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Pharmacists/Docs/Nurses/Pharmacy Techs - Tylenol...
- Thread starter bob4432
- Start date
Rockinacoustic
Platinum Member
They are both pain relievers through different mechanisms of action. An opioid like oxycodone alleviates pain in the CNS while a typical pain reliever or NSAID (ibuprofen) alleviates pain in the systemic areas.
punjabiplaya
Diamond Member
^ yeah: acetaminophen operates differently than an opiate
Meghan54
Lifer
Not to mention that opiates lack the ability to reduce swelling, something Tylenol can do. Not as well as plain old aspirin, but well enough.
Also, something like 5mg of an opiate like hydrocodone or oxycodone would be a tiny, tiny pill while binding it with Tylenol gives a pill that can be scored, broken for titrating into half doses, etc.
Also, something like 5mg of an opiate like hydrocodone or oxycodone would be a tiny, tiny pill while binding it with Tylenol gives a pill that can be scored, broken for titrating into half doses, etc.
Tylenol doesn't have any anti-inflammatory effects.
Powermoloch
Lifer
you don't want to take an opiate at a very very very large dose anyways, otherwise, you'll stop breathing.
Mo0o
Lifer
No. Tylenol usually isnt part of any long term pain management plan, especially in patients with neurologic/spinal cord injuries.
It's very useful for short term pain management. You give it as a combo with narcotics to decrease the necessary narcotics dose for adequate pain control. This prevents a lot of the crappy side effects from narcotics such as constipation, nausea, altered mental status and addiction potential.
Patients with true chronic pain (which is realy really hard to diagnose if its just ambiguous low back pain), often have pure narcotic pain control regimens such as ms contin, fentanyl, methadone etc.
Mo0o
Lifer
Where do you work? I've never heard of tylenol prescribed for any supposed antinflammatory benefit.
bob4432
Lifer
definately not for ambiguous low back pain...spinal cord injury secondary to spinal cord surgery. am on one of the other meds you listed, was on percocet for a long time for "breakthrough 😱" pain but asked if there was a version w/out the tylenol due to pharmacists concerns because of other meds due to migraine/tension h/as due to other neurolgical issue, and those have a decent amount of tylenol in them too. now just wondering why i was on percocet instead of just plain oxycodone for the "breakthrough" pain...fwiw i get my liver/kidneys checked every 3-6mos and they are doing ok, but still curious as to why i had to ask instead of just being moved to this since it doesn't seem the tylenol was a real benefit to me...
Mo0o
Lifer
it's possible you would have needed a larger dose of oxy for breakthrough pain if it didnt come packaged with tylenol. I guess it all depends on how often you're needing "breakthrough pain control." If its so frequently that the tylenol in the percocets are an issue, then you should talk to your doc about possibly upping the dose on your base med.
And as far as migraine headaches go, I'm personally kind of iffy on the excedrin migraine combo of tylenol aspirin and caffeine. If you can find something with a good NSAID (like ibuprofen) that is combined with caffeine, it'll work well for headaches (assuming youre not getting them all the time). If you get them a lot, you can talk to your doc about getting sumatriptan shots.
Instead of wasting money on combination products, just buy Aleve and continue using your Percocet as usual.
Tylenol/Naproxen/Oxycodone are perfectly safe and won't interact with each other.
As a general rule, if you're on Percocet(or any Tylenol combination prescription meds), stop using OTC products with Tylenol in it completely unless you're prepared to be monitoring your daily Tylenol usage to ensure it's less than 4gm(for a patient without liver disease or hepatic dysfunction that is).
bob4432
Lifer
today did move up the main med because of useage of the "breakthrough med", have been fighting moving up for about 6mos because i hate taking the meds, but w/out the pain is not even funny. that is when i asked the doc about the non tylenol breakthrough med.
as far as the migraines, take midrin and for tension headache take phrenilin in addition to botox injections which have helped alot w/ the migraines and the tension h/as follow the dystonia cycle and what i do in regards to my mid/upper back and neck muscle useage wise, but get botox injections for that too which help but don't fix the issues.
bob4432
Lifer
gi issues...
Mo0o
Lifer
Have you guys talked about neurostimulators or intrathecal narcotics. It's pretty aggressive but if pain control is a major issue it's a possible option for your back pain.
Have you tried Imitrex tablets? Other Triptan formulations?
