Opioids On Percocet and other pain killers for back injuries, worried about too much APAP...

[SaosinEngaged]

I've been an on again off again Oxy user for a couple years. One of the reasons I started using Oxy was because of severe pack pain. It turns out, when I finally had an MRI, I have some pretty heinous back issues that have left me out of work for several months and unable to even drive.

Because of that, I was started right away on Percocet, Tramadol, Lyrica, and now Soma. I had previous tolerance to Oxy, and was able to disclose that to my pain management doctor without any reprocussions (honesty in this case, was the best policy). I currently am prescribed 2x 10mg Percocet 3-4x daily. They're the 10mg/325mg percocet, and I'm starting to worry about APAP build up. Of course I know how to do a cold water extraction, and have been every opportunity I can, but it's simply not feasible for me to do one every single time I need to dose my medication.

I've brought this issue up to my doctor and he says it's a non-issue, but I don't necessarily agree. What do you guys think? Too much APAP? He won't switch me to Oxycontin because of risk of dependence, yet I'm taking these now 4x daily, with all the APAP in it.

Also, as another separate question, I've yet to take the Soma I was newly prescribed. I asked my doctor if there would be any increased seizure risk from combining Soma and Tramadol, but he said not to worry. This is another thing I don't believe him on. I know muscle relaxers like Flexeril can cause seizures when mixed with tramadol, and I've heard Soma can also lower the seizure threshold. What do you guys think? Safe to take together? Or not?

Thanks.

 

[NeighborhoodThreat]

Soma is a general CNS depressant, its method of action is different from Flexeril (cyclobenzaprine) - GABA vs. SNRI-like action.

I'd say the risk of seizure is much less with Soma than with Flexeril.

 

[Opiates4lyfe]

You should be ok with APAP as long as you don't exceed over 4000mg in 24hrs, that's when you will start to run into liver damage. I have taken muscle relaxers with Percocets before and was perfectly fine.

 

[Oxide]

As long as you're under 4000mg every 24 hours, and 2g per dose, you should be alright.

It's perfectly okay to be concerned, but don't let it bother you too badly. You'll be just fine.

 

[Jabberwocky]

*Snip*

As has been mentioned, the standard advice is no more than 4g/day or 1g taken at once. However, certain populations (such as alcoholics, or people taking meds that strain one's liver on a regular basis) do not tolerate even the 4g/1g dosage guidelines though. Just another reason to make sure you know you're body as well as possible a priori.

Granted I take really good care of my body and liver, but it's not the end of the world for people such as myself (young/healthy/not a big drinker/not taking meds that hurt my liver function) to take large doses of APAP at once, once in a while. All being said, the less the better. Not worth freaking out about though, unless you can feel/know something's wrong, which I guess isn't always the case...

If you're concerned, and given what you've said I don't see much room for concern, just make sure your liver function and the like are checked regularly. Really, for someone in your position I would think this would be a must, regardless.

<1g APAP on a regular basis shouldn't be a big issue for you though, especially if it's only 650mg. Habituation/dependency/addiction should be much more of a concern. Just take it easy, play it safe, and tread as lightly as possible though. There's a reason I don't seek out Percocet or Vicodin any more.

 

[rave23]

just to let you know:

650mg 3 - 4 times a day is perfectly alright. It is well within recommended dosing.

I however suggest you do not consume any alcohol when taking large (but perfectly tolerable) amounts of Acetaminophen. Alcohol interferes with your liver's function, and this can lead to unforeseen consequences when combined with Acetaminophen. Stay clear of alcohol at all cost if you want to minimize any bodily harm done by the medication you are taking.

 

[verso]

I know that others will disagree with me, and that's fine, but in my opinion even 4 grams in 24 hours is still too much. I would try to keep it closer to 3 grams than four, and less is always better...

 

[Jabberwocky]

As I mentioned, this is certainly true with many people, that they cannot tolerate even 3g per day. Not nearly every one, but enough people for it to be a concern that this means YOU. Just go slowly, and use mature and patient dosing techniques. From what I've heard, dying from liver failure is a horrible, horrible way to go. And all the complications that go along with liver toxicity if you live. Ugh. Then again, the safest thing to do is not take whatever it is with APAP in it in the first place... but that would defeat the whole point. Just because some unlucky wino can't safely tolerate 650mg at once certainly doesn't mean you can't. Also doesn't mean you can.

The trick, then, is figuring out what you can and can't safely do. Treat lightly, mi companero.

Cheers,

-Mk

 

[shady4091]

Why not just do one CWE in the morning using say, 10-15 pills and only sip what you need. You can store a CWE fluid for a couple days in the refrigerator.

 

[Captain.Heroin]

When I broke both bones in my arm, I had severe inflammation. The doctors prescribed hydrocodone/APAP at a rate of 4 grams of APAP per day (8x 7.5/500), as well, they prescribed additional NSAIDS (two of them); ketorolac instant release tablets and diclofenac slow release tablets. (They also increased the dosage of diclofenac when I was complaining how severe the pain was after they gave me all of these meds at a later date and time).

When I filled all three medications at once, the pharmacist acted extremely concerned about the amount of drugs they had prescribed me. I told them I was given very exact dosing instructions (nothing different than they saw on the label; they clearly thought it was way too much) - they urged me not to take the ketorolac or diclofenac unless the regular pain killers (hydrocodone/APAP) wasn't doing anything for me.

I ended up not taking any of the hydrocodone/APAP tablets, and only used toradol (ketorolac), and when I ran out of those, I used some diclofenac. I was using buprenorphine already and hydrocodone/APAP won't do anything for me buprenorphine couldn't.

 

[Oxide]

Answered and closed.