Hep C and Pain Meds

[Betsy55]

My husband has hepatitis C and a great deal of pain in his back, arms, shoulders and needs to know what kind of Pain Meds are out there that are Liver Friendly.

[fretboard]

I know that Methadone is supposedly as liver friendly as a drug can get.  What I've heard about morphine, vicodin or any morphine derivitives is that they replicate the HepC virus  somehow.  That's all I know is what I've heard and what I've read as I've also read that those types of drugs replicate the disease.  I had a friend who was HepC positive and his kidneys, lower back area was very painful and his doctor enrolled him in a Methadone Maintenance program.  That was at least 15 years ago, most doctors are more relaxed about prescribing it than they used to be.  good luck

[dlr2007]

Betsy is right- methadone is harmless to the liver. I never knew that morphine derivitives replicate the Hep C virus! How scary. I would've said that most narcotic pain relievers would be OK- just without the added Tylenol. But if there is any evidence that they could make the Hep C worse- not worth it.
  Methadone maintenance is an option. It would be best if a doctor prescribed it- otherwise your husband would have to go to a clinic. They have lots of rules and he would have to have opiates in his system- they don't let you on for pain management, only addiction.
  If the pain is not too too bad, ibuprophen is an option. I'm on methadone myself- it's great for pain but the side effects aren't fun. Weight gain, fatigue, constipation, memory problems... yuck :(. But nothing is perfect.
  Best of luck to you and your hubby. You're a great wife to be so helpful and supportive :) .
-Dee

[vincenos]

i have had the virus that i know of for 4 yrs. it was in a non active dormant stage till now recent blood work showed that it is active now enzymes through the roof and all that my fcp want me to see a gi dr. my ? is this is it normal to feel sick in the morning every morning  nausua  every morn its so hard to get moving  is this a sid e effect of the virus ?doe sany one know im really nervous about the treatments available .too  my last biopsy showed stge 2 grade 2 fibrosis ...any input would be appreciated thanks  vince

[R Glass]

  Some people have no symptoms of HCV, others have many symptoms. Mine was mostly Fatigue, Muscle, and Joint Pain. The mornings were always the worst. My Dr. put me on Lortab (to be taken only as needed). My personal opinion is, there is no such thing as a drug that is liver friendly. Some are just harder on the liver than others. I am ½ way through tx and undetected. Most of the pain has subsided. This leads me to believe it was caused by the HCV. I still have to fight the fatigue, which is worse in the morning but more than likely is caused by the tx. Fatigue can be a side effect of HCV but is also a common side effect of tx. Keep in mind that almost everyone reacts different to both HCV and tx. This is one of the reasons, it is so hard to understand and predict. I hope this helps in some way

[merryBe]

methadone is used a lot for pain for non-addict these days. Many people avoid or object to it because of the addict "connotation" but it is available in tablet form and used for pain control a lot.
Another similar synthetic is Ultram/Tramadol, it can be an RX minus tylenol, as for that matter can vicodin, or oxycdone be given minus tylenol.

mind you, I'm not recommending them. Ultram rasied my liver zymes..If you have to take something, take as little as possible.

the main question is are any of them safe. It is known that alcolol and marijuana both help the HCV virus to replicate, and it may be that may more drugs than realized do some harm.
It is best to use as little as you can of any drug for this reason. I'm greatly suspicious that there may be hundreds of drugs that give this virus a leg up.

not every drug has been researched like this one...but the more that are, the less good looking they all become.



Li Y, Ye L, Peng JS, Wang CQ, Luo GX, Zhang T, Wan Q, Ho WZ.
Division of Allergy and Immunology, Joseph Stokes, Jr., Research Institute, Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.

