Can I take another painkiller now?

December 12, 2007 1:57 AM

Is there a doctor around that can give me advice? Long story short, I'm in a lot of pain right now. My doctor prescribed Tylenol with Codeine 300 mg, and prescribed 1 or 2 every 4 hours.

But the pharmacist said since I've been on Darvacet and tylenol yesterday afternoon, I have to be careful about not overdosing, which he defined as more than 4000 mg of acetaminophen. This advice is also echoed here:

http://www.rxlist.com/cgi/generic/acetcod_ids.htm

My question is, I'm still in a lot of pain. Do you think it's OK to go over the 4000 mg for one day? Or is this something important to really be concerned about. I'd like to take 2 pills every 4 hours.

Here's what I took so far and what I understand the amounts of acetaminophen are:

11:30 AM 2 Darv 1300mg
3:30 PM 1 darv 650mg
5:30PM 2 tylon 1000mg
12:30PM 1 tylenol with codeine 300mg
3:45 AM 1 tylenol with codeine 300mg

total 3550mg

posted by kdern to science & nature (14 comments total)

So you have advice from a professional pharmacist not to do something dangerous and you're asking for strangers on the internet to overrule them?

Don't do it. If you want a second opinion, ask another pharmacist. They'll tell you no too. Acetaminophen overdose can lead to liver failure and death.

It would be better for you to try to get the codeine dose increased. How much codeine is in each pill?
posted by grouse at 2:51 AM on December 12, 2007 [2 favorites]

I know this is soooo not what you want to hear in your condition, but: Call your doctor's office and use the on-call doctor or nurse practitioner for this. If they have an answering service, tell them you need to have your doctor or an on-call doctor call you back. It's part of their job and exactly what you should use them for. If you are in so much pain that waiting to hear back from them is not an option, then it's the emergency room for you. (p.s., A close friend of mine overdosed on over-the-counter pain relief and that wasn't pretty.)
posted by cocoagirl at 2:55 AM on December 12, 2007

http://en.wikipedia.org/wiki/Paracetamol
posted by mu~ha~ha~ha~har at 2:59 AM on December 12, 2007

Don't go over the 4000mg/day overdosing with acetaminophen is "easy" and dangerous.

You should talk with your Doctor about the pain and the effectiveness of this treatment, there is a lot of pain relief drugs out there. But careful not to overdose.
posted by zouhair at 3:36 AM on December 12, 2007

IANAD... But could you take ibuprofen?

I was in the opposite situation a few years back. When I had my wisdom teeth out the dentist didn't prescribe anything ("Just take ibuprofen," he said). I was in a lot of pain and taking a lot of ibuprofen, to the point where I was getting beyond the max recommended dosage. I went to the pharmacy and they suggested that I definitely *not* increase the ibuprofen any further, but that I could take acetaminophen in addition to it.


http://wiki.answers.com/Q/Is_it_safe_to_take_tylenol_and_ibuprofen_at_the_same_time
posted by sanitycheck at 4:19 AM on December 12, 2007

Several thoughts here, kdern.

(1) Pharmacists, nurses and (most) doctors will never positively advise anyone to go above legal prescription maximum limits, even if it is known that these are set conservatively and marginal/short-term overdosing is unlikely to do very much harm - in the event of an adverse outcome, they would be legally liable. The literature - which is accessible over the internet - suggests that liver damage from acetaminophen is very rare below dosages of around 10,000mg acetaminophen in 24 hours. This is not a licence to play, however, as some individuals have found out to their cost...! Hepatic transplantation is one of the most complicated and costly procedures known to man, never mind having to be on immunosuppression for the rest of your (probably foreshortened) life...! For what it's worth, it might be more useful to increase/change the opioid portion of your analgesic intake, as the side effects (drowsiness, nausea, constipation, risk of addiction if taken for a prolonged period) are in some people's opinion less horrendous than those of acetaminophen poisoning. Clearly, this will require a doctor's prescription.

(2) It may be that your pain can be reduced by adding nonsteroidal anlagesics to the acetaminophen. This is an emerging field of study - conventional wisdom used to state that NSAIDs and acetaminophen act on the same biological receptor systems and combining them therefore makes little sense. As our knowledge of the cyclo-oxygenase (COX) enzyme subtypes increases, this view is now beginning to shift, and there are some studies suggesting that combining the two drug types (NSAIDs act on COX-1 and/or COX-2, while acetaminophen acts on COX-3) can achieve approximately 35% better analgesia (or reduced opioid requirement). I must emphasise that you should be aware of the equally horrendous potential side-effects of NSAIDs: Kidney failure (if you are dehydrated or have poorly functioning kidneys already), stomach ulceration and/or haemorrhage (bleeding), worsening of asthma in asthmatics, and heart failure in those with an already straining heart. Also, a proportion of people are allergic to aspirin and related NSAIDs, whereas true allergy to acetaminophen is quite rare.

