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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Nickengland on May 12, 2005, at 9:16:42
Hi Ed : )
Hope everythings good with you..
Because of the kidney pains I've switched back to Tegretol!..To be honest though i've found that the intial good buzz from trileptal has now wore off anyway and it feels much the same as tegretol so its not such a bad thing changing anyway..
Also I've now got brand Tegretol Retard so hopefully it'll work slightly beter then the Alpha pharma stuff with side effects etc..
Anyway I was wondering what you know about Codedine? I get head aches alot and have had a couple of my mums Co-Codamol Tablets - 8/500, that she was given for back pain. I understand these contain 500mg Paracetamol and 8 mg codeine.
This added 8 mg of codeine makes me feel very relaxed indeed lol...Am i right in thinking you can get this 8/500 mix over the counter in pharmacys without a prescription?
Also taking this codeine could it upset or make bipolar anyworse ? i.e make me depressed or high?
Thanks for your thoughts/advice about this
Kind reagrds
Nick
Ps, i know codeine can be addictive - id only be using it for as needed haed aches though, not everyday use lol
Posted by ed_uk on May 12, 2005, at 11:48:29
In reply to Question for ed_uk, posted by Nickengland on May 12, 2005, at 9:16:42
Hi Nick,
>This added 8 mg of codeine makes me feel very relaxed indeed lol...
Carbamazepine is thought to interfere with the metabolism of codeine and might theoretically increase its effects. Carbamazepine increases the formation of various active metabolites of codeine. (Codeine has many metabolites- morphine is one of the most important metabolites of codeine).
It sounds like you are extremely sensitive to codeine, 16mg of codeine is too low for most people. Because of this, co-codamol 8/500 is rarely any more effective than paracetamol alone. In general, the only people who find co-codamol 8/500 more effective than paracetamol alone are people who are very sensitive to codeine. Carbamazepine might have potentiated the codeine, increasing its analgesic effect.
Dosage requirements for opioids such as codeine are *extrememly* variable and must always be determined on an individual basis- opioids do NOT have a 'standard dose'.
The fact that you were very relaxed after 16mg suggests that 16mg was in excess of the dose required to control your pain- you could try taking 8mg next time. If paracetmol alone is effective for your headaches, please don't take co-codamol :-)
A codeine dose which adequately controls your pain without causing any feelings of relaxation or euphoria is a suitable dose. If the pain completely disappears, the dose is too high. Try to find a dose which reduces the pain to a tolerable level. If your headaches can be treated with non-opioids alone, codeine should not be used.
>Also taking this codeine could it upset or make bipolar anyworse?
If you consistently take the minimum dose required to adequately control your pain, you are unlikely to run into problems. If you regularly take doses which make you feel very relaxed, completely pain-free or euphoric, you are likely to develop an addiction. Regular use of codeine at appropriate doses commonly induces physical dependence ie. withdrawal symptoms will occur when the drug is stopped or if the dose is substantially reduced. Pure physical dependence is *not* the same as addiction. Addiction may occur when a person takes an opioid at doses in excess of the dose required to control their pain. If powerful feelings of relaxation are present, the dose is too high.
Here are some features which suggest addiction (as opposed to pure physical depedence).....
Loss of control over drug use
*Frequently* taking a drug for its euphoric effects
Craving a drug for its psychological effects
Drug use takes priority over work, family or social life
Forging prescriptions
Large amount of time spent aquiring a drug or using a drug
Deceiving others (including doctors) or stealing in order to obtain a drug
'Doctor shopping' in order to obtain large quantities of a drug for recreational purposes
Some people use opioids recreationally without bocoming addicted. Addiction implies loss of control over drug use.
...................................................................................
*Pure physical dependence* is characterised by the occurence of withdrawal symptoms when the drug in stopped or the dose reduced. The above features of addiction are not present. Tolerance may or may not be present.
Opioid addicts are usually physically dependent as well as being addicted.
People who have taken *appropriately titrated* doses of an opioid on a long-term basis (generally for the treatment of severe pain) are usually physically dependent yet they are NOT addicts. An opioid addict is a person who displays definite features of addiction (as listed above) IN ADDITION to being physically dependent.
Some of the opioids used medicinally in the UK include.......
Codeine
Morphine (MST Continus, Zomorph, MXL, Oramorph, Sevredol etc)
Dihydrocodeine (DF118)
Fentanyl (Sublimaze, Durogesic) Seriously, what were they thinking when they named it Sublimaze!!!!
Pethidine
Oxycodone (OxyContin, OxyNorm)
Hydromorphone (Palladone)
Methadone (Physeptone)
Diamorphine (aka heroin)Here is a list of common opioid withdrawal symptoms..........
mental distress, anxiety, agitation, restlessness
nausea/vomiting
muscles pain
runny nose, watery eyes
sweating
goose bumps
diarrhoea
yawning
fatigue
insomnia
exacerbation of underlying pain (rebound pain)>Am i right in thinking you can get this 8/500 mix over the counter in pharmacys without a prescription?
Yes. Codeine/ibuprofen combinations are also available.
>id only be using it for as needed haed aches though, not everyday use lol
For certain types of pain, long-term daily use of opioids can be useful. Long-term opioid use may be useful in carefully selected patients suffering from severe arthritis pain, severe pain due to intervertebral disc disease, severe pain due to vertebral crush fractures and cancer pain. Opioids are also useful for some patients with severe neuropathic pain. Opioids are *not* suitable for the treatment of mild pain.
