http://www.pdrhealth.com/drug_info/r.../vic1480.shtml

http://www.nida.nih.gov/DrugPages/Pr...rugsChart.html

"Be aware many narcotic pain-relievers also contain tylenol, including Anexsia, Darvocet N-100, Lortab, Lorcet and Vicodin."
Tylenol =Acetaminophen

__________________________________________________ _____________

Acetaminophen, the popular over-the-counter pain and fever remedy, possesses a Jekyll and Hyde personality.

At recommended doses it's one of the safest drugs. In excessive doses, it seriously can damage the liver.

In fact, acetaminophen overdose is the No. 1 cause of acute liver failure.

A recent analysis found that, over a six-year period, the incidence of acetaminophen-induced liver failure spiked dramatically, going from 28 percent to 51 percent of all cases. A striking number of these cases were intentional overdoses (suicide attempts), underscoring how lethal excessive amounts are.

Accidental overdoses, on the other hand, were responsible for almost half the cases. These involved people taking two or more acetaminophen-containing products at the same time or prescription narcotic pain relievers containing acetaminophen.

Of those with acetaminophen-induced liver failure, 35 percent died, including some who had undergone a liver transplant.

Clearly, people need to sharpen their acetaminophen antennae.

It may help to know how Dr. Jekyll morphs into Mr. Hyde. At recommended doses, things proceed without a hitch: The liver breaks down acetaminophen for removal from the body.

Excessive doses, however, can overwhelm the liver, causing it to shift to an alternate breakdown route.

This secondary route produces a liver-toxic compound. Ordinarily, a protective body substance called glutathione rides to the rescue and muzzles the harmful compound. But the acetaminophen overload rapidly depletes the available glutathione, allowing the toxic chemical to build up.

At what level does acetaminophen pass from the safe zone into the danger zone? The generally recognized cut-off point is 4,000 mg over 24 hours.

To stay in the safe zone, avoid taking more than 4,000 mg at one time, or taking lower doses several times daily that exceed a total of 4,000 mg. Over-the-counter "extra-strength" acetaminophen pills contain 500 mg, so eight pills takes you to the ceiling limit of 4,000 mg.

Be aware many narcotic pain-relievers also contain acetaminophen, including Anexsia, Darvocet N-100, Lortab, Lorcet and Vicodin.

These prescription products contain substantial amounts of acetaminophen -- from 500 mg to 750 mg per pill.

Taking more than eight pills of the 500 mg products or more than five pills of the 750 mg products in a 24-hour period puts you in the danger zone.

Keep in mind more than 200 over-the-counter products contain acetaminophen, including remedies for pain, fever, allergy and cold and cough.

Protect yourself by adding up your total daily dose of acetaminophen. Check product labels and count amounts from all sources.

Extra caution is warranted for chronic heavy users of alcohol and individuals with impaired liver function.

Richard Harkness is a consultant pharmacist, natural medicines specialist, and author of eight published books. Write him at 1224 King Henry Drive, Ocean Springs, MS 39564; or rharknaol.com.

NSAIDs : non-steroidal anti-inflammatory drugs



Aspirin (Anacin, Ascriptin, Bayer, Bufferin, Ecotrin, Excedrin)
Choline and magnesium salicylates (CMT, Tricosal, Trilisate)
Choline salicylate (Arthropan)
Celecoxib (Celebrex)
Diclofenac potassium (Cataflam)
Diclofenac sodium (Voltaren, Voltaren XR)
Diclofenac sodium with misoprostol (Arthrotec)
Diflunisal (Dolobid)
Etodolac (Lodine, Lodine XL)
Fenoprofen calcium (Nalfon)
Flurbiprofen (Ansaid)
Ibuprofen (Advil, Motrin, Motrin IB, Nuprin)
Indomethacin (Indocin, Indocin SR)
Ketoprofen (Actron, Orudis, Orudis KT, Oruvail)
Magnesium salicylate (Arthritab, Bayer Select, Doan's Pills, Magan, Mobidin, Mobogesic)
Meclofenamate sodium (Meclomen)
Mefenamic acid (Ponstel)
Meloxicam (Mobic)
Nabumetone (Relafen)
Naproxen (Naprosyn, Naprelan*)
Naproxen sodium (Aleve, Anaprox)
Oxaprozin (Daypro)
Piroxicam (Feldene)
Rofecoxib (Vioxx)
Salsalate (Amigesic, Anaflex 750, Disalcid, Marthritic, Mono-Gesic, Salflex, Salsitab)
Sodium salicylate (various generics)
Sulindac (Clinoril)
Tolmetin sodium (Tolectin)
Valdecoxib (Bextra)

Note: Some products, such as Excedrin, are combination drugs (Excedrin is acetaminophen, aspirin, and caffeine).

