liver problems from doing cwe to much?

[Anon54]

for almost 2 years ive regularly been doing cwe for the codeine. I usually use 40 tablets each containing 500mg apap & 10mg of codeine in 100mL of water.

how much apap do u think would be soluble in 100mL in very cold water?
im assuming it would be about 300mg anyways... Ive been doing cwe twice a day lately. It's been getting a bit out of control. sometimes I take higher than the ceiling dose too & need to use 150mL or even 200mL if Im using 80 tablets to try to get up to 800mg of codeine.

I know APAP is toxic to ya liver. im not to sure about codeine itself though. Does anyone know anything about how bad codeine is for ya liver.

I was told today by a dr that if ya liver is fine than ya kidneys should be fine too because the liver starts to get damaged before the kidneys. So, if u get a liver test & it comes out fine most likely ya kidneys are too.

Anyways I got a liver function test today because i told the dr how i regularly do cwe.

I'll let yas know the results when I get them but im interested if anyone else here on BL has had any liver problems from using APAP/codeine (or any other opiate particularly oxy which i also take occasionally. sometimes over 100mg)

If the codeine is slowly destroying my liver than i might consider quitting or at least cutting down because these days im using quite alot of it & im not sure how bad it actually is for ya liver.
Does anyone know more about this or has been an opiate user or cwe user who has been tested themselves & can give me there results.

Again, im interested in damage caused by opiates & the small amount of apap soluble in cwe or that has gotten through the filter used over a long period of time.

my health is more important than catching an opiate buzz. i dont care about addiction but I dont wanna get sick. Ive read that even 500mg a day of apap used for like a year can cause damage & im doing cwe almost every day. Liver damage wouldnt be worth it for the weak buzz I get from codeine. Plus the codeine itself probably isnt very good for ya liver.

I'll find out in a few days anyway. im a little nervous about finding out but im sure i do cwe effectively & i dont think codeine itself is to bad for ya. yeah I'll soon find out. wish me luck

 

[effie]

Approximately 1g is soluble in 100mls of cold water but it varies depending on the temp - it's important to use really cold water and the smallest volume you can. 200ml twice a day is right at the upper limit of safe, and if the water is warm or some APAP leaks through then it is taking you over 4g. Taking 4g day in day out is not always a good idea either. People vary in their capacity to handle APAP so it is hard to be precise about the risks - what is fine for one person could lead to liver failure in another.

Codeine should not harm your liver in itself. The most important thing is the APAP - no more than 2g in one go and 4g in 24 hours (in the US the FDA recently changed their guidelines to say 3g). Opioids are relatively safe in terms of organ damage. There are a few studies which found hepatotoxicity in rats but I can't find anything about humans.

Kidney damage can occur before liver and be caused by different things, but if you're thinking in terms of APAP then yeah - it's going to hit your liver first. Ibuprofen and aspirin can cause renal failure without hepatic failure however.

Good luck with the test! Hopefully you will be fine, and it's really good that you are taking your health seriously

 

[eukaryote]

Codeine it self is not hepatoxic. APAP is as you know, I've seen a few people come into my facility with fulminant hepatitis from improper CWEs. But that is generally an acute occurrence, presenting within 24-72 hours of ingestion. It is extremely severe and you would not be posting here on BL if that happened. Doses of 4 gram per day will cause some changes in liver function but are not harmful as such. APAP displays no known chronic toxicity, only acute toxicity due to the mechanism of its toxic effect being inherently quite immediate and dependent on a large quantity in a short period of time.

@Effie- Acute Renal failure nearly always occurs in APAP overdose, usually presenting between 36-48 hours after the dose, and is itself a major cause of morbidity and mortality in APAP overdose It's co-morbid with it and generally APAP overdose is really multi-system organ dysfunction, not just hepatic.

@Anon- If you do have problems, at this stage they are likely quite minor and will readily heal. Your Dr is testing you and if any problems are found- which I highly doubt- they are almost certainly easily treated. In all cases, I hope no abnormal values are found.

 

[effie]

^ Yeah indeed, I meant that the elevated liver enzymes would be detected first and isolated ARF from an APAP overdose would not be likely. I'm interested in whether APAP does exhibit any chronic toxicity or not - I believed it did not either and I've not read any papers which suggest it does (not done a full literature search yet though) but I was discussing it a couple of people on BL a while back who believed it did. As far as I was aware taking 4g/day every day would not cause any actual hepatotoxicity but since that discussion I've been wary of saying it is definitely safe.. been meaning to do a proper check of the literature for a while now

 

[eukaryote]

I've done somewhat of a search and found nothing to suggest it causes chronic toxicity, nor anything to suggest that 4g/day will cause any harm... but I've not done a truly in depth search. I'm also guilty here of going off conventional wisdom that gets passed around, and off my own experience and observation. Which I admit is not exactly a rigorous study.

As for opiate toxicity, I've never, ever seen a study or heard of natural or semi-synthetic opiates causing any sort of organ damage. I do recall vaguely a study done a very long time ago, just after narcotic laws where enacted in the USA, on previous heroin addicts who where put on morphine as maintenance. They where all autopsy'ed and each had been on it for at least 20 years, and nothing remarkable was found. No signs of organ damage or other histological findings.

I do appreciate the fact that pathology in the 1920s was a bit lacking, but still, I do remember the proff making a point of introducing this.

 

[verso]

I usually use 40 tablets each containing 500 mg APAP & 10mg of codeine in 100mL of water.

HOLY SHIT! That's 20,000 mg (or 20 grams) of acetaminophen!

For sake of argument, let's just imagine that a very small percent of the acetaminophen escapes into the solution you drink... let's say just 10%... that's still 2,000 mg (or 2 grams) of acetaminophen you're ingesting. (It's not an unsafe amount of acetaminophen; I'm just pointing out that even a mere fraction of the total acetaminophen in those pills is still a significant amount.)

Now, I cannot say for sure just how much acetaminophen is escaping into your solution, and I don't want to alarm you, but you should be very, very, very careful with how you perform your cold water extractions from now on.

I'm exhausted, so you might have already mentioned it in your post... but are you experiencing any symptoms of liver failure?

 

[Anon54]

^^^
ive done it using the same pack of tablets probably a hundred times!
I get the 40 pack of chemists own pain tables. they dissolve easily in the water. sometimes ive been doing cwe twice a day so thats twice as much to. i have some in the freezer now

but sdont worry i do a first filter through a hanky whicih i squeeze over a bowl which gets most of the apap. than i do a filter through a coffee filter which catches bascially bothing aftern the hanky but i do it to be safe.

again i'll let everyone know how my liver function test goes