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Medical Forum / General / Pharmacy / August 2003

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Rx narcotic question

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Emma Chase VanCott - 18 Aug 2003 17:36 GMT
re: analgesia

In tablets, what is stronger and/or equivalent to codeine,in analgesia
power,  but weaker than oxycodone?

Is anything equivalent to codeine, realistically?

I have an old psoas rupture: codeine isn't working well for the pain
anymore. Oxycodone makes me dysphoric, doesn't last as long, and knocks me
out.

My doc says nothing is equivalent to the Tylenol #3s that are causing me
allergic swelling of hands/itching.

Hydrocodone, perhaps?

Any other ideas?

Thanks.

Emma
Aimee G - 18 Aug 2003 18:11 GMT
> re: analgesia
>
> In tablets, what is stronger and/or equivalent to codeine,in analgesia
> power,  but weaker than oxycodone?

Everything from meditation on up. Codeine is great for coughs, that's about
it.

Aimee
John Dyson - 18 Aug 2003 21:06 GMT
> re: analgesia
>
> In tablets, what is stronger and/or equivalent to codeine,in analgesia
> power,  but weaker than oxycodone?

Hydrocodone (close to oxycodone),  Darvon (close to codeine), Ultram (close
to codeine), Morphine (by oral, is stronger than codeine -- but requires
higher dose than Hydrocodone... By IV Morphine is quite a bit stronger.)
I wouldn't suggest Darvon because it seems to have too many side-effects
(clumsiness even at low doses.)  I'd really suggest Ultram (if you
can afford it, and if it works for you), because it lasts longer in
some situations.

If you can avoid the Tylenol, it is best to keep your Tylenol intake
minimal, but it is easier to deal with the scripts that have Tylenol
in them (I hate dealing with CII scripts, even to the extent of quitting
a prescribed CII medicine to see if I can function without...)  So
far, so good (but not great.)  With the meds that also contain Tylenol
(e.g. Lortab), your doctor only has to prescribe a CIII, which is
generally easier to deal with (multiple months supply.)  If you travel
much (I used to), a CII can be irritating to deal with.

> Is anything equivalent to codeine, realistically?

Ultram, but it is probably slightly weaker.  It lasts longer than
codeine (perhaps 1.5X as long.)  Ultram can be expensive.

> I have an old psoas rupture: codeine isn't working well for the pain
> anymore. Oxycodone makes me dysphoric, doesn't last as long, and knocks me
> out.

Hydrocodone is SLIGHTLY different from Oxycodone -- it MIGHT be slightly
less drowsy making, but is too close to call.  Some of the strong narcotics
can make you nervous and lose sleep, and a friend of mine says that he
has seen a difference between them.  Oxycodone might be 1.5X stronger
than Hydrocodone, but it is certainly not weaker.

> My doc says nothing is equivalent to the Tylenol #3s that are causing me
> allergic swelling of hands/itching.

The codones and Ultram will probably cause less allergic response for
a given pain relief.  If I was a 'liberal' doctor, I'd prescribe a small
Hydrocodone med, and then expect to potentially double the script (with
an up-front caveat to the patient.)

> Hydrocodone, perhaps?

You can ask to try it...  For a given pain relief, it will probably cause
less allergic response.  If your dose of codeine is small (e.g. 30mg/60mg
TID/QID), then make sure that you don't get big hydrocodone horse pills.
10mg of Hydro might be overkill, but maybe not?
5mg of Hydro vs. 30/60mg of Codeine is probably an approximate equvalent,
YMMV.  Even then, the Hydro will seem stronger.
The equvalency between Codeine and the stronger drugs isn't really
straightforward.)

With less of the agent, the Hydro will likely cause less allergic reaction,
but the narcotic action is strong.  At the 5mg point, you have alot of
opportunity for increase (as needed).

With Ultram, you'd need to start close to the maximum dose allowable.  However,
the good thing is that the 'narcotic' side effects are slightly less.  There
is a withdrawal syndrome with all of these (including Ultram), but used in
moderation, they are all useful.  With Ultram, the withdrawal might be qualitatively
different, but it still exists.  You'll likely not have problems with that
given the pain is real.

John
BilZ0r - 18 Aug 2003 22:45 GMT

> Is anything equivalent to codeine, realistically?

Codeine is a bit tricky, because essentially, it us just time release
morphine (i.e the body turns it into morphine).

A medication that is often refered to as being equipotent to codeine is
dextropropoxyphene, I think it american lexicon its called devocet, but
don't quote me.
John Dyson - 19 Aug 2003 06:45 GMT
> > Is anything equivalent to codeine, realistically?
>
[quoted text clipped - 4 lines]
> dextropropoxyphene, I think it american lexicon its called devocet, but
> don't quote me.

The only problem with Darvon (other than it's relative strength) is that
it can given a worse 'drunken' effect than the other narcotics.  The
common way darvon is sold as 'darvocet' with Tylenol.

John
 
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