ACETAMINOPHEN

What is the max one should take when it comes to acetaminophen per day? My doctor raised my hydro's to 7.5/750 every 4 hrs for breakthrough pain. I'm also on 50ccg/hr Fentanyl patch every 48 hrs. I was taking 5/325 hydro's every 4 hrs but it wasn't really working anymore. I'm just a little surprised that she upped the acetaminophen. Is that too high?? Thanks for any help

[Tuckamore]

The maximum recommended amount of acetaminophen is 4,000 mgs per 24 hour period.  However that recommendation is being reconsidered of late and there has been talk of changing the dosage guidelines. The researchers for the medical profession are now leaning towards changing the recommendation to a max of 2,500 mgs per day.

There are 7.5 mg hydrocodone bitartrate and 325 mg acetaminophen tablets available. I would suggest that at your next refill you request the 7.5/325 dose. In my opinion there is no need to take more tylenol than required. However you may find that the added acetaminophen does make a difference in your pain levels.

Be sure you take it with a little something in your tummy and with a full glass of water and drink another glass soon after. The more liquids the better. This will help dilute the concentration, decreasing some of the suspected liver/kidney toxicity and allow your kidneys and liver easier filtration and easier metabolism.

Peace,
Tuck

[lawless2009]

Thanks for your reponse. I asked the question because I found the additional APAP a little odd since they had lowered it in the past and added the Fentanyl to avoid possible damage to my liver. I do take ONDANSETRON 8MG 3 times a day for nausea so I'm not too worried about that. I was also concerned since the doctor I see was unavailable so her PA saw me then had my doctor write the RX. I'm thinking it may have been an error but hate to second guess her. She has been a great doctor!

Thanks again,
Lori

[Red931]

Tuck has given you all the information that you need to know in reference to the acetaminophen. As she stated they are going to lower the standard to 2500 mgs. a day and I think that is still too much as it builds up in the liver over extended and continuous use.

I had a problem last year with my liver enzymes going up while taking the same prescription you are taking and I was taking less. Once my medication was changed and the acetaminophen was removed my liver enzymes returned to the normal range rather quickly. I was lucky.

I take 500 mgs. of Milk Thistle a day to help my liver out with the detoxification of the pain meds and I have found that this works very well with no adverse reactions to any medications that you may be taking. You may want to talk to your doctor about it to see if it may be good for you as well.

Good Luck

[lawless2009]

Thanks for the suggestion, I'll look into the Milk Thistle. Luckly I have an appointment on the 28th to run full blood work and will be seeing my regular Dr. a week later so we can discuss options then.

Thanks!

[OtisDaMan]

As Tuck says, 4gm is the upper limit for daily use, so long as you don't use it every day, that is, you don't take it for extended periods. As people age, their liver's capacity to metabolise acetaminophen declines. Typically doctors try to take that into account, but in my opinion it is usually best to treat acetaminophen as not suitable for anything beyond occasional use, and for you to keep track of the various pharmaceuticals which include it. Lower daily doses, say 2.5gm or less, are probably safe enough for extended use for many people, but it can't hurt to keep track of liver function via blood tests. All pain medications have some risk of damage. The risk depends a lot on the individual's genetic profile, which is why it is good idea to keep track of things via blood tests. I usually test three or four times a year and I've stopped one medication in the past because of a severe change - the culprit was Tegretol (carbamazepine).

The best place to get summaries on various medications and evidence of the benefits vs harm - technically referred to as the "Number Needed to Treat" (NNT), and the "Number Needed to Harm" (NNH), respectively - is from the review papers in the Cochrane Library, available on the web. For example, overdose intervention for paracetamol. The Cochrane Library do not keep reviews that are inaccurate or that have insufficient evidence to support the conclusions; the reviews summarise the state of the evidence-based research at a given time.

Finally, a lot of good information can also be found at the pubmed website, although the articles their are often at the cutting edge of research, and so should be regarded as speculative. Review articles are able to be found on pubmed, and they summarise the state of the art at that time. Generally they consolidate evidence as well.

Hope this helps,

Regards,

OtisDaMan

[lawless2009]

I do take this on a daily basis and will be on pain meds for the rest of my life so that is why I posted my original concern about the daily max. I will discuss this with my doctor. Thanks to all for your replies!

[Red931]

I will most likely be on meds for the rest of my life as well. That is why my PCP switched me to Oxycontin.

