Aa
Prescribed Drugs
It seems my sister is being over medicated with prescription pain killers among other things. She weighs 112 pounds and is on the following:
75 mg. of Fentenol every 72 hours for pain (just a year ago her prescription for Fentenol was 100mg. every 48 hours!)
600 mg 2x’s a day of Gabapentin (Neurontin) for nerve pain
Lortab for pain 10/500 1 tab every 4 hours
Oxycodone – Tylenol 10/325 (Percocet) 1 tab every 4 hours as needed for pain
Percocet 1-2 tabs every 4 hours as needed for pain
Celexa 20 mg 1 tab daily for depression
Cymbalta 60 mg 1 tab daily for depression
Does that seem excessive?
75 mg. of Fentenol every 72 hours for pain (just a year ago her prescription for Fentenol was 100mg. every 48 hours!)
600 mg 2x’s a day of Gabapentin (Neurontin) for nerve pain
Lortab for pain 10/500 1 tab every 4 hours
Oxycodone – Tylenol 10/325 (Percocet) 1 tab every 4 hours as needed for pain
Percocet 1-2 tabs every 4 hours as needed for pain
Celexa 20 mg 1 tab daily for depression
Cymbalta 60 mg 1 tab daily for depression
Does that seem excessive?
Is it the same doctor prescribing all these meds, even with all her problems it seem like alot of medication and the potential for abuse and or addiction is very great, tell her to be careful and if she is getting all these meds from different doctors I would hope doc#1 knows what doctor #2 is doing and so on. I am sure she is in alot of pain but as her concerned loving sisters you don't want her to have a addiciton/abuse problem to go along with her other problems. Let me know.... Fentenyl is a good long acting pain med and loratab is good for breakthrough pain put all the rest seems like she is asking to have onother problem. lyerhc
Very Well said OtisDaMan,
Sometimes our initial "look" at a situation, especially in tragic circumstances is not the entire picture. I have been in a similar situation with a wonderful Uncle. At first glance it looked like way too many medications that certainly must have caused his death. After an investigation the picture became clear. His heart had been supporting a pain racked frail body for years. It finally gave out without warning. It was a quiet merciful death to a decorated and honored veteran that had suffered in severe unrelenting pain for far too many years.
And Concrenedsisters I too wish you the very best and hope that you will discover some answers that can aid in easing you grief. My heart goes out to you.
Tuck
Sometimes our initial "look" at a situation, especially in tragic circumstances is not the entire picture. I have been in a similar situation with a wonderful Uncle. At first glance it looked like way too many medications that certainly must have caused his death. After an investigation the picture became clear. His heart had been supporting a pain racked frail body for years. It finally gave out without warning. It was a quiet merciful death to a decorated and honored veteran that had suffered in severe unrelenting pain for far too many years.
And Concrenedsisters I too wish you the very best and hope that you will discover some answers that can aid in easing you grief. My heart goes out to you.
Tuck
Tuckamore's point about having to trial different medications, and hence having different scripts and meds floating around, is a valid one. I still have some unused scripts or medications in the drug drawer. Tuckamore offers wise counsel about being careful on assuming that your sister was over-medicated: it might look that way at a first glance, but until checking the script dates, whether the medication from filled scripts has been taken as prescribed (or discontinued by your sister), and so on, it isn't possible to make a definite conclusion one way or another.
Opioid medications may be taken in very high quantities by people who have adapted to them; what looks like a high dose for a naiive user might be a normal dose for a regular user of opioid pain medication. Chronic pain management involves some judgement as to how to handle tolerance if/when it develops in a patient.
If your sister had consumed lethal quantities of pain medication, the post mortem may indicate this. However, given what I have said about tolerance effects, a black-and-white conclusion may be impossible to draw.
A couple of years ago my best friend died ultimately from multiple organ failure. He drank too much and was on enough medications to kill an elephant. But, he was monitored on the meds and he needed that much for therapeutic effect - an overly exuberant liver and renal system. In the end the manic depression, from which he had suffered for some time and for which he required the meds, is the killer. The alcohol and meds played a part but wouldn't have been there if not for manic depression in the first place.