(3) I feel you are getting very focussed on the here & now of your pain and on pharmaceuticals. It would be much more productive to ascertain what is causing your pain, and how certain the diagnosis is: Knowing this could both inform more efficacious prescribing as well as (possibly) open up other (non-pharmaceutical) approaches to alleviating the pain. Don't forget, BTW, that physical pain is (usually) nature's way of telling you that there is something going wrong within you. This needs to be excluded first, before it makes sense to try and suppress the pain message or tune down your receiver (brain).

(4) Are there other stressors that may operate to increase your pain perception, such as psychological factors independent of but coexisting with, your pain problem (family, job, etc...?). Are you lacking - or not allowing yourself to access - emotional supports (friends, partners, family)? If you seriously think about it, is there possibly a (psychological) "secondary gain" associated with being seen by others as having an unsolved pain problem? I appreciate that you are crying out for help over the internet, and this is not necessarily a dumb way of going about it, but are there not suitable sources of aid closer to you on the ground? For the reasons outlined above, for persistent pains refractory to straightforward treatments this may reasonably extend beyond doctors, nurses and pharmacists to include counsellors, psychologists and psychotherapists.

I hope this helps.
posted by kairab at 4:53 AM on December 12, 2007 [1 favorite]

Is it just me or does it seem really insane to ask about medication recommendations but not mention what your ailment is? Seems like that would be relevant.
posted by hermitosis at 5:59 AM on December 12, 2007

Call the doctor's office and tell them the darvocet isn't controlling your pain. This happens all the time. There are lots of combo drugs like darvocet where the acetaminophen limits how much you can take. Your doctor can prescribe one with proportionally less acetaminophen so you can take more and get more pain relief. In the meantime, you can add ibuprofen.
posted by selfmedicating at 6:10 AM on December 12, 2007

If the medication isn't helping, you may need to start looking at coping and distraction techniques.

Pain Coping Techniques 1
Pain Coping Techniques 2

I'm not trying to minimize your suffering. Sometimes (quite often in fact), getting enough drugs to eliminate pain ends up putting the sufferer in a stupor or even semi-comotose state. If you want to still be functional (and it appears you're somewhat functional, as you're able to post to MeFi), you would be well served by looking into these techniques.

Good luck and feel better.
posted by grumpy at 6:12 AM on December 12, 2007

4-6g is the lower limit for reported liver failure. Liver failure sucks, don't do it. Acetaminophen interacts with some other meds and alcohol (and chronic alcohol); it would be a bad idea to try cocktailing it with other things on your own. Call your MD and get a better opioid.
posted by a robot made out of meat at 6:22 AM on December 12, 2007

DON'T ASK US. Please ask your doctor. No one here has any idea what they're talking about.

Please, please ask your doctor.
posted by sondrialiac at 6:41 AM on December 12, 2007 [1 favorite]

Do you think it's OK to go over the 4000 mg for one day?

If you are willing to listen to the advice of random internet people over that of your pharmacist, then perhaps you can serve as a warning to others and a catalyst for change as far as the AskMe policy on medical questions.

No, really, trolling the internet for a justification to disregard a medical professional's instructions is NOT A GOOD IDEA.
posted by splice at 6:50 AM on December 12, 2007 [1 favorite]

doctors will never positively advise anyone to go above legal prescription maximum limits, even if it is known that these are set conservatively and marginal/short-term overdosing is unlikely to do very much harm

This is bullshit and dangerous advice. Why would a doctor continue to stuff you with a painkiller that isnt working. The idea is that if youre on two painkillers both at or near the max dose then the proper avenue of treatment here isnt adding more of a drug that doesnt work but moving you to a different drug. Or if your pain is this serious, seeing if your problem was misdiagnosed.

On top of that its not just "unlikely" liver damage you have to worry about but kidney damage as well. The internet anti-doctor brigade does not know all the risks and without going to medical school probably will never ever understand the risks, but if you want validation to poison yourself this morning then, yes, they will help you with that.

Call your doctor. Pronto. Get off the internet.
posted by damn dirty ape at 6:57 AM on December 12, 2007

When I was a poison control officer, the dose of tylenol at which we sent patients to the emergency room for decontaminaton and blood levels drawn (to see if they needed the antidote) was 100 mg/kg. Less if you are an alcoholic or have some other liver issues. At high doses, not only will you fuck your liver, you'll get cardiotoxicity as well.

acetominophen is nasty shit. don't mess around with it.
posted by gaspode at 7:38 AM on December 12, 2007