Darvocet alternatives?

[Myc0]

I take 10mg of oxycontin twice daily for pain control, with darvocet for breakthrough pain. I have been taking more of the darvocet recently as my neuropathic pain has been steadily increasing. I didn't really know anything about darvocet, but have been reading up on it recently. I am not comfortable with the large amount of acetaminophen in it. Then I read this article (http://www.msnbc.msn.com/id/11604116/), which states that the primary active ingredient can be dangerous, yet not very effective:

Dr. Sidney Wolfe, said the main active ingredient in the drugs, propoxyphene, is a relatively weak painkiller and poses an unacceptable toxic risk to the millions of patients prescribed it each year.

An analysis of 26 studies that compared propoxyphene and acetaminophen with just acetaminophen or a dummy pill found the “narcotic combination offered little benefit over acetaminophen alone” in treating pain.“Thus, propoxyphene provides minimal if any additional analgesia to acetaminophen alone and is associated with significant adverse effects. It cannot be recommended for routine use”

So I would like advice on a suitable replacement for this medication, as my doctor was not very helpful or informative in this department.

[rollin64]

i'm no help probly. i take lortab 10 in between the oxys. they seem to help some.

i know darvocet does absolutely nothing for me. i can take 4 or 5 and......NADA. :dontknow:

[zillazangel]

The analysis, which I had not seen before, appears to be fairly convincing that Darvocet should be avoided.

Keeping in mind that Oxycontin = slow release version of oxycodone, to replace the Darvocet, you could try

vicodan (= tylenol + hydrocodone)
percocet ( = acetaminophen + immediate release oxycodone)
Percodan ( = aspirin + immediate release oxycodone)
oxycodone tablets immediate release (these are far more unusual, not always stocked at a pharmacy routinely).
Valium or Ativan (not a painkiller but an anxiolytic which will quell muscle spasms with is often a cause of breakthrough pain)Of all of those, I would recommend immediate release oxycodone, 5 mg and see if that does the trick. Least recommended is Percodan due to risk of gastric bleeding with unbuffered aspirin.

ETA: you should also consider simply upping your Oxycontin dose if you are having alot of breakthrough pain - 10 mg twice a day is a very low dose. Chad takes 20 mg 3x a day and even that is considered a low level dose.

[Myc0]

Well I was taking a lot of oxy when I first came home(80mg 2x day), but I've been trying to cut back. I was going to ween myself off completely, but then my neuropathic pain started getting worse. The Percodan might be good, as I take a aspirin every morning anyway, so I could just skip that and get my aspirin with the perc. They reccomended that I take aspirin after I got off of the coumadin that I was taking after I got a blood clot in the hospital. What is unbuffered aspirin?

[SCI-Nurse]

Have you tried adding anti-depressants to your regimine. Breakthrough pain can also be treated with other drugs, such as some of the ones listed above. What other drugs have you tried?

BTW- buffered aspirin is aspirin that has a coating to make it easier on your stomach.

CKF

[firesmurf]

you are actually on a pretty low dose of the oxycontin itself,if you could try raising the overall amount by even 10mgs a dose or even going to a three times per day,it may take away your actual need for any BT meds entirely.with my PM when the oxy isn't covering,instead of adding the short acting meds,they will try and cover the increased or untreated pain with a small raise in the oxy amount.my PM is very hesitant about Rxing more than two BT meds per day.it sucks as i will have at least four really bad(over an hour at least) of really bad increases or flares.but i am managing those with other modalities.my TENS really helps alot with my RSD but not too well with my central pain.

but just sitting down with your Rxing doc and discussing this may help tons.like i said,you really are not getting alot of actual OC at a time with only 10mgs.in reality,you are actually only getting 5mgs at one hour and then the other 5mgs at six.If your actual base dose of OC is already not covering your pain to begin with either you are already kind of starting your day behind the pain and never really getting on top of it at all you know what i mean?

i totally agree about the use of darvocet,it really is a crappy pain killer.and that huge amount of tylenol is a real nasty part of using it.why put that crap into your body when there are better options that some have without any tylenol at all ya know?i use the oxy IR 5mgs for my BT pain and it does work fairly well although not as well as it used to.but you really do need to discuss these options with your doc.good luck,marcia

[Myc0]

I have tried a couple of different antidepressants, and it's hard to say if they helped my neuropathic pain because I wasn't experiencing much when I tried them. But I don't like the idea of drugs that mess with my brain chemistry, and when I was taking the antidepressants it made me want to die, I was way more depressed and hopeless than usual.

I have been on oxycontin for over a year, and I'm taking a lot less than I started with. I don't want to go back to taking more, but I may end up needing to. When I first got home they put me on 40mg 2x day, but we upped it to 80mg, and I was taking morphine for breakthrough pain. I felt kind of like a junky, so I've been trying to ween off of the pain meds. Unfortunately my pain had been increasing and I've developed quite a tolerance to the meds, so it doesn't look like that's going to happen.

[alan]

Try a pure opiate for breakthrough, instead of an opiate plus acetaminophen.