************************************************** ************
Note that acetaminophen (Paracetamol; Tylenol) is not on this list. Acetaminophen belongs to a class of drugs called analgesics (pain relievers) and antipyretics (fever reducers). The exact mechanism of action of acetaminophen is not known. Acetaminophen relieves pain by elevating the pain threshold, that is, by requiring a greater amount of pain to develop before it is felt by a person. It reduces fever through its action on the heat-regulating center of the brain. Specifically, it tells the center to lower the body's temperature when the temperature is elevated. Acetaminophen relieves pain in mild arthritis but has no effect on the underlying inflammation, redness and swelling of the joint.
Paracetamol, unlike other common analgesics such as aspirin and ibuprofen, has no anti-inflammatory properties, and so it is not a member of the class of drugs known as non-steroidal anti-inflammatory drugs or NSAIDs.

************************************************** ******

* Naproxen Sodium
" Naprelan contains naproxen sodium, a member of the arylacetic acid group of nonsteroidal anti-inflammatory drugs (NSAIDs)"
"The chemical name for naproxen sodium is 2-naphthaleneacetic acid, 6-methoxy-a-methyl-sodium salt, (S)."

******
Study Shows Long-term Use Of NSAIDs Causes Severe Intestinal Damage
http://www.sciencedaily.com/releases...0111123706.htm

****************
Ibuprofen tablets

Cardiovascular Risk
NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk (See WARNINGS).
* Ibuprofen tablets are contraindicated for treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery (see WARNINGS).

Gastrointestinal Risk
* NSAIDs cause an increased risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious gastrointestinal events. (See WARNINGS).
http://www.drugs.com/pro/ibuprofen.html

