2 weeks of hell

November 26, 2006 10:20 AM

My doctor is making me quit Percocet(been on for 3 months) and Celexa(been on for a year) at the same time. I will be weening off the celexa but going cold turkey on the percocet. Shouldnt this be against the geneva convention? What kind of hell am I in for?
posted by ryanissuper to health & fitness (21 comments total)

How much percocet are you taking?
posted by drleary at 10:22 AM on November 26, 2006

What were you taking it for?
posted by SpecialK at 10:28 AM on November 26, 2006

350mg for headaches
posted by ryanissuper at 10:29 AM on November 26, 2006

sorry, 325mg 3-4 times a day
posted by ryanissuper at 10:31 AM on November 26, 2006

Additional info:He wants to switch me to Fioricet and my options are limited due to my high intake of coumadin.(INR 3.5-4)
posted by ryanissuper at 10:35 AM on November 26, 2006

Percocet is addictive. He's doing it for a reason.
posted by Ironmouth at 10:38 AM on November 26, 2006

I realize that percocet is addictive and I dont mind quitting. Doing so cold turkey, however, seems to be asking for pain.

Additionally, the medication he is switching me to is also highly addictive. It is however a barbiturate and not an opiate.
posted by ryanissuper at 10:47 AM on November 26, 2006

You're not supposed to stop Percocet cold turkey. And yes, it will be miserable.

For those that argue you shouldn't take it because it's addictive, I would argue that when you have serious long-term pain, being addicted is preferable to being in pain. Once the source of the pain is fixed, the addiction is easier to break. Obviously the original pain is not caused by lack of Percocet, but until the docs can figure out what is causing it, Percocet or similar stuff is better than hurting and not being able to think clearly.

If you have migraines, please look into Magnesium supplements as a possible help. It has helped many people, and it's cheap.
posted by Katravax at 10:49 AM on November 26, 2006

If you're being switched to something else, the withdrawal may not be so bad. You should be able to fade from one to the other, though. 3 of one, 1 of the other a couple days, 2 and 2 a while, 1 and 3 a while, then whatever. I'm making up the numbers, but you get the idea. Not being in pain should make withdrawal easier.
posted by Katravax at 10:51 AM on November 26, 2006

Thanks for the article. A little evidence in my corner is exactly what I was looking for.
posted by ryanissuper at 11:13 AM on November 26, 2006

Katravax: can you point me in the right direction for more info on magnesium for migraines?
posted by fionab at 11:16 AM on November 26, 2006

Paging ikkyu2...
posted by dendrite at 12:00 PM on November 26, 2006

I had to intervene when an inmate-client was taken off oxycodone (the ingredient in percocet) cold turkey. He had been on for two plus years, and experienced vomiting and blackouts from cold turkey withdrawal. The FDA label (which I sent to the people in charge) clearly states that you have to taper oxycodone. I'll find it again and post it here.
posted by ClaudiaCenter at 12:02 PM on November 26, 2006

There is existing research on some migraines being caused by a magnesium deficiency. This Google search for magnesium and migraines returns a bunch of hits. I know in the hospital if you have a migraine they give you a magnesium drip.

There's the book Miracle of Magnesium that takes a couple hundred pages to say "take 400mg of Magnesium a day." The author says take Magnesium Oxide because it's cheap, but Bill Sardi says the research shows it is poorly absorbed, and the Citrate form is way better absorbed.

That's the form that helped me and my brother -- Magnesium Citrate. The cheap way to get it is in the laxatives aisle of the drugstore, as a flavored liquid. It's cheap, and for a laxative effect you take 10 oz, but for a normal 400mg dose, you just drink 2 oz or so, and there
is no laxative effect. Trivia - it's the same stuff in Doan's Pills (backache pills) too.

You can also absorb magnesium through the skin via a soak in Epsom salts, but follow directions and limit the soak to 20 minutes, because magnesium is also a muscle relaxer and if you stay in too long, it relaxes the same muscles that the laxative relaxes, and you don't want that. :) More, smaller doses is better than fewer larger doses. The Epsom salt soak has helped me when I felt one coming on.

I had no luck with doctors fixing my headaches. I gave the alternative answer (magnesium) a try, and it worked. I take 200mg twice a day, or 400mg once a day, and it works for me. YMMV.
posted by Katravax at 1:09 PM on November 26, 2006 [1 favorite]

Here's the FDA label for Oxycontin (a form of oxycodone). There should be a similar FDA label for percocet.