I wish you the best under very tragic circumstances.
Regards,
OtisDaMan.
Opioid medications may be taken in very high quantities by people who have adapted to them; what looks like a high dose for a naiive user might be a normal dose for a regular user of opioid pain medication. Chronic pain management involves some judgement as to how to handle tolerance if/when it develops in a patient.
If your sister had consumed lethal quantities of pain medication, the post mortem may indicate this. However, given what I have said about tolerance effects, a black-and-white conclusion may be impossible to draw.
A couple of years ago my best friend died ultimately from multiple organ failure. He drank too much and was on enough medications to kill an elephant. But, he was monitored on the meds and he needed that much for therapeutic effect - an overly exuberant liver and renal system. In the end the manic depression, from which he had suffered for some time and for which he required the meds, is the killer. The alcohol and meds played a part but wouldn't have been there if not for manic depression in the first place.
I wish you the best under very tragic circumstances.
Regards,
OtisDaMan.
Hello Conernedsisters,
I am so sorry to hear about your loss. The death of your sister must bring much grief. Death is often difficult to deal with and accept. Sometimes acceptance comes easier if one can find a reason that we feel is valid, such as over medication.
Just some thoughts...Are these the medications that you found in your sisters home after her death or is it a fact that she actually took all these medications daily? According to your post her Fentanyl had been reduced from 100mcg every 48 hours to 75mcg every 72 hours.
Oxycodone with Tylenol and Percocet is the same medication, one is brand name and one is not. Loretab is basically the same as Vicodin, it is hydrocodone with Tylenol.
Neurontin 600mg twice daily is not an excessively high dose. Some patients take as much as 2,400 to 3,200mg a day.
Celexa dose is 20-40mg per day. It is an antidepressant. So her dose was not excessive. Cymbalta is used not only for depression but in several other conditions such as peripheral neuropathy or anxiety. 60mg is a low starting dose. Was the physician taking her from one antidepressant to another? Or with both at low doses he/she could have prescribed them for different conditions.
You did not indicated your sisters age. Age has an effect when you consider the body's ability to metabolize medications along with any other medical conditions your sister may have suffered from.
If I were to have died a month ago and my loved ones looked at the medications that I had they may believe I was taking a lot more and a larger variety than I actually am taking. My PCP prescribed me several antidepressants in an attempt to treat my chronic pain. I take none but I kept them for awhile. She has also prescribed me several pain medications in an attempt to find one that works well for me. I had those also. I kept all of them for several months (they cost a lot of money) until we have settled on one that worked well. I did not discard them until I was sure we were not going to return to any that I had already bought. I have three that I take at different times for varying degrees of pain. I am not saying that this is what your sister did but I know that my practice is not all that unusual. So I would suggest that you check the dates and the physicians names. This will allow you to better determine if she was using them all at the same time and if they were prescribed by the same physician.
If after you do your research you fell she was over medicated by one physician I would attempt to discuss this with her physician. HIPPA may prevent you from much success but it is worth a try. It may ease your mind. And as Sandee indicated there are cases that the Fentanyl Patch has been defective. There have even been recalls. I do agree that if she took all these meds on the same day it was excessive. Good luck to you. Again I am so sorry for you lose.
Peace, Tuck
I am so sorry to hear about your loss. The death of your sister must bring much grief. Death is often difficult to deal with and accept. Sometimes acceptance comes easier if one can find a reason that we feel is valid, such as over medication.
Just some thoughts...Are these the medications that you found in your sisters home after her death or is it a fact that she actually took all these medications daily? According to your post her Fentanyl had been reduced from 100mcg every 48 hours to 75mcg every 72 hours.
Oxycodone with Tylenol and Percocet is the same medication, one is brand name and one is not. Loretab is basically the same as Vicodin, it is hydrocodone with Tylenol.
Neurontin 600mg twice daily is not an excessively high dose. Some patients take as much as 2,400 to 3,200mg a day.
