Looooong term vicodin use!

[mikep22]

My wife has been on 80 to 100 mg 10-325 dosage vicodin for close to 10 years now. Blood tests say her liver is fine (so the doctor says) and she has hep C. She also started taking oxycodone 10 mg 5 times a day about 1 1/2 years ago. We feel she needs to end the vicodin usage asap and up the dosage of the oxycodone. She has been bringing this up to her pain management phys-assistant for 6 to 8 months and she tells her just keep doing what your doing! I cant find much info on this subject(s) such long term use and hep c. Also she has had staph infections on and off for the same amount of time, and now the staph will not go away! Can this be related in any way? And what can we do to change her meds without having to change doctors???

[Advocate1955]

You've had some great advice above.  I would just add as she increases her narcotic pain medications and dosages, her perception of pain is changing and her tolerance for pain is decreasing.  I'm not very knowledgeable about this, but prior to neck surgery following a car accident, I was on narcotic pain meds for about 2 weeks before doctors figured out what was wrong with my neck and what surgery was required.  As I was being prepped for surgery, I was told that being on narcotic pain meds for two weeks, to expect that after surgery I may perceive pain as being worse than it actually is, I may feel the need for more pain medication than I actually needed, and my tolerance for pain would be decreased.  I was told to expect that and that the nurse would help me monitor my need for pain meds following surgery.  I have to say that it was tough not to want to press that pain med button more than prescribed the first few hours after surgery (it wouldn't have let me anyway!), and it was tough to figure out when and how quickly to taper off of pain meds during the recovery stage after surgery.  There is a strong psychological component, not only to pain, but also to pain management.  There is a balancing act between managing pain so as to avoid the pain cycle, but at the same time making sure one does not become addicted to the pain meds themselves.  My advice is to work closely with the doctor to taper back or taper off the narcotic pain meds.  They may be damaging the liver in conjunction with the damage that her Hep C is very likely doing already.  Additionally she may be addicted to them, which would add another layer of complexity to treating her Hep C.  Heaven forbid, should she ever reach the stage of her liver failing and needing a liver transplant, the pain medications could be a significant issue in receiving a liver.  I don't know if that's the case, but it would be a question I would be asking.
Good luck to you.  Keep us posted.
Advocate1955

[mikep22]

Thank you!

[mikep22]

Thank you so very much for your quick response. I'm on it ASAP!

[Idyllic]

I agree with everything that has been said. In my view slow to non-healing infection is a rather alarming symptom under any circumstance. And this is just one symptom you overtly notice since it is lingering.

While I am not suggesting this is the case, I can easily envision an inexperienced PA concluding  normal liver enzymes indicate your wife's Hepatitis C is being managed and that is not quite how it works. It would help to know the stage of fibrosis your spouse has in the disease process. Most of all a recent set of labs and a thorough assessment with a liver specialist might be in order.

Ideally the pain management specialist and liver doctor could work in tandem.

Take care ♫

[HectorSF]

What stage is your wife's liver disease? From her biopsy report.

Vicodin contains: Hydrocodone Bitartrate + Acetaminophen.
The 325 is the dosage of Acetaminophen.

The maximum amount of acetaminophen that you can take in one day (24 hours) is 2,000 mg. That would be 6 10-325 dosage vicodin MAX.

"On January 13, 2011, the FDA requested that all makers of prescription products that contain acetaminophen limit the amount of acetaminophen to 325 mgs per tablet or capsule, thereby lessening the risk of an acetaminophen overdose. Furthermore, the FDA requested that the same products carry a warning, highlighting the potential for severe liver injury in products that contain acetaminophen.

When it made the announcement, the FDA noted that it still receives reports of severe liver injury associated with acetaminophen-containing products. Patients who develop liver failure linked to acetaminophen may require a liver transplant and may not survive their acetaminophen toxicity.

"Overdoses from prescription products containing acetaminophen account for nearly half of all cases of acetaminophen-related liver failure in the U.S., many of which result in liver failure or death," says Sandra Kweder, deputy director of FDA's Office of New Drugs. The FDA has taken the new steps regarding prescription acetaminophen products to try to limit the number of cases of acetaminophen toxicity.

Over-the-counter medications, including Tylenol, are already required to change their label to include a warning about the risk of liver injury."

Constant use or high dosages of Acetaminophen can lead to liver disease, liver failure and death.

Infections are usually the sign of a reduced immune system or can be cause by advanced liver disease. Staph infections are caused by bacteria, commonly found on the skin or in the nose of even healthy individuals.
But staph infections can turn deadly if the bacteria invade deeper into your body, entering your bloodstream, joints, bones, lungs or heart. Many staph infections no longer respond to common antibiotics. Your wife should see a  infectious disease doctor.

A pain management doctor or phys-assistant has no knowledge or experience of hepatitis C or liver disease. Blood tests do not tell the whole story about liver disease. She needs at least liver biopsy to know how advanced her liver disease is.

I would suggest you make an appointment with the nearest liver clinic or teaching hospital to see a gastroenterologist or hepatologist (liver specialist) and get her hepatitis C and liver disease assessed. The longer your wife doesn't treat her hepatitis the more advanced her liver disease will become. Having taken so large amount of drugs addictive drugs for so long and having hep C is a dangerous mixture. Hopefully it is not the case but it wouldn't be uncommon. For many or most patients with hep C and liver disease they have no symptoms until the very late stages of the disease.

Best of luck to you and your wife!
hector