Misc Why has APAP largely replaced Aspirin (in opioid preparations)?

[Changa707]

Now, I think the main reason I am asking this is as a result of frustration as I watch my CWE codeine solution drip through a silk garment that I use as a makeshift filter (not sure if that is even appropriate, but the threading is very tight).
Part of my frustration is simply because I am anticipating this 120 mg codeine, but i'm used to doing CWE with T1's...and the aspirin in T1's make the process a breeze. Yet with APAP I find that the stuff gets all bubbly during the process and prevents separation...or at least it seems that way.

Overall I just never understood why APAP has replaced Aspirin as the #1 most common OTC painkiller...I have always loved aspirin for some reason, and would much rather take a 1000 mg of aspirin at once, than 1000 mg APAP. My favorite aspirin preparation is Endo/Percodan...which is really damn hard to come by these days, what a shame.

I don't mind the blood-thinning properties of Aspirin, but i'm guessing APAP replaced Aspirin because of this (due to increased chance of complications, as opioids are often used during surgery)????
But even then, people should have the option to take a codeine or oxycodone preparation that contains Aspirin rather than APAP...I don't know anyone that gets prescribed the Aspirin combinations except for relatives who also take coumadin (so it actually helps there). But hell, seems like APAP is fucking EVERYWHERE I LOOK!!! If this drug is really so toxic as it sounds, why the hell is it still so popular? Get rid of the crap...it's probably killing way more people due to liver toxicity...I had someone quite close to me die recently who took a lot of APAP for years, but not even above the daily toxic dose (as far as I was aware). She abused opioids but actually avoided APAP whenever possible and would stick with oxycodone IR....but then her liver failed in her late 40's and she died suddenly. Very sad. But much of that may have been due to her history of drinking also.

...or because some kind of study showed Aspirin to be more toxic? I'm not sure, but I am under the impression that APAP would be much worse to take daily long-term than Aspirin? I know that for some people it can be dangerous, but APAP just seems so much worse for the liver (from what I read and hear). Is this the case?

 

[Euphorogenesis]

Good question. The blood-thinning properties of aspirin might even be beneficial in light of cardiovascular considerations.

 

[The Doc.]

Both drugs have their issues for one aspirin is extremely hard on the stomach and kidneys whereas acetaminophen is very unlikely to cause any stomach upset. Acetaminophen has been given a bad rep because so many medications contain it and people unknowingly take more than is recommended in the form of two different products. But the fact is no matter what drug your taking it will have unwanted side effects. Its just about finding what seems to be a reasonable balance and apap seems to fit that profile for a lot of doctors. Asprin/ibuprofen does come in different medications too but many doctors/patients prefer acetaminophen for their own reasons. Your friend probably died from years of abuse and drinking. Apap Is hard on the liver whereas asprin/ibuprofen is hard in kidneys and stomach. Either drug used responsibly can be helpful in maintaining a patients pain but both can cause issues when used excessively.

And since when does Tylenol #1 contain asprin?

 

[falsifiedhypothesi]

I'm sorry about your friend, I've also wondered why they had such a high amount of apap in some forms of meds. The 10/1000 vicodins seemed like overkill to me. I've never been able to tolerate acetaminophen very well and it would always give me brutal stomach aches when I would take it without an opioid.

 

[Changa707]

Thanks for the replies, now I understand that there is probably a lot of negative hype surrounding APAP simply because it is so widely used...so statistically speaking more likely to cause difficulties, but i'm aware now that there are many people using more than 4000 mg of APAP a day without liver problems...so it's hard to say how it will effect the individual, but I was under the impression that APAP was more toxic than Aspirin.

And DOC...I'm sure they make T1's with APAP also, but the pills I used to get (AC&C contained 8 mg codeine, 15 mg caffeine, and 325 mg Aspirin. And then before that I used to get the endodans, which seemed to have more punch than percocet.

 

[Rybee]

Largely because of the amount of interactions that NSAIDs have with other medications and illnesses. Even moderate use of NSAIDs such as Aspirin can cause painful acid reflux, stomach ulcers, holes and bleeding. On the other hand, APAP can be taken chronically with a little wear and tear on the liver, but it's generally regarded as a very tolerable medication.

I have to take a proton pump inhibitor such as Omperazole whenever I take any form of NSAID for more than three days, otherwise I have awful stomach cramps and acid reflux.

Below is a list of those that should not take NSAIDS:

Children and teenagers with viral infections with or without fever should not receive aspirin or aspirin-containing products due to the risk of Reye’s syndrome
Those who have an upcoming surgical procedure, including dental surgery
Diabetes that is difficult to control
Known kidney disease
Known liver disease
Known allergies to medications, especially aspirin
Active peptic ulcer disease (stomach ulcers or previous history of stomach ulcer bleeding)
Bleeding problems (people who have a history of prolonged bleeding time or who bruise easily)
People who consume three or more alcoholic beverages per day
High blood pressure that is difficult to control
Active congestive heart failure
Asthma that worsens when taking aspirin
Pregnancy in the third trimester
Simultaneous use with certain medications such as warfarin (Coumadin®), phenytoin (Dilantin®), cyclosporine (Neoral®, Sandimmune®), probenecid (Benemid®), lithium (Eskalith®, Lithobid®) and drugs used for arthritis, diabetes, high blood pressure, heart disease and vitamins


One thing difference I've noted as a British Bluelight user is the difference in prescription attitudes between US doctors and UK doctors.

Here in the UK, if you were to visit a doctor with some kind of painful condition, they will prescribe you:
Initially: 60mg Pure Codeine Phosphate pills, 50mg Pure Tramadol pills, or 30mg Pure Dihydrocodeine pills
Then: A varied dose of Pure Morphine Sulfate liquid (Oramorph), Pure MS Contin pills, Pure Tapentadol pills, and Pure Oxycodone Hydrochloride pills
Finally: Fentanyl or Methadone

...

I've been a pain patient for several years and it's just not common practice to prescribe opiates that are combined with a dose of APAP (Paracetamol), you're just given whichever opiate is deemed suitable in it's purest form and probably coupled up with an NSAID such as Diclofenac, Naproxen, Ketoprofen or Indomethacin as well as a suitable medication for neuropathic pain such as Pregabalin, Gabapentin or Tricyclics etc... and then just tell you to go buy some separate APAP (Paracetamol) and take 1g, four times daily in addition.

Kinda makes me thankful that I've never had to bother with this CWE mularky as I've always been given pure opiates.