Celexa dose is 20-40mg per day. It is an antidepressant. So her dose was not excessive. Cymbalta is used not only for depression but in several other conditions such as peripheral neuropathy or anxiety. 60mg is a low starting dose. Was the physician taking her from one antidepressant to another? Or with both at low doses he/she could have prescribed them for different conditions.
You did not indicated your sisters age. Age has an effect when you consider the body's ability to metabolize medications along with any other medical conditions your sister may have suffered from.
If I were to have died a month ago and my loved ones looked at the medications that I had they may believe I was taking a lot more and a larger variety than I actually am taking. My PCP prescribed me several antidepressants in an attempt to treat my chronic pain. I take none but I kept them for awhile. She has also prescribed me several pain medications in an attempt to find one that works well for me. I had those also. I kept all of them for several months (they cost a lot of money) until we have settled on one that worked well. I did not discard them until I was sure we were not going to return to any that I had already bought. I have three that I take at different times for varying degrees of pain. I am not saying that this is what your sister did but I know that my practice is not all that unusual. So I would suggest that you check the dates and the physicians names. This will allow you to better determine if she was using them all at the same time and if they were prescribed by the same physician.
If after you do your research you fell she was over medicated by one physician I would attempt to discuss this with her physician. HIPPA may prevent you from much success but it is worth a try. It may ease your mind. And as Sandee indicated there are cases that the Fentanyl Patch has been defective. There have even been recalls. I do agree that if she took all these meds on the same day it was excessive. Good luck to you. Again I am so sorry for you lose.
Peace, Tuck
My goodness. The doctor may have had some good reasons for the two antidepressants being taken together. The celexa (citalopram hydrobromide, an SSRI) at 20mg/day is the usual initial dose.(http://www.rxlist.com/celexa-drug.htm). [The url just given is a great site for picking up the basic safety info and dosing regimes of most medications.] The cymbalta (a SNRI) at 60mg/day is the usual dose. Both celexa and cymbalta are for majore depressive disorder. In addition, cymbalta is also used for anxiety, and for pain of osteoarthritis, diabetic peripheral neuropathy, and fibromyalgia.
It is possible that cymbalta was being prescribed for major depression *and* additional specific chronic pain conditions, while the celexa was for major depression.
It is worth observing that a chronic pain patient may have more than one type of pain condition, and the conditions respond to different medications. I have that problem myself.
Fentanyl is an opioid which takes several days to build up to a stable concentration in the body, and also takes a number of days to clear out. Given that the fentanyl patches have had an FDA warning of overdosing due to defects, definitely keep all patches for evidence/testing.
With several opioids in the system and fentanyl already giving base analgesia, it is quite possible for someone to go to sleep and then develop respiratory depression. Only a post-mortem would detect that. The neurontin, celexa, and cymbalta taken together could place a load on the kidneys, if the kidneys are already affected by illness like diabetes. When using SSRIs, SNRIs, or even GABA inhibitors like neurontin, the doctor should have the patient undertake regular renal, liver and blood tests. Therefore, there should be some record of regular testing in your sister's case notes. That would resolve the question of the condition of her kidneys.
You said that doctors (ie plural) were involved. Did she have one doctor who tracked all of her medication, or did she have prescriptions spread across several doctors? I don't know how it works in the USA but here in Oz there isn't much coordination and tracking of information from doctor to doctor - sometimes it is up to the patient to tell their new doctor what they are on. Anyway, my point I suppose, is that if all of the medication was prescribed by a single doctor then something is seriously wrong - consider whether it is worth the pain of lawyering up and pursuing it legally. On the other hand, if she was using multiple doctors to get those scripts, then I'm not sure there is as strong an argument of doctor culpability, although every doctor should ask their patient what medication they are currently using before writing a new prescription.
Unfortunately these tragic circumstances occur all too often with chronic pain patients; the fallout hurts family and friends - no words can really adequately describe it.
Regards,
OtisDaMan
It is possible that cymbalta was being prescribed for major depression *and* additional specific chronic pain conditions, while the celexa was for major depression.
