drug mixing question

[builder5840]

Hey I had an interesting thing happen today and was wondering if any others may have dealt with this. I went to pick up my Morpine tablets and the gal and the Pharmacy counter asked if I was still taking the Vicodin. I told her yes and she said that you can't take them together becuase of risk of overdoes. Any way i've been on vicodin for the last 3 plus years and morphine about 3months the first year of my injury but I started back on it this year. At first I was only taking the morphine at night but I'm up to taking it all day. I was taking the vicodin during the day and the morpine at night now i'm taking the morphin and supplimenting it with vicodin when i have more pain than the morpin is handeling. My doctor knows this but I will be calling him tommorrow. I went to webmd and it doesn't list vicodin as a possible problem while taking morpine but I did find out that it is a problem with a muscle relaxer that they have had me on which i'm not currently taking but the xanax I take occasionally for insomnia is a big no no which you would think the pharmacy should have flagged being I just got it filled last week.

Anyone use a pain management doctor for all of their meds?

I should be doing a better job of making sure i'm not taking things that don't get along but you'd think my doctor should be doing that?

Fall off ladder in 05 lots of pain
ddd C5,6,7 all of the test and programs
Planning ADR surgery in 09 two level

[Justin]

I'll answer some of your questions:

You might have spoken to a Pharmacy Tech. The pharmacy should have a record of everything you are taking and the possible interactions associated.

It sounds like your physician has been fully aware of what meds you are taking. I also use a pain management doctor for all my meds.

The "overdose" the pharmacy is probably talking about is respiratory depression (rate of breathing is slowed). If you are on long-term opioid therapy, you will develop tolerance to this. However, you will not development tolerance to constipation and miosis (small pupils). This is why patients most patients are prescribed something to address constipation when on long-term use of opioids.

Be well,

[New-disc]

Builder,

These are great ?'s ..... hope you get lots of feed back... stay safe!!

Todd

[kimmers]

Builder,

Sounds like you are taking morphine as your maintenance pain medication and then you take Vicodin as needed or prescribed for breakthrough pain.
This is okay as long as it is okay with your doc and you already said so. You just have to be careful if you are taking a med with Tylenol in it. Vicodin has acetaminophen and hydrocodone.
Always be careful not to take more than 3,000 mg of acetaminophen (tylenol) a day (24 hours). So you have to watch your Tylenol dose even if it is over the counter medication.
People get in trouble when they mix too many meds and I found a good idea when taking pain meds was to write down the med, the dose and the time i took them each day so I did not take too much. It is amazing we forget what we took and it is easy especially when you are on these mind--numbing meds.

Also and this is not aimed particularly at you Builder, but you have to watch alcohol consumption while on pain medications. Alcohol can cause things like respiratory depression by interacting with pain meds. Basically too much sedative. You also shouldn't consume alcoholic drinks while taking Tylenol.

You just have to be mindful of what you are taking.

When I went under care with my neurosurgeon, all my medications relating to my back were switched to their service from the pain and rehab doc. This saved me the trouble of calling two doctors for prescriptions and my neurosurgeon knew exactly what I was taking. I remember my pain doc had me switch all my meds to one pharmacy. That was a change for me, but now I have all my meds at one 24 hour pharmacy and it works out well. I found the other pharmacies I was using didn't have the pain meds available, particularly when I was taking Oxycontin.

One time, when I came straight from my doctor's office with a prescription, my old pharmacy would not honor the prescription. So here I am, not able to drive, my teen daughter has driven me to my doctor's appointment and to get the prescription and they will not fill the prescription (I think my birthdate was missing or something). I was chided for not coming in earlier when I got there before the pharmacy closed, I arrived 45 minutes before close. Boy, did I feel the stigma then. How do you explain to a pharmacy person that you need this med desperately? He even told me to come back tomorrow. I told him I had back pain that was incredibly painful and I needed medication now. How do you explain to these people that you don't have transportation or a way to get to their pharmacy tomorrow? Or you cannot last the night without pain meds?
I was on the phone trying to contact the doc's office through the exchange and asking the pharmacy to fax the request to the doctor's office and my daughter was telling me she was missing her chem tutor session. It was crazy. It all goes back to the fact if we are not using a walker, people don't believe anything is wrong with us. They do not believe you are in pain. I am amazed when a doctor can write down that you are in no apparent distress and you are in a lot of pain.
That really irks me.

So the message is, when in doubt, ask your doc about the meds you are taking, including over the counter medication.

K

[builder5840]

Hey,

Thanks for the post, I talked with my doc and he said that the vicodin was fine with the Morphine the way that i'm using it. He did say that the Mucle relaxer that I have and the Xanax that i use isn't a good idea while on Morphin and he suggested that i discontinue using them. Apparently using the muscle relaxer and or sleep aids slow things down and Morphin can have cuase some slowing of your respitory system so the combination of the two could cuase some problems so i'll have to find other ways to get to sleep on those sleepless nights. which are mostly caused from the pain but some of its from the mind racing.

Justin as to your question about if I had talked to tech. You where right it was a tech but they got me thinking and asking some questions which I think has been good.

Kimmer thanks for the info I know what you mean about doc's and pain. I've also run into the driving issue and pharmacy issues yesterday the doc's office called to tell me my prescrip is ready so I go over to the office and sit there for an hour and a half becuase the doc forgot to sign the script. luckly they cuaght it before i got to the pharmacy

I really hope that after surgery I'll be able to get off of the Drugs they are a blessing and a curse.