Source: New York Times
Date: 10 May 2007

In Guilty Plea, OxyContin Maker to Pay $600 Million

By BARRY MEIER
<B>

</B>

ABINGDON, Va., May 10 —The company that makes the narcotic painkiller OxyContin and three current and former executives pleaded guilty today in federal court here to criminal charges that they misled regulators, doctors and patients about the drug’s risk of addiction and its potential to be abused.
To resolve criminal and civil charges related to the drug’s “misbranding”, the parent of Purdue Pharma, the company that markets OxyContin, agreed to pay more than $600 million in fines. That is the third-highest amount ever paid by a drug company in such a case.
Also, in a rare move, three executives of , including its president and it top lawyer, pleaded guilty today as individuals to misbranding charges, a criminal violation. They agreed to pay a total of $34.5 million in fines.
OxyContin is a powerful, long-acting narcotic that provides relief of serious pain for up to 12 hours. Initially, Purdue Pharma contended that OxyContin, because of its time-release formulation, posed a lower threat of abuse and addiction to patients than traditional, shorter-acting painkillers like Percocet or Vicodin.
That claim became the lynchpin of the most aggressive marketing campaign ever undertaken by a pharmaceutical company for such a drug. Just a few years after the drug’s introduction in 1996, annual sales reached $1 billion. Purdue Pharma heavily promoted OxyContin to doctors like general practitioners who had little training in the treatment of serious pain or in recognizing signs of drug abuse in patients.
But both experienced drug abusers and novices, including teenagers, soon discovered that chewing an OxyContin tablet or crushing one and then snorting the powder or injecting it with a needle produced a high as powerful as heroin. By 2000, several parts of the United States, particularly rural areas, began to seeing skyrocketing rates of addiction and crime related to the drug’s use.
Details about the plea agreements are expected to be announced at a press conference at noon today in Roanoke, Va., by John L. Brownlee, the United States attorney for the Western District of Virginia. “Misbranding” is a broad statute that makes it a crime to mislabel a drug, fraudulently promote it or market it for an unapproved use.
In a proceeding this morning in United States District Court in Abingdon, Va., both Purdue Pharma and those executives acknowledged that the company fraudulently marketed OxyContin for six years as a drug that was less prone to abuse as well as one that also had fewer narcotic side effects.
The time period covered by those expected guilty pleas runs from late 1995, when the Food and Drug Administration approved OxyContin for sale, to mid-2001, when Purdue Pharma, faced with both public criticism and regulatory scrutiny, dropped its initial marketing claims for the drug.
Federal officials said that internal Purdue Pharma documents show that company officials recognized even before the drug was marketed that they would face stiff resistance from doctors concerned about the potential of a high-powered narcotic like OxyContin to be abused by patients or cause addiction.
As a result, company officials developed a fraudulent marketing campaign designed to promote OxyContin as a time-released drug that was less prone to such problems. OxyContin is made of a long-used narcotic, oxycodone. But unlike other medications like Percocet that also contain the narcotic, OxyContin is pure oxycodone and, because it is a time-released drug, contains its in very high doses. The drug is valuable in treating serious, long-lasting pain.
But to increase the drug’s use, Purdue Pharma and those executives are expected to acknowledge that “with the intent to defraud or mislead” they marketed and promoted OxyContin as a drug that was both less addictive, less subject to abuse and less likely to cause other narcotic side effects than other pain medications.
For instance, when the painkiller was first approved, F.D.A. officials allowed Purdue Pharma to state the time-released of a narcotic like OxyContin “is believed to reduce” its potential to be abused.
But according to federal officials, Purdue sales representatives falsely told doctors that the statement, rather than simply being a theory, meant that OxyContin had a lower potential for addiction or abuse than drugs like Percocet. Among other things, company sales officials were allowed to draw their own fake scientific charts that they then distributed to doctors to support that misleading abuse-related claim, federal officials said.
Between 1995 and 2001, OxyContin produced $2.8 billion in revenue for Purdue Pharma, a closely held company that is based in Stamford, Conn. At one point, it accounted for 90 percent of the company’s sales.
As part of the plea agreement, Purdue Frederick, a holding company, pleaded guilty to a felony charge of misbranding OxyContin. The company agreed to pay $600 million in criminal and civil penalties, which will be split among federal government and state agencies.
Purdue Pharma will also be required to use some of that money to settle civil lawsuits. The company has also agreed, among other things, to subject itself to independent monitoring.
The three top former and current Purdue Pharma executives pleaded guilty to criminal misdemeanor charges of misbranding, a charge that not require prosecutors to show knowledge of intent. However, the three individuals ran Purdue Pharma during the period in question.
Those executives are Michael Friedman, the company’s president, who agreed to pay $19 million in fines; Howard Udell, its top lawyer, who agreed to pay $8 million; and Dr. Paul Goldenheim, its former medical director, who agreed to pay $7.5 million.

Purdue
Sources
'Hillbilly Heroin'
Oxycontin adverts
The OxyCon Game
Oxycodone: structure
Long-term oxycodone
Oxycodone: metabolism
Oxycodone plus sertraline
Morphine versus oxycodone
Tramadol versus oxycodone
OxyContin: politics and science
Doctor traded OxyContin for sex
OxyContin: prescribing indications
Rush Limbaugh and 'Hillbilly Heroin'
'Santa' robs pharmacy of Oxycontin
Oxycodone: controlled- v immediate-release


Refs
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Future Opioids
BLTC Research
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The Hedonistic Imperative

Any drug has major different affects on different people.I have several drug allergies and drug sensitivities but elavil is the onlyreason I sleep at all. I went through 2 breakdowns from no sleep and increased pain(the vicious cycle ugh) before i finally agreed to go on elavil. I gained 20 pounds on it but thats where i stayed. I was so underweight all my life that the 20 pounds was actally healthy for me.
Elavil is actually a tricyclic and has been around for many ,many decades. It is even used in children for bedwetting. I was wary of going on anything long term for years. After doing a ton of research several years ago I finally agreed with my doctorand tried it. I was sleeping about 2 hours per night so something had to be done.all 3 docs that i see call elavil the "undrug". the way it was explained to me was my body does not make serotonin which is what causes us to sleep. Elavl just makes my body produce serotonin.Thats why my docs call it the undrug, because it only makes your body produce what your body should naturally produce.its not a sleeping pill or drug to knock you out, it just promotes sleep by making serotonin.Thats how it was explained to me and what i found researching it.I have been on it for 15 years now and it also has no bad sideeffects(damage) to the body.