I wasn't going to mention it, but since we are headed in that direction I will. Since you are on a Fentanyl Patch for round the clock pain relief why doesn't your doctor just put you on 5mg. Oxycodone or 7.5 mg Hydrocodone without any acetaminophen for breakthrough pain?

If you are being prescribed the acetaminophen for the anti-inflammatory properties there are other drugs that can be prescribed in addition to the narcotics.

I am suggesting this because as I stated my enzymes were only slightly elevated and I began to feel pain and tenderness in the abdomen around the liver. Doctors would rather write the prescription for the hydrocodone because of the DEA Schedule but you need what will work best for you.

I also forgot to tell you that 500 mg. of Dandelion Root as well. It helps out the liver too.

[Tuckamore]

It is my understanding that you cannot get either hydrocodone or oxycodone without the acetaminophen. Oxycodone is no longer manufactured without the apap at least it is still unavailable in my state. Hydrocodone is simply not made without the apap.

Otis brought up a several good point that I neglected to mention. Primarily all pain medications have side effects, some worse than others. Often how your system reacts is based on ones individual make up. My pain med contains acetaminophen. My PCP monitors my liver enzymes every six months. They have always been WNL (within normal limits). I average 2,000- 2,400 mg per day and on rare occasion more.

There are not any anti-inflamatory properties in acetaminophen. It is an analgesic but not an anti-inflammatory.  

The recent "scare" in the acetaminophen amounts we ingest are founded but as with all media carried stories over-hyped. Ppl are not developing liver disease in mass based on the proper use of acetaminophen or even the improper use of it. It is a possibility as are all side effects from medications. Our bodies are an amazing machine and every one is different.

[Red931]

Thank you Tuck, I was confusing aspirin with acetaminophen with the anti-inflammatory reference.

In New Jersey you can still get Oxycodone IR at a 5 mg. dose. This does not contain any acetaminophen. I have a friend who was prescribed it earlier this year. I didn't realize that it existed either. The Hydrocodone that I was referring to that contains no acetaminophen was Hycodan. My doctor told me that it is usually prescribed for coughing but that doctors prescribe it for pain as well in some cases. He just didn't prescribe it to me because he felt that the Oxycontin was better suited to my pain levels.

[sandee1818]

There are several medications such as oxycodone that do not have acetaminophen in them.
There are various strengths of oxycodone such as 5mg, 15mg, 30mg. I am sure there are other strengths but these are the ones I am aware of.
The DEA at one point had tried to take the drugs with acetaminophen like percocet and vicodin off of the market but they have not done this to date. I do not think they will suceed as these are some the number one prescibed drugs.
If one is taking pain medications for an extended period of time then it is always best to try and avoid the ones with acetaminophen. Many doctors prescibe the extended release medications instead. Though some do take the short acting medications with acetaminophen and they do fine. I just advise getting regular test to make sure your liver is not being affected too harshly.

[concerned621]

I was on a similar dose about 2 years ago and was switched to oxycodone (percocet) for breakthrough pain.  It was a much better program and better for break through pain. I also needed much less medication.  

I also found out I am also allergic to tylenol. I had a seizure from it after a surgery.  The paramedics and doctor think the seizure was from high doses of tylenol.  I can tolerate it in lower doses but not in the higher doses. So please be careful.  Take good care.

[lawless2009]

The additional acetaminophen that was added to my break through medication was my main concern. My doctor has been very caring especially considering she, as a PCP chose to take on my pain meds after the PMP she recomended gave me injections that did nothing to help then wished me good luck. She could have left me hanging but instead continued to work with my PMR to get to the bottom of my pain. So far i"ve been diagnosed with piriformis syndrome, degenerative disc disease (mild), spinal arthritis, scoliosis, sacroiliac joint dysfunction and carpal tunnel syndrome. I'm scheduled for a full body bone scan on Monday a new EMG on Thursday due to failed carpal tunnel release surgery and have been experiencing (new) joint pain in my elbows, wrists and knees. They are also suspecting I may have RA. I guess my whole point is that she and my PMR seemed concerned with the amount of acetaminophen in my hyro's to the point of lowering it to 5/325 then adding the Fentanyl patch, then when I starting getting no relief from the hyro's for breakthrough I did ask to have it adjusted and requested to not raise the patch because I felt it does cause drowsiness at times. Unfortunately this was all relayed through her NP (since she was booked solid until my upcoming visit 12/2) So...... I'm thinking the nurse perhaps made a mistake in ordering the 7.50/750. I'm just wondering if it would be okay for me to go ahead and use the RX I was given until I see my PCP then? After reading several of the stories here I would hate to cause a problem by my questioning the new RX when we're only talking about a few weeks. I don't want to appear to be complaining nor do I want to make specific recomendations as to what narcotic I think I should be on however I do believe that a different medication for break through pain is in order in hopes that I can take less per day. 1 every four hours is driving me crazy since I actually awake in the middle of the night just to take it. I have not slept for more than 3 hours at a time in over six months! Sorry this post is so long, thanks to all here for taking the time to listen and respond. Hopefully it made a little sense.....

