Posted by Larry Hoover on March 17, 2005, at 20:56:19
In reply to Re: Percocet » Larry Hoover, posted by ed_uk on March 16, 2005, at 12:32:16
> Hi Larry,
>
> Do you use 5/325 oxy/acet or 5/500? I don't really like 'fixed dose' opioid/acetaminophen products, there's not much room for dose titration. If you need a high dose of oxycodone, you overdose on acetaminophen. If you only need a small amount of oxycodone, you get dose of acetaminophen which is likely to be sub-therapeutic.Good point. I checked the formulary. There are all sorts of oxycodone products that don't have acetominophen or acetylsalicylic acid in them.
> Could you encourage your doc to prescribe acetaminophen and oxycodone separately? You could take 1g acetaminophen up to four times a day prn + a variable dose of oxycodone 4-6 times a day. Is oxycodone IR called Supeudol in Canada?
No, it's called oxycodone IR. Seriously.
> If it's difficult to get acetaminophen and oxycodone separately, it might be useful to get a prescription for some 5/325 pills *and* some 5/500 pills. You could take up to three 5/325 pills for severe pain or up to two 5/500 pills for less severe pain. If you need less oxycodone than this (eg one 5/500 pill) you could take a 'plain' acetaminophen tablet in addition. Hmm, I've just realised that Percocet probably comes in lots of different 'strenghts' in Canada that I don't know about. Never mind.You made the point....best to have oxycodone straight up. I can easily manage the NSAID dose on my own.
> I know this is all obvious really but I thought I'd post anyway :-S I hope you doing think I'm being rude by posting these things, you probably do all these things anyway.Just never gave any thought to oxycodone tablets themselves.
> >Taking a half tablet every two hours is the same total dose as one tablet every four hours, but the blood concentration does not oscillate as much.
>
> Do you mind dosing so frequently?No. I only do it when I'm in a pain flare, and that kind of distorts time anyway. It's all about the pain.
> Have you ever taken a low dose of OxyContin + regular acetaminophen + oxycodone IR for breakthrough pain. I suppose since you'd be taking the acetaminophen so frequently the OxyContin wouldn't increase convenience that much.
Well, Oxycontin would be good for maintaining a more stable oxycodone blood concentration, but I doubt my doctor would go that route.....this is a Worker's Comp case, and you would have to know just how much bureaucracy is involved to get any narcotics....this is now 14 months post-injury. Still waiting for surgery.
> I don't know what schedule oxycodone is in Canada, I don't know anything about your schedules to be honest. In the UK, oxycodone's always schedule 2, even when it's combined with acetaminophen, which is probably why they haven't bothered marketing any oxycodone/acetaminophen combinations here. If Percocet was available, it would never be a popular as co-codamol 30/500, which is schedule 5! Schedule 5 drugs have very few restrictions, schedule 2 drugs have the full controlled drug requirements, not that they make much difference to the patient. Certain doctors seem to live in some kind of strange fantasy land where schedule 5 opioids like dihydrocodeine tabs are much safer than schedule 2 drugs like oxycodone! I suppose many doctors are just afraid of looking suspicious, I worry that it has a bad impact on pain control - people being given inadequate doses etc.
I don't think there's as much differentiation between narcotics here. I honestly don't know, though.
> >I find that Percocet with Toradol (keterolac tromethamine) is a very effective combination.
>
> Do you respond well to any other NSAIDs? I'm a bit suspicious of ketorolac!The only thing about keterolac that scares the bejeezuz out of me is the list of adverse reactions. It doesn't work so well on its own, but with oxycodone, it's golden. I don't know why. I stumbled on the combo when I was trying to augment the Percocet. Ketoprofen, ibuprofen, naproxen, some less well known prescription NSAIDS (forget the names), turmeric, I was throwing anything in there to see what would work. Keterolac came through a winner.
BTW, turmeric is the absolute best COX-type med I've ever used. Beats Vioxx, Mobicox, Celebrex....works better, lasts longer, and costs pennies a dose.
> Scroll down to table 5 for a comparison of NSAIDs. Table 2 is also interesting. Perhaps you take an anti-ulcer drug, or only take ketorolac occasionally.
Ya, I don't wanna get a bleed. I try to be careful.
> http://www.jr2.ox.ac.uk/bandolier/booth/painpag/nsae/nsae.html#Heading10
>
> Table 5 is called 'Relative risk of gastrointestinal complications with NSAIDs, relative to ibuprofen or non-use'.
>
> I take it you've tried ibuprofen and it wasn't good, have you tried up to 2400mg/day?Ya, that's my fallback behind keterolac. When it isn't as bad.
> I always wonder whether ibuprofen is really any safer that other NSAIDs or whether its apparant safety is simply a reflection of the tendency to prescribe it at relatively small doses for mild/moderate pain compared with other NSAIDs which tend to be prescribed at comparatively high doses for the treatment of severe pain in rheumatoid arthritis etc.You know what? I don't worry about GI bleeding when I'm in pain....other than by taking with food. People suing over Vioxx adverse effects.....they'd rather be in pain? Ya, right. Sue God for that.
> Best regards,
> Ed.You too. Thanks for the support.
Lar
poster:Larry Hoover
thread:470781
URL: http://www.dr-bob.org/babble/20050317/msgs/472274.html