I always check everything with my pharmacist before taking it! It is a really good idea as they are more knowledgable and up to date on drugs than most docs.

interesting. i think that when used properly, long acting meds like oxycontin and opana ER really are better at reducing the chance of addiction when using narcotics long term...the short acting meds give such ups and downs. I know for me the opana is much easier to deal with than the vicodin. Also, the absence of the tylenol is certainly a good thing.

i think the key point must be the part they mentioned about marketing to family docs who, unlike pain docs, are not used to treating long term severe pain and less focused on recognizing drug addictions.

hopefully it does not result in the removal/changing of these meds. certainly it would suck if people who really need them lose access to them.


interesting, though, thanks for the post.

"Drug is indicated for moderate to severe pain where use of an opioid analgesic is appropriate for more than a few days"

__________________________________________________ ___________

I took Oxycontin for about 5 years and to my knowledge did ok. My family may say different, but was it the long term chronic pain/sleep deprivation, loss of career and physical abilities that changed me or the oxycontin.

I know when I first started it, what a relief to have some of the pain gone.

I was still hurting so I asked for a change in pain med. My doc changed me to Kadian without a problem

About 3 months later my husbands insurance company sent a letter out saying that they would no longer be paying for oxycontin. No other pain meds were mentioned.

My kidney and liver function studies are still normal.

OK, sorry, but this is a personal pet peeve of mine, as some of you know. i had an absolutely horrid experience behind Oxycontin and a certain PM doc who shall remain nameless.

if you read the article or other press accounts of this matter closely i think you will gather that what they actually found the manufacturer guilty of is a bit more dastardly than a bum steer on the marketing front by targeting a perhaps naive demographic in going after internists who admittedly aren't familiar with the insidious nature of drug addiction (albeit iatrogenic), nor the wily ways of the drug addict who lies and manipulates to get their drug of choice.

(yes, if i sound a little too educated on the subject, i have been to rehab folks...).

it is my understanding that the makers of Oxycontin totally fabricated clinical trials which it had NOT conducted, in order to obtain FDA approval of Oxycontin. They were in a hurry to do so at the time (Endo could tell you why...).

the chairman of the board also went before the FDA, claiming this medication to be "no more addictive than an aspirin..." and that the end to cancer pain and chronic pain was well in hand if the feds would only approve the miracle drug!

who needs snake oil in this day and age?

for both of those representations are patently false. pun intended.

and while i agree than an extended release delivery system is on its face a good thing, and that no chronic pain patient in enough agony to need narcotics should be relying on short-acting medication alone to "control" pain, Oxycontin as we all know by now has a totally penetrable delivery system. hillbilly heroin and boy, howdy!

why, it says right there on the bottle, "do not crush or chew," or words to that effect.

that's an invitation to an addict if ever i heard one!

now, as many of you know there was also a huge lawsuit having to do with trademark infringement between Endo and Purdue Pharma which settled last year i believe, having to do with the fact that the former had brought a generic version of oxy to market, which was found to be actionable and a patent infringement (i'm not a lawyer, just making this stuff up as i go along, but something like that anyway). big pharmaceutical giants wrangling, quite a mess 'til the judge made them play nice!

more packs of lies, all with money at the heart and patients' needs could not be further from their interests. are we at least all agreed on that point?

in my own personal experience and opinion, and this is just my own take on it everyone, we all react differently to these meds and for some it may be different, Oxycontin is a very nasty drug. there, i've said it.

it may work at first to "manage" the pain. then, it stops working, or you need more. and more. then, it stops working. and slowly, inexorably, it starts working AGAINST you. it actually starts to create more pain in your already ravaged body. yeah, you read that correctly.

