Opioids Hydro/acetaminophen vs. hydro/ibuprofen?

[TimeForLunch]

I have a back injury which, before it got bad enough for opioids, I’d alternately tried managing with ibuprofen, acetaminophen, and both together. As is most often the case for me, ibuprofen worked much better for my pain than both an equivalent *and* higher dose of acetaminophen; the combo of ibuprofen and acetaminophen worked only slightly better than ibuprofen alone.

Right now the pain is managed by generic Vicoprofen (hydro/ibuprofen) 7.5/200, and has been for a couple of months (I’m waiting on an MRI). I’ve taken this drug in the past with some regularity for other reasons, but my current dose of two tabs in the AM and one in the PM is bit higher than I’m used to—and while I don’t usually have much of an issue with tolerance, I’ve definitely been noticing it get less effective for this injury as time goes on.

The pain was really bad this past week and I ran out of Vicoprofen. A friend offered generic Vicodin (hydro/acetaminophen) 10/300, so I used that instead, although I expected it to be at least somewhat less effective. It did *not* occur to me at the time that I could always add ibuprofen to it (duh)! But this turned out not to matter.

In the AM I took one and a half tabs of the Vicodin, which has the equivalent amount of hydrocodone as the two Vicoprofen I take at the same time of day: 15 mgs. When it kicked in, my pain got so, so much better, better than it had in a few weeks! I took the same dose once a day in the AM for two more days (I didn’t have enough to also take some in the PM, which is fun) Same improvement each time! I never added any ibuprofen to it, because I never had to.

So my question is: WHAT? WHY?! All I can think is that each may have been made by a different manufacturer—but I don’t know for sure because my friend doesn’t have the name of the manufacturer of the generic Vicodin. (Amneal makes my generic Vicoprofen and that hasn’t changed recently.) But could one manufacturer’s hydro really work that much better than another? Is there *any* other reason acetaminophen would work better than ibuprofen in combo with hydrocodone, either inherently or for a back injury?

The answer here matters in terms of the issues/delays I might incur if I ask my doc to change my usual script, then potentially to change it *back* if it was just a manufacturer thing and the tabs I get are made by someone different from my friend’s. So I would really, really appreciate any help, and request that folks be kind in their replies. Thank you so much for reading!!

ETA: Should have also said that while my friend doesn’t have the name of the generic manufacturer of the Vicodin, I know 100% for sure that it really is Vicodin and doesn’t have anything sketch in it.

 

[unodelacosa]

It could be a number of different things. For starters, it could be the binding agents in the tablet are different and slow down absorption in one of the two. Or it could be that you happen to respond better to acetaminophen and that's making the difference.

Remember though: as you build tolerance you also build dependency. If you stopped the pain meds suddenly right now, you'd experience a bit of withdrawal. It wouldn't last long, but you should consider cutting back the pain meds, not upping your doses at this point.

Also worth noting: acetaminophen (Tylenol, Paracetamol) is hard on the liver, so are NSAIDs like ibuprofen (Advil), naproxen (Alleve), and acetylsalicylic acid (Aspirin), and they recommend not using them for more than 10 consecutive days.

I certainly wouldn't mix an opiate, acetaminophen and an NSAID, btw. These things seriously tax the liver more than ppl realize. Just bc they're OTC doesn't mean they're harmless. Taking 1.5 Vicodins means you're taking 450 mg of acetaminophen each time. Please don't drink on top of these, too, for your liver's sake.

Do physical therapy and talk to your doctor about getting that surgery sooner, and I think you should speak to them about your pain medication needs and the fact that you're developing tolerance. This is not something to fuck around with. Thousands of ppl get snared up in opiate dependency each year. Avoid it and save yourself some misery.

 

[ChemicallyEnhanced]

It could be a number of different things. For starters, it could be the binding agents in the tablet are different and slow down absorption in one of the two. Or it could be that you happen to respond better to acetaminophen and that's making the difference.

Remember though: as you build tolerance you also build dependency. If you stopped the pain meds suddenly right now, you'd experience a bit of withdrawal. It wouldn't last long, but you should consider cutting back the pain meds, not upping your doses at this point.

Also worth noting: acetaminophen (Tylenol, Paracetamol) is hard on the liver, so are NSAIDs like ibuprofen (Advil), naproxen (Alleve), and acetylsalicylic acid (Aspirin), and they recommend not using them for more than 10 consecutive days.