Lori

[Red931]

If you are taking 6 Vicodin 7.5/750 a day you are above the high end of the 4 grams a day.

As Tuck mentioned, everyone is different. Diet also comes into play with this. My opinion on it though is why make your liver work on overtime if you don't have to. If it is only going to be for a three week time period you will probably be fine but once your enzymes go up it could take quite sometime to bring them back to normal, because as previously stated, everyone is different.

I was lucky. My PCP was surprised that mine came down as fast as they did.

[Tuckamore]

Ok I'm confused. Oxycodone is not available in any strength in my area without apap, It is available in extended release form without apap which is than OxyContin. OxyContin is generally not used for break-through pain.

When it was prescribed by his physician a few months ago we have searched the state for my father's oxycodone without apap for break-through pain. We are told it is simply not being manufactured in any numbers. Hospitals can generally still obtain it but the general public cannot. He must take oxycodone with apap. Our pharmacist searched for it for an entire day. So are you all telling me that it IS available in other states? Thanks for your assistance.

Thanks Red. I did know about the cough formulas of hydrocodone but have never seen it used for pain relief alone. Hycodan does come in a tablet but in all forms it contains an antitussive. Many ppl can not take the antitussive long term for numerous reasons. I have allergies and it would interfere with the medications I take for those.

And Lawless, Red is correct. six doses of 750mg of acetaminophen (apap) is above the recommended daily intake. I'll bet your medical provider just made a mistake. I'm surprised the pharmacy didn't call him/her on it. When my physician increased the amount I could take in a 24 hour period without decreasing the acetaminophen my pharmacist called my physician immediately and requested the acetaminophen dose be reduced and the hydrocodone be increased. Mine were only Hydro 5/500 apap at the time and the pharmacist had the physician change it to Hydro10/325 apap. Again I am blessed that not only do I have a great physician, I also have an astute pharmacist.

[lawless2009]

I have decided not to wait until my appointment on 12/2 to discuss this with my physician. I will try to contact them today to change it from 750 to 325. Thanks for everyone's input! It is most appreciated!

[peekawho]

If you have any impairment of your liver, the recommended max amount of acetaminophen is only 2000mg.

There used to be hydrocodone with ibuprofen....I think it was called Vicoprofen.  Also, oxycodone IS available with aspirin, under the name Percodan.  

Obviously, if someone cannot take NSAIDs or aspirin, these would not be appropriate.  And in most states, Percodan cannot be called in to a pharmacy.  The original prescription must be presented at the pharmacy.

[lawless2009]

Thanks but no, I can not take NSAID's or aspirin and as I had stated eariler, I don't feel it is appropiate for me to make specific requests for my pain medication. Doctor's do frown on that unless they ask you if you've tried something in the past that is helpful. My plan is to contact her office and confirm that the amount of ASAP added to the lastest RX was correct or perhaps in error since I normally have 325's instead of 750's. Since I am on the Fentanyl patch already I'm sure she will have no problem changing the break through meds as she feels they are warranted. I try to be a patient "patient". ;) Though I will speak up for myself when I feel further examination is needed!

Thanks!

[Red931]

Yes Tuck, Oxycodone is indeed prescribed in my state without APAP. I asked my pharmacist when I picked up my prescriptions Sunday to see if they still did for the purpose of this discussion. She said that they do have it in 5 mgs. and 10 mgs. at my pharmacy but that the doctors in my area don't seem to prescribe it much and lean to the Percocet. So it may in fact be that they just don't have it in your state, but that would seem weird to me as the drug companies want their dough. lol

I am also aware of the antitussive in Hycodan because my doctor mentioned it when he spoke to me about it. He specifically asked me if I smoked when we were talking about it. He has been treating me for 36 years and knows I don't smoke but always asks me anyway. It is kind of funny.

Personally, I don't like hydrocodone at all because, while it does the job with my pain issues it keeps me awake all night for some reason.

[TrayCee]

to reiterate:

Roxicodone is oxycodone WITHOUT apap it comes in 5mg 15mg & 30mg