Oxycontin creates the very sx it was designed to tx. PAIN. period. not saying this was intentional or proven in court, but certain things not only were proven, weren't they, but were ADMITTED to and pled to in court. you have to wonder what else there is and is not being said here, or i do anyway...

to the tune of $600M PLUS in damages awarded to the FDA. against Purdue Pharma and certain execs including its top lawyer. and the class action cases are just starting, better believe it.

so, not having any tylenol in it was a good thing. true, that. but Opana doesn't have any tylenol in it, either. Nor Kadian. Nor MS Contin or a bunch of other long-acting meds.

OK, no more lecture.

PS, i was NOT chewing the damned pills, doctor X!!!!

i feel vindicated now.

my name is alison, and i am not an addict.

Alison,
Thank you for sharing your experience with us.
I know you are very passionate about this subject because you have walked the walk.
I really feel for you in the way the medical establishment has jerked you around (and for a tos'er especially that hurts)

I wonder sometimes how your life would have been different if you had a timely diagnosis with your tos. You have had to fight tooth and nail for what should be a right to any person with an illness.

An accurate and timely diagnosis. Compassion and empathy from your physicians. Pain control so you can have some type of quality of life.

Well, if you're like me those 'what if's' can really make you miserable.

I'm happy we have found each other, we can help each other get through the hard times with tos. I'm sure you could teach us all so much in the experiences you have had with doctors, the disability system and living with long term chronic pain.

I am personally very tired of fighting all the time for the things I need to survive with tos. Yes, mr. ER doc I do take a large dose of pain medication but I have a bad problem. Yes, mr ER doc my doctor Ernestina Saxton takes good care of me and I will thank you not to interfere in Dr Saxton's pain management plan for me.

Yes, mr ER doc I am well aware that my dose of Kadian may have added(note the word ADD to not CAUSED) to my problems with asthma and that is why I HAVE ON MY OWN RECOMENDATION REDUCED MY PAIN MEDICATION DOSE BY ALMOST HALF. You act like that is no big deal mrER doc, you look down your nose at me like I'm weak and you are strong. What you don't know mrER doc is that tos'ers are some of the strongest people on earth, to live with tos you have to be.
When you are feeling cr*ppy the last thing I want is to take *&^% from you

take that mrERdoc.

And another thing mrERdoc, I don't appreciate one of your nursing staff treating me with disrespect when I came into your ER unconscious from an asthma attack.
You gave me narcan to reverse the pain medications in my body, then you wonder why I tell you I'm hurting.
My husband said I was hurting and asked for something for pain, and my request was met with my nurse denying my request-not with an explanation but with an accusation that my pain med got me into this problem! Don't diss me especially in front of my daughter and husband.

I couldnt agree more seapines and ocgirl!! I made my doc take me off oxycontin. It made me hateful and miserable and I tooj it for 4 years. I am now on slow release morphine which seems to agree with my whole system much better. I have severe bowel troubles and tylenol constipates me, do you thnk I could get a doctor to beleve that?? NOOOO they all said tylenol wont do that. Well my last bowel surgery I made them put t to the test and surprise!! they actually saw that tylenol constipates me!! I too am tired of doctors not listening! My primary care doctor is great, she has been treating me for 20 years. I dont allow any other doctor to screw with my meds. If they want me on something different they can write to my doctor about it, because she knows me and my body! I will almost die before i will go to an ER anymore. You hear the whispering on the other side of the curtain( psst did you see what she is on for medication?? do you think she is here just drug seeking??? grrrrrrrrrr..... I can tell you know exactly what I mean. I can hand over my entire bag of pills to show them i have lots and I am not and do not seek drugs!! Have er doctors never heard of chronic pain?? If i am desperate eneough to go to the er mr.doctor, then I have something very wrong with me!! I went to the er after my surgery because I could not sleep, eat or breathe. I got looked at like a drug addict and sent home. The next day I was rushed to our nmajor hosptal 100 miles away because I had 2 1/2 litres of fluid in my chest! I just cannot believe how insensitive some of these doctors can be! The one who sent me home got a personal call from my family doc and she ripped right into him!! I think several more er docs need the same treatment. To me when they treat me like that , they are showing a major disrespect to my own doctor. She wouldnt have me on what I am on if she didint feel I needed it. So when they look down their noses at you they are also dissing your doctor for prescribing. My doctor has an outstanding reputation, that alone should make them think. Anyway , sorry, rant over. Im heading off to bed. My prayers for you all to have a low pain day!! ((hugs)) cindy