Heroin addicts are a high-risk group for hepatitis C virus (HCV) infection and the development of chronic HCV disease. We thus examined whether morphine, the active metabolite of heroin, has the ability to inhibit intrahepatic interferon (IFN)- alpha expression, facilitating HCV replication in human hepatocytes. Morphine inhibited intrahepatic IFN- alpha expression, which was associated with an increase in HCV replication in hepatocytes. Moreover, morphine compromised the anti-HCV effect of recombinant IFN- alpha . Investigation of the mechanism responsible for the morphine action revealed that morphine inhibited expression of IFN regulatory factor 5 in the hepatocytes. In addition, morphine suppressed the expression of p38, an important signal-transducing molecule involved in IFN- alpha -mediated anti-HCV activity. These findings indicate that morphine plays a cofactor role in facilitating HCV persistence in human hepatocytes.

[merryBe]

not trying to depress you but to help here, the article clues you more to the dangers.

One thing yu may ask your doc for is called an IGF-1 test. this gives a HGH reading. HGH repairs tissue each night. If you do not make enough HGH in your pituitary then yes indeed sore all over becomes ones middle name.
If his IGF-1 indicates more tests, he could qualify for treatment and this makes the soreness leave.
You should also have him checked for sleep aphnea if he snores as this can cause muscle soreness also.

Murphy EJ.
Department of Anaesthesia, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia.

The clinical utility of most analgesic drugs is altered in the presence of patients with impaired renal or hepatic function not simply because of altered clearance of the parent drug, but also through production and accumulation of toxic or therapeutically active metabolites. Some analgesic agents may also aggravate pre-existing renal and hepatic disease. A search was performed, taking in published articles and pharmaceutical data to determine available evidence for managing acute pain effectively and safely in these two patient groups. The resulting information consisted mainly of small group pharmacokinetic studies or case reports, which included a large variation in degree of organ dysfunction. In the presence of renal impairment, those drugs which exhibit the safest pharmacological profile are alfentanil, buprenorphine, fentanyl, ketamine, paracetamol (except with compound analgesics), remifentanil and sufentanil. none of these deliver a high active metabolite load, or suffer from significantly prolonged clearance. Amitriptyline, bupivacaine, clonidine, gabapentin, hydromorphone, levobupivacaine, lignocaine, methadone, mexiletine, morphine, oxycodone and tramadol have been used in the presence of renal failure, but do require specific precautions, usually dose reduction. Aspirin, dextropropoxyphene, non-steroidal anti-inflammatory drugs and pethidine, should not be used in the presence of chronic renal failure due to the risk of significant toxicity. In the presence of hepatic impairment, most drugs are subject to significantly impaired clearance and increased oral bioavailability, but are poorly studied in the clinical setting. The agent least subject to alteration in this context is remifentanil; however the drugs' potency has other inherent dangers. Other agents must only be used with caution and close patient monitoring. Amitriptyline, carbamazepine and valproate should be avoided as the risk of fulminant hepatic failure is higher in this population, and methadone is contraindicated in the presence of severe liver disease.

[vincenos]

i gues im so sick of feeing like i am dead tired 1st  thing in the morn. and then i get up through an on and off sleep night and have reaally nothing to vomit but am very nausuas do any of you get that feeling s ? i also have joint lower back disc / arthrititus issues its all new to me and need someone to talk to im a little scared on the hep/c  treatments /also like if my liver is half gone how much longer will i live i have  a wife 3and a half  yrs old  a12and a14 years old thanks all for bending an ear and listening any advise would be helpfull  thanks  vince

[vincenos]

i guess i didnt read the post  clearly .are you saying the fatigue in the morning and the feeling like your in super low gear happens to us ,which it does for me ,before treatment and gets even worse when treatment is started? omg im a little scared about the treatment, so it is that bad as what people say ? i mean i guess if i want to live  i will go through with the treatment.but i wish i had some more knowlege on it . my next visit is on 3/13 my pcp has instructed me to cut back on the norco currently 6 a day but somtimes 4 she has prescibed a time release ms contin only 15 mg. sorry to bother you all and ramble on but just have many confused thoughts on the matter thanks all for listening nad your responce  vince l.