Oh and Kimmer I don't drink so that's a plus when your on these kind of meds

[Terry]

Builder:

There are some medications that can be used that are not in the Benzodiazepine class of drug to help you sleep, (Benzodiazepine = Valium, Xanax, Ativan, Librium, Serax, etc.).

Some of these are in the anti-depressant class. Here's a partial list to go over with your doctor: Cymbalta, Elavil, Trazadone, etc. Benadryl is also used as a sleeping aid and there are some teas that can help.

Sleep is all important to help in the healing process. Discuss some of these with your doctor and, have them check for drug interactions.

Don't skip your pain medication as this is so important to help in the healing process.

Hang in there.

Terry Newton

[KBear]

I had this same "scare" when I was put on Fentanyl two years ago. I was reading the pharmacy handout (the one you get with every new prescription) and came across some scary information. I read not to take with Vicodin (which I was to continue to take for 'breakthrough pain", not to take with muscle relaxers (which I take Zanaflex nightly for sleep) and not to take Benadryl (which I also take nightly for allergies and sleep). Of course, I am reading this in the evening (my only "me" time, when kids are in bed and not crawling all over me) and I had just taken all of the above medications, as I was getting wound down for bed. I am panicking at this point, and here is my train of thought... " I am about to OD and possibly die".... "Why did the doctor prescribe me Fentanyl, Vicodin and a muscle relaxer when the warning says do not use together".... "I know I wrote down on my med sheet that I was taking Benadryll." So, I then had the great idea to look up the interactions on the internet, I then read about people dying from just Fentanyl, not to mention the other interactions. I debated on going to the emergency room; but was afraid that doing so, would put me on the crazy, OD, drug abuser, etc list. I decided to go to sleep and take my chances. Suprisingly (to me at the time), the next morning, I woke up (thankful I survived the night!) I immediately called my family doctor and went in to discuss these prescriptions prescribed by my pain doctor (whom my family dr. had referred me to). I went to the family dr. instead of the prescribing pain dr. to make sure this was ok. Turns out, since I had been taking all of these medications prior (Vicodin, Zanaflex and Benadryll) that these warnings did not really apply to me. He explained, that since I was 'opiod tolerant', having been on Vicodin for close to a year, as well as the other medications, that my body was already used to all these medications and that I would not be 'dying' from any of it. Two years later, I am now on Kadian (time-released morphine) and still take Vicodin for breakthrough pain (4 10mg pills a day), as well as the muscle relaxer Zanaflex and Benadryll. Anyway, I think the warning is just that, a warning; but in my opinion, does not seem to apply to people who have been on long term treatment for chronic pain (at least that is my humble understanding). Of course, I would always and do always double check with my doctor and/or pharmacist when put on any medication that suggests any drug interactions with a medication that I have been taking. Rather than worrying about it, that puts my mind at ease and I don't have to worry about dying in my sleep everynight! JMO

[builder5840]

Terry and Kbear, Thanks for the info, I'm really bummed becuase I'm know out of state for the next couple of weeks. This started a couple of days before I was to leave and so I was hurriedly trying to resolve this, which as I stated I contacted my doctor which for me is my general practioner that does all of my meds. So when I called him the other day he just tells me yah these other drugs I.E. the xanax and flexaril are on the list for reactions when taking morpine and said that they would probably not hurt me but since they are on the list if I wanted to stop taking them I could and that if I wanted something else to help me sleep to make an appointment to see him. If he had told me that I probably had allready built up a opiod tolerance and could still take them I'd be fine. But no... I have a doc that probably trying to cover his butt instead of taking care of me and so I didn't bring any of my drugs to help me sleep and Got about an hour and a half sleep last night. Bummer!!! And it i'l be at least a month before He'll be able to see me and two weeks before i'm home to get the meds I left there. I quess I'll try to get some benidrill. You guys know of any other over the counter stuff I could try? Hope tonights better, I never know until after I go to sleep how its gonna go sometimes I sleep most of the night with no problems and sometimes I don't sleep at all or just the last two and then I drag all day. enough rambling

Thanks again for the help
Richard

[Terry]

I think Benadryl over the counter is the best stuff for making you sleepy. I'm sorry that this is going on for you. You could always call him and see if they can call in a script for you where you are at. They will not do this for opiate class medication but may for a benzo that will help. If not, could someone pick something up for you, family wise, and overnight it to you?

Hang in there.

Terry Newton

[KBear]

I agree with Terry- I would try to have someone mail it to me. If that is not possible, take 2 Benadryll at night. Another thing you can do, which I do all the time, unless otherwise directed, is to take any medications that make you drowsy at night. I take my Lyrica & anti-depressant at night, as well as the muscle relaxer and Benadryll (although now, because of my prescription stregnth, I do have to take a dose of the Lyrica and anti-depressant in the morning.) For me, the Vicodin helps with pain; but it makes me wired and awake. I try not to take it for the 2 to 3 hours leading up to bedtime, so I can sleep. But, as you know, pain is not a planned thing, and sometimes I do have to take it in that time, in order for me to get to sleep then, I must take all of the above mentioned to A. get to sleep B. stay asleep and C. wake up rested. My doctors are completely ok with this, I have asked them and inform them at every check-up, when we discuss medications. I am sure some docs would not be ok with this, or would not ok it due to fear of malpractice and what not. It all just really depends on what dr. you are asking. I am currently at my fourth pain dr/ spine facility and they have all had me on the same things (although the medications are the only thing that have been the same; but that is whole other story!) Good Luck, and I hope you can get some sleep.