Concerns about APAP with Oxycodone

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New Member

Date Joined Jan 2012
Total Posts : 14
   Posted 1/2/2012 9:28 AM (GMT -6)   
I am new on this forum, so please forgive me if this has been addressed, but I did not find it. I currently take 3-4 10mg Oxycodone 10/650 per day on a schedule for chronic back and foot pain. I can also take 15mg Oxycodone or 15mg morphine for breakthrough, more severe pain. I am concerned about the amount of acetominophin I am taking daily. My Dr doesn't seem too concerned about it, but should I talk to him about maybe taking the 15mg on the schedule instead, and supplementing it with the 10mg w/apap when I have the breakthrough pain? I don't know how much is too much, before it begins affecting your liver. But I take other daily meds too and am just concerned.

Again, sorry if this has been covered.

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Date Joined Sep 2006
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   Posted 1/2/2012 10:08 AM (GMT -6)   
I had heard that 4000mg of ibuporfen is max for the day-don't know about acetaminophen. I think 4000 every day is pushing it as far as liver health goes. I would take straight oxy for B/T pain as there is no apap in it.

the FDA is trying to get patients on lower ibuprofen levels. I was recently changed from 10/500 hydro/ibuprofen to 10/325 because of concern over liver and gastric health. My doc is changing over all his patients. I don't think there is enough long term studies to tell us exactly how much damage is being done. I would err on the side of caution.

Welcome and I hope that partially answers your question

"We never realize how strong we are, until being strong is the only thing left"
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Date Joined Jul 2009
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   Posted 1/2/2012 10:47 AM (GMT -6)   
The medical community currently says 4000 mg per day for adults and 90 mg per day for children is the max safe dose for acetaminophen, however in July of 2011 the makers of Tylenol revised their recommendation to 3000 mg per day for adults.

4 of your Oxy 10/650 equals 2600 so you are good to go there regardless of which guideline you choose to follow.

IMHO though I would be careful taking much more acetaminophen per day than that.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.
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Screaming Eagle
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Date Joined Sep 2009
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   Posted 1/2/2012 10:53 AM (GMT -6)   
Hello JoJoGal!

….and "Welcome" to the Chronic Pain forum! Yes!…this has been discussed here many times, but we are always happy to discuss it again, as needed for new members. You also might want to try the "Search Button" in the upper righthand corner of this page….just type in the keywords of your search, and you should find quite a bit on it.

I thought as patients we could no longer be scripted the pain med's with anything over 325mg of acetaminophen in it, but I could be misinformed. I did take the liberty of providing you a link on the subject and the ruling that the FDA seems to have imposed. Take a peek at it, and maybe another member can shed more light on it for us. Please watch the Video announcement by the FDA representative. It is one of the best explanations I have seen to date. One thing I did hear in the Video was that there is a three year timeframe to implement the new changes, if I understood it correctly. This could be the reason you still have access to the /650mg…but in time will be reduced to the FDA's orders. The FDA website is an excellent source of information!…here is the home page for you to view. I believe it is wise to also bookmark it, and view it often.

…as far as too much acetaminophen,….until you hit the 3000mg or somewhere around the 4000mg a day, most likely you should be ok. However many of us here do have concerns about long term use, even at the lower dosages. If you are indeed a long term CP patient….and this is my opinion only….I really believe your PM should have you on a long term pain med. The Oxycontin, is just such a med, and might very well be suitable in your case as it is an ER (extended release Oxycodone) product.

Many of us here also believe that the IR (immediate release) products should be used for BT and not used as a baseline for your long term care. That being said….you should always follow your Dr's advice, but it never hurts for a patient to question their reason behind the scripting. Always ask questions while at your appointments…..generally they are free, and can be a well worth education for the patient.

I hope this information helps you, and I'm sure others will join with their opinions. We are not Dr's here, and cannot tell you what you should do, or diagnose,….but we can share our experience with you.

Were glad you found this forum!….and hope you become part of our daily family. You will certainly enjoy the members, and all of us have that one thing in common….Chronic Pain! We do understand living with it on a daily 24/7 bases.

Again!…Welcome, and Enjoy the forum!

All our best to you!

SE wink
Moderator Chronic Pain Forum

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Post Edited (Screaming Eagle) : 1/2/2012 9:16:59 AM (GMT-7)

Veteran Member

Date Joined Apr 2009
Total Posts : 856
   Posted 1/2/2012 11:08 AM (GMT -6)   
You're still under the max daily dose, even if you're taking it every day. If you are uncomfortable with your dose, you can always ask your doctor. Also, you can ask him to run a liver function test just to check on everything. Many doctors do that if a patient is taking APAP daily.

Welcome to HW. This is a great place for support.

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Date Joined Feb 2003
Total Posts : 16799
   Posted 1/2/2012 11:13 AM (GMT -6)   
Hi JoJo and welcome to Healing Well's chronic pain forum. I see the others have all given you some excellent info. One thing about it this forum does try to stay up-to-date on what is going on in the medical community, as we all have so many different needs in dealing with CP. From the dosage you have given it appears that you are in the safe zone. I think its best overall though, that from time to time people have some labs done just to make sure there are no problems with the liver. In the past, ones that have had elevated liver enzymes, they went off the meds and things would return back to normal once off of the medication.

As SE stated above when it comes to dealing with CP and trying to have some pain control with some quality life, it is best to be on a long acting medication and then have something for BT pain. Otherwise, we spend out time watching a clock till its time to take another pill and not really having good control with the pain. Trying to chase the pain can be a viscous circle. It is always best to stay on top of the pain rather than under it.

Perhaps the next time you go in and see your dr if it will help maybe you can discuss having some labs done to check things out and to help ease your mind. Anyway, I wanted to pop on and tell you welcome aboard.

Take care.
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Veteran Member

Date Joined Oct 2010
Total Posts : 932
   Posted 1/2/2012 2:32 PM (GMT -6)   
It will be a few years still until the 325mg limit is fully in effect.

See the FDA's FAQ on the topic:
Q6. When will the new limit on the amount of acetaminophen per dosage unit in oral prescription drug products take effect?

Drug companies will have three years from the date of publication of the Federal Register Notice (January 14, 2011) to limit the amount of acetaminophen in their oral prescription drug products to 325 mg per dosage unit (see the Federal Register Notice Docket number FDA-2011-N-0021-0001).
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

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Date Joined Mar 2011
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   Posted 1/2/2012 5:47 PM (GMT -6)   
Hi JoJoGal,

You have been given some excellent advice already - I'm not sure that I can add to it, just wanted to pop in and welcome you :-)

Moderator - Chronic Pain Forum

Full body CRPS with spasms, dystonia & contractures, gastroparesis, orthostatic hypotension,bradycardia/tachycardia, bursitis, CTS, osteoporosis, multiple compression fx, disc bulges.

Oxycodone ER/IR, Topamax, Mobic, Somac, Cipramil, Midodrine, Vit D & C, SCS, baclofen/bupivacaine pump
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