[vincenos]

i guess i didnt read the post  clearly .are you saying the fatigue in the morning and the feeling like your in super low gear happens to us ,which it does for me ,before treatment and gets even worse when treatment is started? omg im a little scared about the treatment, so it is that bad as what people say ? i mean i guess if i want to live  i will go through with the treatment.but i wish i had some more knowlege on it . my next visit is on 3/13 my pcp has instructed me to cut back on the norco currently 6 a day but somtimes 4 she has prescibed a time release ms contin only 15 mg. sorry to bother you all and ramble on but just have many confused thoughts on the matter thanks all for listening nad your responce  vince l.

[R Glass]

In the mornings it is mostly fatigue not nausea. Once I get up (forcefully), have my shower, and get stirring around. It lightens up. It comes and goes through out the day and some days I have none at all. Keep in mind that almost everyone reacts different to both HCV and tx. This is one of the reasons, it is so hard to understand and predict. Some people have little to no side effects from tx and others cannot complete the treatment because of severe side effects. You may be one of the lucky ones. I wish I could tell you everything will be fine with tx but this is one you won’t know the answer to until you try. They are constantly working for new Treatment but I don’t think any of us believe they will come up with the “Magic Bullet” in the near future.

[vincenos]

thanks for th response i watched for it all day this thing is raelly emotionnally tearing me up a bit and i know my situation and it aint great  im pretty scared of the tx and i know thats what the gi dr is going to recommend tx but maybe i can convince him to do another  biopsy since its been 3.5 to 4 yrs. to see if the results actually have got any worse thank so much for your reply and god bless

[HARRYBEADS]

Hey Vince, I thought I wrote you back but.... anyway as for the pain meds, I have alot of pain with this hep thing to and the Docs had me on, amytriptaline at night, 4mg hydromorphone for breakthru pain as needed ,percodan 4 times a day plus 175mg of Lyrica.
Before I started they dropped the lyrica, perks and amytriptaline, because they suggest that these are not good for the liver. They gave me MSContin three times a day plus the hydro for breakthru. My liver enzymes dropped all thru treatment and the VL did to, I WAS a 1a'er ,now after 48 weeks of treatment I have a clear VL.
Hep can cause some types of arthritis, next trip to the Doc get checked for (cryo)...cryogobulinanemia, treatment will help if you have it. Opiates are not going to cause any issues unless the liver can't get rid of them but that would be in end stage only and then they monitor you closer so as not to overdose you.
You can find a study that says just about anything now a days, the other day I was reading how drinking your own urine will cure what ales you and it was backed up by studies from India where it is a common practice?!!!
  It is scary starting treatment but now looking back it was easy concidering the alternatives. I have grown up kids and grandkids to see, so it was easy to decide.
  Also had the fatigue as soon as I would get up if I slept, work was really hard I had to drag myself home at night.

Hope this helps a bit, write a list of concerns for next visit and go thru it with the Doc's  bring the wife in to, she has a better memory if she's like mine.

Harry

[vincenos]

thanks for the post . did i understand you right you saying opiates dont really raise enzymes ?? than i wonder in my case what is than the hep c im sorry im new to alot of this thanks  every1  vince

[R Glass]

HarryBeads just gave you some advice I strongly suggest you follow. Wright down a list of questions before your next visit. I still write down a list.  Most people get overwhelmed when they visit their Dr. and their mind shuts down. In other words, you see their lips moving but don’t hear a word they say. After you leave, you want to kick yourself because you didn’t ask most of the questions you wanted and needed answers to.
We need to remember to suggest this to every “New Be” that post.

[HARRYBEADS]

  The pain meds are not harmful to the liver as long as they don't contain aspirin and acetaminefen and are taken under a Docs care, along with regular blood tests you'll get any way for the treatment. Most pain meds ,codein, hydrocodone, etc.,metabolize to morphine in the liver , so morphine has the least pressure on the liver aslong as you are in good enough shape to rid the liver of the drug and not let it build up. That is rare though and only seen in end stage liver disease.

Vince hope this helps
if not ask again
Harry