Unfortunately........ regular use of opioids can sometime aggravate headaches. Occasional headaches can be *transformed* into a chronic daily headache which may be severe and difficult to treat. Because of this, opioids are best used sparingly in the treatment of headaches unless the headaches are extremely severe and there is no alternative. Preventive medication is often useful for people who suffer from frequent severe migraines. Specific anti-migraine drugs such as sumatriptan can be a useful treatment for acute migraine attacks which have not responded to paracetamol or NSAIDs such as ibuprofen.
Kind regards,
Ed.
Posted by ed_uk on May 12, 2005, at 12:00:41
In reply to Headaches: codeine » Nickengland, posted by ed_uk on May 12, 2005, at 11:48:29
OK, maybe I posted an excessive amount of information LOL. I'm supposed to be studying for my exams but I got stressed out and decided to ESCAPE on p-babble! I nearly wrote more but I had to force myself to stop........
Ed.
Posted by Nickengland on May 12, 2005, at 13:56:15
In reply to Re: Headaches: codeine, posted by ed_uk on May 12, 2005, at 12:00:41
> OK, maybe I posted an excessive amount of information LOL. I'm supposed to be studying for my exams but I got stressed out and decided to ESCAPE on p-babble! I nearly wrote more but I had to force myself to stop........
>
> Ed.LOL It was a little excessive, but very interesting information Ed and a great read! : )
If I paid a privite doctor he probably wouldn't give me so much information on codeine!..Many thanks Ed, greatly appreciated.
The relaxed *buzz* from the codeine has now wore off and I must admit at first it felt good but then I just felt kinda thick you know?!
Hmmm..I think it'd be a wise move for me to avoid the use of any codedine for my headaches, I could end up using it forgeting it was for the headaches and get carried away with the need for that relaxed *buzz* : /..not a good thing!
However I did find it helped relieve the headache, but only because I was distracted by the relaxion it produced.
I have always had headaches..(sometimes migraines but not so much lately) and over he past years have had the most relief from ibuprofen, ingeneral ive found paracetamol useless. What with the kidney pains from Trileptal and reading about the long-term damage ibuprofen can cause, I think maybe its time I tried something new for my headaches as I dont want to damage my kidneys at the young age of 22!
You mention sumatriptan, I've heard about the triptans and that they work on serotonin? Any problems with bipolar and the triptans because of this serotonin action?
Kind regards
Nick
Ps Write as little or as much as you like LOL..Don't let me distract you too much from your studying though!
Posted by ed_uk on May 12, 2005, at 16:28:03
In reply to Re: Headaches: codeine, posted by Nickengland on May 12, 2005, at 13:56:15
Hi Nick!
>I did find it helped relieve the headache, but only because I was distracted by the relaxion it produced.........
Although opioids can be very effective for certain types of pain, they are often not particularly effective for headaches/migraine. They sometimes cause headaches!
>ibuprofen, in general ive found paracetamol useless........
Ibuprofen and other NSAIDs are often effective for migraine, paracetamol is less consistently effective for this type of pain.
>long-term damage ibuprofen can cause........
Severe side effects are unlikely if you use ibuprofen intermittently. The maximum over-the-counter dose (in the UK) is 400mg three times a day because it has a relatively good safety record at this dose. Doctors sometimes prescribe up to 600mg four times a day or 800mg three times a day. Side effects are more likely at these doses. Peptic ulcers are usually more of a concern than kidney damage. Try to find the minimum dose which controls your symptoms.
>Any problems with bipolar and the triptans because of this serotonin action?
I haven't heard of there being any problems. Perhaps some bipolar people on p-babble have used triptans and can tell you how they responded.
Triptans are suitable for occasional use only ie. in the treatment of an acute moderate to severe migraine attack. Regular use of triptans can cause a 'rebound headache' when the drug wears off.
Triptans available in the UK include............
almotriptan (Almogran tablets)
eletriptan (Relpax tablets)
frovatriptan (Migard tablets)
naratriptan (Naramig tablets)
rizatriptan (Maxalt tablets and wafers)
sumatriptan (Imigran tablets, injection and nasal spray)
zolmitriptan (Zomig tablets, orodispersible tablets and nasal spray)Surprisingly, low doses of various antipsychotics can be effective in treating both the pain and the nausea/vomiting of severe migraine attacks. In the UK, the antipsychotic/antiemetic prochlorperazine is available without a prescription for the treatment of migraine attacks. The brand name is Buccastem- the tablet is placed between the upper lip and gum and left to dissolve. Although it is sold for the treatment of nausea due to migraine, it is also effective for the pain. Prochlorperazine is suitable for occasional use only. If you have previously reacted badly to prochlorperazine (aka Stemetil) or other 'old fashioned' antipsychotics, you will want to avoid Buccastem. On the other hand, the dose is relatively low and so side effects are unlikely to be severe.
Certain drugs used to treat bipolar disorder are sometimes effective in preventing migraines. Valproate can help but I know it made you feel ill. Topiramate (Topamax) can prevent migraines, a common dose is 100mg/day.
Kind regards,
Ed.
Posted by Nickengland on May 12, 2005, at 16:54:27
In reply to Re: Headaches » Nickengland, posted by ed_uk on May 12, 2005, at 16:28:03
As always Ed, im very much grateful of your advice.
Good luck with your studies...with your knowledge I expect top marks!
Kind regards
Nick
Posted by ed_uk on May 13, 2005, at 11:14:01
In reply to Many thanks Ed, posted by Nickengland on May 12, 2005, at 16:54:27
Hi again,
I just wanted to add that after you've been on Tegretol for a longer period of time (at your current dose) or if you increase the dose, the effects of codeine may be potentiated even more than they were last time. Take care! I guess it doesn't matter if you won't be taking codeine again.
Kind regards,
Ed.
This is the end of the thread.
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