I certainly wouldn't mix an opiate, acetaminophen and an NSAID, btw. These things seriously tax the liver more than ppl realize. Just bc they're OTC doesn't mean they're harmless. Taking 1.5 Vicodins means you're taking 450 mg of acetaminophen each time. Please don't drink on top of these, too, for your liver's sake.

Do physical therapy and talk to your doctor about getting that surgery sooner, and I think you should speak to them about your pain medication needs and the fact that you're developing tolerance. This is not something to fuck around with. Thousands of ppl get snared up in opiate dependency each year. Avoid it and save yourself some misery.

450mg is a VERY low dose of acetaminophen. The normal dose is 1000mg.

 

[TimeForLunch]

It could be a number of different things. For starters, it could be the binding agents in the tablet are different and slow down absorption in one of the two. Or it could be that you happen to respond better to acetaminophen and that's making the difference.

Remember though: as you build tolerance you also build dependency. If you stopped the pain meds suddenly right now, you'd experience a bit of withdrawal. It wouldn't last long, but you should consider cutting back the pain meds, not upping your doses at this point.

Also worth noting: acetaminophen (Tylenol, Paracetamol) is hard on the liver, so are NSAIDs like ibuprofen (Advil), naproxen (Alleve), and acetylsalicylic acid (Aspirin), and they recommend not using them for more than 10 consecutive days.

I certainly wouldn't mix an opiate, acetaminophen and an NSAID, btw. These things seriously tax the liver more than ppl realize. Just bc they're OTC doesn't mean they're harmless. Taking 1.5 Vicodins means you're taking 450 mg of acetaminophen each time. Please don't drink on top of these, too, for your liver's sake.

Do physical therapy and talk to your doctor about getting that surgery sooner, and I think you should speak to them about your pain medication needs and the fact that you're developing tolerance. This is not something to fuck around with. Thousands of ppl get snared up in opiate dependency each year. Avoid it and save yourself some misery.

I honestly appreciate the reply! But it does say some stuff that doesn’t cohere with the information in my own post—e.g., I don’t respond better to acetaminophen, as I explained in some detail; I didn’t mention anything about surgery.

There’s also some good advice in there, which I also appreciate!! But I’m already doing PT; I do not drink; and I mentioned the tolerance to my doctor as soon as it came up. I’m definitely educated about withdrawal (and have experienced it). You’re100% right to say that thousands of people get addicted, way more than that actually. But thousands of chronic pain users also use opioids in various doses for more than 10 days at a time. For this injury, I have no intention of going any higher on my dose because it makes me feel like total crap all the time. That’s part of why it would be amazing to get better relief with exactly the same dose of hydrocodone by just changing from the ibuprofen to the acetaminophen combo. Either way I can’t wait to get off this dose, but the pain is not manageable enough right now and I don’t even have a diagnosis yet because, insurance. Meanwhile, as the commenter said below, 450 is a really low dose of acetaminophen per day; even if took double that I’d be well below the safe limit. Same with the ibuprofen.

The binding agent idea is interesting, thanks for that suggestion! Does that vary according to the manufacturer or just the hydro combination?

 

[unodelacosa]

The binding agent idea is interesting, thanks for that suggestion! Does that vary according to the manufacturer or just the hydro combination?

Well it's probably the biggest difference between the original manufacturer's formula and the generic formula. They have different classes of generics with some being more stringent about duplicating the original medication in terms of binding agents and lubricants in the tablet mixture and such.

I don’t respond better to acetaminophen, as I explained in some detail;

No I meant in combination with the hydrocodone, which I believe you had not taken before, only the combination of hydrocodone and ibuprofen. Btw, FWIW, naproxen is overall a more effective NSAID in terms of being an anti-inflammatory.

I didn’t mention anything about surgery.

Yeah that's my bad. You had said diagnosis and for some reason in my head I took that to mean surgery. Apologies for the misunderstanding. How exactly did you hurt your back?

And yes, also my mistake on the acetaminophen dose. You and @ChemicallyEnhanced are right about that part. However, having said that, I think it's worth pointing out that acetaminophen is the leading cause of liver injury. Seriously look it up. But that's good to hear you're avoiding alcohol and taking the dependency seriously…Think what you want, but taking many OTC analgesics is probably not good for your hepatic system. I would ask your doctor if it's recommended for you to take all three things at once. But hey, that's just me; I seem to remember reading somewhere that it's not advisable to take Tylenol and an NSAID, but I could be mistaken. Either way, I'm sorry you're in pain, and I wish you a speedy recovery.