morphine similar to your 100mg Morphine dose- this is just an example of how adjuvants like these work, not an actual suggestion or completely realistic dosage scenario). And mentioned earlier, IV Toradol is an NSAID that can provide similar pain relief as a moderately potent opioid (recently a person I spoke to at a NA meeting said they thought they were given a shot of an opiate in the hospital when it was only Toradol, since it provided the same pain relief they would expect and knew from IV opioids for pain).

Hope some of the ideas in this thread can help you talk things out with your doctor and bring reasonable suggestions to the table so you and he/she can find a regimine that gives you the highest quality of life without tempting you with the large amount of outpatient potent (and pleasurable) narcotics. I really hope it works out well for you whatever the regimine outcome.
 
Tchort said:
I think Propoxyphene (Hcl and Napsylate versions), despite its well established and widely known cardiac risks, is a good tool for medical professionals and is the perfect fit for specific medical situations. It's my personal opinion that the media coverage regarding The Peaceful Pill and other how-to-commit-suicide books, which Propoxyphene (specifically Propoxyphene Hydrochloride - Darvon - not Propoxyphene Napsylate- Darvon-N) is the main actor, is what brought about the change in policy. Darvon, Darvon-N and Darvocet have been on the market for decades and have an established place in the medical pharmacopiea.

The latest news I'm aware of concerning whether it is still available in the US is this:



http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm234350.htm

While the brand name versions of Darvon, Darvon-N and Darvocet have been voluntarily taken off the market in the US, I can't say whether or not the generic manufacturers of Propoxyphene formulations have withdrawn their products from the market. Its been a long time since I worked in a pharmacy, and I sincerely hope it has not been completely removed from medical practice in the US. If anyone has additional news since the above mid-2010 announcement where the FDA has declared Propoxyphene no longer available in any form in the US, please share it.
Click to expand...

Both the brand and the generic products are no longer available in the United States.
 
Tchort --- THANK YOU, for your detailed, experienced response... i i will look-up these meds, and see what i see..... this is helpful information. i agree that darvon has a respectable place in our pharm market.... and yes, the "N" version is still available, generically, at least over-seas. but we'll see... i suspect that any amount of Subs would make it impossible for me to deal w/real opiate meds for break through pain... at least subs w/naltraxone, which, understandable, is the type they are more likely to feel comfortable prescribing. but i have enough, verifiable issues and pm history, that no one should give me a hard time rx'ing real opiates....i just don't want to get hooked again, or even experience the joy associated w/them. the idea of an injectable NSAID that avoids the GI tract, is very appealing, though i wonder if it's available for take home? like that migrain med that they allow people to optain, in injectable form, from the local pharmacy. i just can't deal w/ emergency rooms, or really even afford them, which is why i want to re-establish a pm doctor, for these bad days. thank you again for your exremely helpful info!!
 
Missykins said:
Both the brand and the generic products are no longer available in the United States.
Click to expand...

hey Missykins! i've read many of your posts and popular threads. i feel honored to get a reply from you.... i seem to have differing info re: Darvon-N specifically, but maybe that's because i've been checking overseas. certainly in the Northern US they've removed it..... too many lawyers, imho, as i feel that people w/good hearts could use this med, and suspect that the deaths associated w/it had other complicating causes. thank you again for your input!
g
 
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