How often do you get headaches? If you experience it very often chances are your Midrin(and other combination products) is probably contributing to it.
bob4432
Lifer
have talked about the neurostimulators and also dbs, but am putting it off and letting it be perfected on others. figure the longer i wait, the better they will be w/ the installation and the hardware will just get better, at least that is my hope. had a couple friends that went the neurostimulator route and although i understand that is an extremely small group to look at, none had much luck w/ it, definitely didn't take the pain away like they were told and they are still on narcotic pain meds.
bob4432
Lifer
tried imitrex about a decade or so ago and it just made my tongue swell😱...don't get the migraines near as much since we started treating that w/ botox, now probably only a couple times a month, possibly less, but whenever i would get a migraine i would exceed the daily recommendation of tylenol when on the percocet.
i had recently been told about rebound headaches from tylenol from my neurologist which was another reason i want to move off of tylenol as much as possible.
no triptan that i know of, i have tried a lot of medications over the years though, what would be a triptan formulation?
edit - just looked up triptan medications and have tried imitrex, maxalt, zomig and avitriptan sounds familiar, but guess they didn't work on me for some reason or another or had a side effect that was worse than the benefit. i have had migraines for nearly 30yrs, so i may have tried others that i don't remember.
Last edited:
Hayabusa Rider
Admin Emeritus & Elite Member
Acetaminophen containing drugs can be used as part of long term therapy, but not as the primary medication.
To answer "Why is Tylenol in everything", adding a second medication to oxycodone and like drugs helps more than oxycodone alone.
Why acetaminophen (Tylenol)? Because of a few reasons. First, this medication has been out a long time. You had a choice of two drugs with which to formulate a medication, Tylenol or aspirin at that time. Very often it was given to a patient for an inpatient procedure. The last thing you wanted to do was give a patient something which could muck with anticoagulants or worsen stress induced GI problems. That's why you don't see aspirin used in anti-inflammatory doses anymore. It's a bad choice.
So that leaves acetaminophen, which was thought to not effect anticoagulants (not true BTW, but it's still far less than aspirin) and leaves the GI tract pretty much alone. In other words it's the better choice.
What follows into the community also applies if to a lesser degree. NSAIDs (of which aspirin is one) still screw with the above conditions and other medications and therefore narcotic/APAP (APAP is a common abbreviation for acetaminophen) is often favored.
So why the big shift away from Tylenol? Well someone woke up to 1970 at the FDA. Acetaminophen is still a good choice for many people but it turns out to be more toxic than originally thought when combined with alcohol. That's bad.
Then there is the ubiquitous presence of it in other types of medication which can be purchased without a prescription. It's not just a pain reliever but a fever reducer.
So imagine this. The 24 hour acetaminophen maximum dose for a healthy adult is 4000 mg. That's an unbreakable rule in medicine.
Let's say that you were prescribed Percocet with 325 mg of acetaminophen. , the most common. That means 12 a day tops. The doctor writes directions to reflect the maximum dose. All's well until the medicine isn't quite making it. Well let's take some Tylenol. Two 500 tablets a couple of times a day. Then there's that pesky cold. That multi-symptom cold formula sounds great. Oh, while I'm out shopping lets get some beer for the game on TV tonight.
Well you are now looking at a potential disaster. Suddenly the FDA says "whoa" after the better part of half a century and starts sending out all these messages that acetaminophen isn't as harmless as first thought. Go figure.
Docs? Many aren't much better. They'll go for a combination drug because that's what they've always done. Besides there is the abuse issue here. Someone who is addicted or has been taking large doses of opiates could swallow enough of narcotic and be OK that would literally kill them if combined with acetaminophen. Even if they disregard that there's the pesky DEA which frowns on practitioners prescribing stand alone narcotics. Of course officially they don't, but they lie. They aren't concerned with therapeutics but drug abuse.
Anyway, that's more than you asked for OP.
The way to treat chronic pain with opiates and related drugs is to use a long acting medication to get constant coverage and add a second shorter acting one for break through pain. That's when the Percocet or single ingredient medication would be used. It NEVER should be used as the primary drug for severe chronic pain.
One other thing, the goal of pain management is NOT to be pain free, but to provide relief such that you can do whatever you need to do within reason. You can walk or work or whatever, but never expect to have no pain at all. That's not realistic, sorry.
bob4432
Lifer
thanks for the explanation Hayabusa Rider, kind of figured i would never be pain free again too, already been over a decade. fwiw, i don't drink alcohol of any type.
just out of curiosity why would the dea be so concerned w/ stand alone narcotics when you can get strong doses of oxycodone w/ the 325 apap? i really don't know what type of amount they look at but 12 10/325 percocets a day would be a lot of oxycodone, or are they looking much higher number?
just out of curiosity why would the dea be so concerned w/ stand alone narcotics when you can get strong doses of oxycodone w/ the 325 apap? i really don't know what type of amount they look at but 12 10/325 percocets a day would be a lot of oxycodone, or are they looking much higher number?
Because the addiction potential is still there.
bob4432
Lifer
i can understand that, but i would have thought the amount the dea would be looking into would be more like those that get it to sell vs addiction. or are you more likely to get addicted to stand alone narcotic vs one mixed w/ tylenol? if so, why?
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