Page 13, Tolerance and Physical Dependence

Tolerance is the need for increasing doses of opioids to maintain a defined effect such as analgesia (in the absence of disease progression or other external factors). Physical dependence is manifested by withdrawal symptoms after abrupt discontinuation of a drug or upon administration of an antagonist. Physical dependence and tolerance are not unusual during chronic opioid therapy.

The opioid abstinence or withdrawal syndrome is characterized by some or all of the following: restlessness, lacrimation, rhinorrhea, yawning, perspiration, chills, myalgia, and mydriasis. Other symptoms also may develop, including: irritability, anxiety, backache, joint pain, weakness, abdominal cramps, insomnia, nausea, anorexia, vomiting, diarrhea, or increased blood pressure, respiratory rate, or heart rate.

In general, opioids should not be abruptly discontinued see DOSAGE AND ADMINISTRATION: Cessation of Therapy).

P. 24, Cessation of Therapy

When the patient no longer requires therapy with OxyContin Tablets, doses should be tapered gradually to prevent signs and symptoms of withdrawal in the physically dependent patient.
posted by ClaudiaCenter at 2:15 PM on November 26, 2006

What kind of headaches do you have? There is a lot of great advice on migraines here but I didn't see that you said you have migraine headaches.

FWIW, my sister began taking Fiorcet in her teens for tension headaches and has been addicted to various narcotics for twenty years now. Despite seeing dozens of practitioners and trying dozens of treatments, she has never had lasting relief. Don't let this get you down; she gives up easily (but not on the narcotics)! If your headaches are ongoing, consider going to a pain clinic rather than a primary practitioner. Also consider mental health counseling in case whatever you take the Celexa for could be helped in that way.

Hope you feel better soon!
posted by forensicphd at 3:51 PM on November 26, 2006

Your doctor is out to lunch, to put it mildly. Asking a person to quit an opiate cold-turkey after more than several weeks, depending on the total daily dose, is irresponsible and goes against the Hippocratic oath of to do no harm. It's patently stupid, frankly.

Unfortunately, few drugs seem to be more capable of producing chronic daily headaches quite as adeptly as Fiorinal/Fioricet, so the switch you are making doesn't seem very sensible, other than getting you off a schedule 2 drug and freeing your doctor from the possible prescribing hazard.

Please go back to your doc and present a reasoned plea for a more gradual taper or find a new physician, in case this is representative of their general judgement.
posted by docpops at 4:12 PM on November 26, 2006

FYI, my pharmacist friend says that your dose of oxycodone is not 325 mg -- that's the acetaminophen (Tylenol) content in the Percocet tablet. The oxycodone would be either 2.5, 5, 7.5 or 10 mg per tablet. She says that you may experience some withdrawal symptoms, and when patients take greater than 60 mg oxycodone/day, physicians often taper the patient off the drug by decreasing the dose by 50%/day every 1-2 days. It is likely, however, that your withdrawal will be minimal and short lived. She also said that Fioricet is considered a much less addictive drug than Percocet and that it is very effective for many people.
posted by wheat at 4:53 PM on November 26, 2006

Wheat - not to be contrary to your friends input, but we commonly see patients following surgery, often an orthopedic case where their surgeon has been prescribing Percocet 5/325, one or two tabs every 6 hours, who suddenly find themselves cut off by the surgeon without warning and who don't realize they can turn to us for help, who universally describe awful symptoms after only a month of use.

The scenario described simply makes no sense, clinically or otherwise. Fioricet is a terrible choice for the treatment of any sort of potentially chronic headache syndrome, and using it as a temporizing measure for narcotic withdrawl is akin to giving a drunk fortified wine to help them with their gin habit.
posted by docpops at 6:44 PM on November 26, 2006

No problem docpops. Just adding what information I can to help the OP sort it out. I just knew that Fioricet is indicated for tension headaques. But if your patients' experiences with it have been consistently problematic, that's good to know.
posted by wheat at 8:06 AM on November 27, 2006

ryanissuper, I can send you my copy of that magnesium book if you want it.
posted by Katravax at 1:26 PM on November 27, 2006