It is worth observing that a chronic pain patient may have more than one type of pain condition, and the conditions respond to different medications. I have that problem myself.
Fentanyl is an opioid which takes several days to build up to a stable concentration in the body, and also takes a number of days to clear out. Given that the fentanyl patches have had an FDA warning of overdosing due to defects, definitely keep all patches for evidence/testing.
With several opioids in the system and fentanyl already giving base analgesia, it is quite possible for someone to go to sleep and then develop respiratory depression. Only a post-mortem would detect that. The neurontin, celexa, and cymbalta taken together could place a load on the kidneys, if the kidneys are already affected by illness like diabetes. When using SSRIs, SNRIs, or even GABA inhibitors like neurontin, the doctor should have the patient undertake regular renal, liver and blood tests. Therefore, there should be some record of regular testing in your sister's case notes. That would resolve the question of the condition of her kidneys.
You said that doctors (ie plural) were involved. Did she have one doctor who tracked all of her medication, or did she have prescriptions spread across several doctors? I don't know how it works in the USA but here in Oz there isn't much coordination and tracking of information from doctor to doctor - sometimes it is up to the patient to tell their new doctor what they are on. Anyway, my point I suppose, is that if all of the medication was prescribed by a single doctor then something is seriously wrong - consider whether it is worth the pain of lawyering up and pursuing it legally. On the other hand, if she was using multiple doctors to get those scripts, then I'm not sure there is as strong an argument of doctor culpability, although every doctor should ask their patient what medication they are currently using before writing a new prescription.
Unfortunately these tragic circumstances occur all too often with chronic pain patients; the fallout hurts family and friends - no words can really adequately describe it.
Regards,
OtisDaMan
I am very very sorry for your loss:(
I hope an atopsy was preformed. Also any fenytal patches she has left KEEP them.
There has been cases of defective patches leading to death. I will send you a PM shortly.
Again sorry for your loss. The amount of pain meds she was taking if they were all being taken at the same time is way excessive.
I hope an atopsy was preformed. Also any fenytal patches she has left KEEP them.
There has been cases of defective patches leading to death. I will send you a PM shortly.
Again sorry for your loss. The amount of pain meds she was taking if they were all being taken at the same time is way excessive.
I am sorry to hear about your sister ConcernedSisters. That is such a tragedy. Maybe in her memory you can be an advocate for others that need to hear your sisters story. So many of us trust our doctors way too much. After all, they are just Practicing Physicians not miracle workers as some of them want to believe.
My prayers are with you and your family ~ El
My prayers are with you and your family ~ El
Thank you Bob - yes it is a tragedy because she trusted the doctors not to prescribe anything that would ultimately hurt her. It sounds like she didn't have a chance.
Good luck with your fight in overcoming your dependence on Xanax!
Good luck with your fight in overcoming your dependence on Xanax!
We (my other sisters and I) think over the years the doctors were far too generous in writing prescriptions every time my sister complained about pain. We called her doctors and told them how the drugs were affecting her life and she was a zombie most of the time but they wouldn't listen. She just died and they're trying to say it was her kidneys that gave out. We think her heart couldn't take the drugs any more. A year and a half ago she spent 6 months in the hospital and was detoxed from Methadone. As soon as she got out she got a doctor to start her on Fentanol and when she died last month she was on all of the above.
I have scoliosis too, and that doesn't call for a really strong pain killer, unless you are always making heavy lifting or other stressing actions to your spine,I have also arthritis and never needed any pain killer.
She had severe arthritis and scoliosis for years but the doctors have been far too willing to prescribe pain killers instead of helping her.
HOLY ****, what kind of doctor is prescribing all these drugs?!?
what kind of pain is your sister even in to get that kind of medication
fentynal is quite strong on its own, your sis is going to have to go to rehab to detox off all those meds
what kind of pain is your sister even in to get that kind of medication
fentynal is quite strong on its own, your sis is going to have to go to rehab to detox off all those meds
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