fbodgrl,

It would be a simple switch for your doctor to order Hydrocodone/Acetaminophen 10/325 mg to cut down on the Tylenol content abit. It is sold under the brand name Norco 10/325mg. That would mean you could use up to 12 pills a day of the Norco 10/325 mg without going over the critical 4000 mg limit of acetaminophen in one day. That doesn't mean I still wouldn't be concerned about the ongoing "highish" amount of acetaminophen, but at least you would't be hitting the maximum recommended dose.

When I was at that stage, when occassionally I would need to take 2 tabs in the same 4-6 hour period, that my neuro added some MS contin ER to the mix. I don't know how your doc would react to the request for "more" meds or "increased doses. An important thing to remember when switching to a longer acting med is that one will probably still need some of the shorter acting med to use for breakthrough pain.

A sample of an "ideal" plan for someone currently taking Lortab 10/500 mg every 4 hours (6 times a day) consistently would be switching to MS Contin ER 30 mg twice a day. The total of hydrocodone 10mg 6 x day = 60 mg, so the MS Contin 30 mg twice a day is an equivalent dose. For many, the MS Contin ER doesn't last the full 12 hours that it does for others. In those cases, MS Contin 20 mg 3 x day would allow coverage every 8 hours and still total the 60 mg a day. I would still want to have 1 or 2 Lortab available per day for breakthrough pain. These "numbers" are also for someone with reasonable control of their pain who always uses at least 60 mg of Lrtab per day. If you consistently use 9 Lortab a day to account for the times when you take 2 at a time, that would be 90 mg per day, so an equivalent order on MS Contin ER would be 30 mg 3 x day. This is just a mini lesson on narcotic equivalent dosing and obviously not any comment on what your doctor would find to be a good treatment course.

Just to add, if a decision was made to go with Oxycontin ER, that dosing would be a little less, usually figure 2/3 of the equivalent narcotic dose. Some docs are more hesitant to order OxyContin ER just because it's more famous for being a drug of choice for people who abuse drugs.....and what the thugs try to steal from pharmacies. I don't get it myself.....an OxyContin ER 20 mg pill crushed wouldn't get an abuser any higher than a MS COntin 30 mg pill, but maybe druggies aren't smart enough to figure that out.

I don't know how comfortable you would be or your doctor would be with having that discussion regarding the switch to longer acting meds to cut down on your acetaminophen intake. At least suggeting the switch to Norco isn't "asking" for "more" meds or "stronger" meds. If it helps you feel more confident in the discussion, realize that asking for a switch to the longer acting meds doesn't actually involve taking MORE narcotic per day, just a different type. Good luck with trying to find reasonable pain control.