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January 29, 2012 5:27 AM   Subscribe

Vicodin for post-surgery pain = itchy hives. Percocet for same pain = itching and no pain relief. Another surgery in the near future... What are my options for pain mitigation?


I have two things going on; one is immediate, the other is happening in March.

The first thing: I had rhinoplasty done on Jan19. The first weekend, I was given Percocet for the pain. It didn't work very well and made me itch like mad. The surgeon switched me to Vicodin on Friday and now I've broken out in tiny, itchy, red bumps after taking a few doses of it (7.5/750 strength) (starting Friday evening, I took two pills four hours apart, then again one pill on Saturday morning, afternoon, then evening; then the hives started). Is this something I should be dashing off to the hospital about or can it wait till I see the surgeon on Monday (tomorrow)? The last dose of Vicodin I took was last night, around eleven; since then, the red bumps have spread mostly across my upper arms and thighs, some down my calves, forearms and belly. They seemed to have faded while I slept but now that I'm up, the hives have returned.

The second thing, happening in March:

I'm scheduled for gastric sleeve surgery at the end of March and will be flying back home three days after the surgery. Based upon my recent experience with surgery, percocet and vicodin, I'm a little worried that either I'll (a) have a bad reaction to any other pain meds; or (b) have no pain mitigation (or, as in the case of Percocet: have both a bad reaction and ineffective pain mitigation). I've done several Google searches to see if I can find a list of pain medications besides Percocet and Vicodin - the other options I've been able to find have issues: Oxycontin is the same active ingredient as what's in Percocet; Darvocet has been banned by the FDA. So far, Google hasn't turned up any other answers.

What else is out there besides Percocet, Vicodin, and OTC acetaminophen, ibuprophen and NSAIDs?

(Obviously, I'll be asking the March surgeon this same question but I'd like to have an idea of options before doing so.)
posted by LOLAttorney2009 to Health & Fitness (13 answers total) 2 users marked this as a favorite
Lately everyone I know is being prescribed Tramadol for pain. Including the dog. Most everyone complains it makes them sleepy.
posted by AuntieRuth at 5:34 AM on January 29, 2012 [1 favorite]

Talk to your pharmacist as well - they often know more about other options than the surgeons.
posted by leslies at 5:42 AM on January 29, 2012

This pain ladder may be what you're looking for.

Look up Fentanyl patches on this page.

Also: "Even in large doses, fentanyl does not cause histamine release like morphine does" + "Allergic reaction is rare "

Best of luck on the surgery!
posted by lemuring at 5:57 AM on January 29, 2012

Sounds like you have an allergic reaction to opiates. You definitely need to talk to your doctor(s) about this issue before surgery, so they can work-out a pain-control strategy for you.
posted by Thorzdad at 6:13 AM on January 29, 2012 [5 favorites]

One solution to this problem that I've heard of involves prescribing an opioid-plus-antihistamine combination. Stuff in the morphine family causes histamines to be released, and as I understand it that's where the itching comes from.

This is definitely an ask-your-doctor-first thing, since my understanding is that antihistamines have a potentiating effect on opioids and so dosing needs to be adjusted — you really don't want to just up and decide to pop a benadryl along with your regularly prescribed painkiller without checking with a doc or pharmacist first. But so maybe put it on the list of things to ask about.
posted by nebulawindphone at 8:45 AM on January 29, 2012

Could it be a reaction to the Tylenol (acetaminophen) in Vicodin? Coincidentally, the other night a friend was recounting that there is an ibuprofen-based version called something like "Vicobon" (can't seem to find it in the Google, natch). Might be worth a mention to your doc/pharmacist.
posted by rhizome at 9:03 AM on January 29, 2012 [1 favorite]

It's either the acetaminophen or the oxycodone/hydrocodone. If it's the acetaminophen, they make similar drugs with ibuprofen instead (e.g., Vicoprofen). Have you had issues with OTC pain medication before?
posted by J. Wilson at 9:23 AM on January 29, 2012

Vicodin and Percocet have two things in common: opiates and acetaminophen. Sounds like you are allergic to one or the other or both. I have several friends who are allergic to opiate painkillers, and I'm pretty sure that opiate allergies are more common than allergies to acetaminophen, but it's possible you are allergic to both. Have you ever had a reaction to Tylenol?

To alleviate the itching now, ask a pharmacist for advice on whether it's safe to take an antihistamine and which one to take at which dosage. Then, talk to your surgeon about pain management with a non-opiate painkiller. It is important that they know about this reaction, because if you are given pain meds in the hospital they'll want to avoid opiates as well.
posted by bedhead at 9:32 AM on January 29, 2012

Bummer on the reactions!
it seems you are of the unfortunate class of people allergic to opiates. Oxys/Percs are stronger in nature than Vicodin, so its odd you had no pain relief.

Probably will have to take a synthetic drug like fentanyl which is pretty good, but the patches take forever to kick in. Let the doctor know before hand so that he can find something to work. Darvons are/were the worst in pain management, granted I knew people with vicodin scripts that would trade for my darvocets like they were going out of style (vicodin actually took care of my pain, where as darvons I had to cold water extract the good stuff out as I am no fan of acetometaphen).

Tramadol can cause some really terrible side effects, so just an fyi. I am one of those folks who takes tramadol and feels next to death the next day. Fever, sweats, aches and eventually vomiting.
posted by handbanana at 10:41 AM on January 29, 2012

i've heard from novice heroin users, that an antihistamine is the key, taken half hour before the opiate.
posted by goutytophus at 12:28 PM on January 29, 2012

I'm not sure how things go post-sleeve, but after my RNY I was not supposed to take pills for a couple weeks, so I had liquid Vicodin (after the morphine drip in the hospital). And I'm also not supposed to have NSAIDs ever. Fentanyl patches sound like an idea, but you may want to check if the allergy is to opiates or acetaminophen before they hook anything up to your post-op IV.
posted by elsietheeel at 2:47 PM on January 29, 2012

I'm going to address the first question, since everyone else is addressing the second. (except to say that oral Dilaudid is another potential option no one has mentioned, although it is also an opiate, but so's fentanyl and tramadol is an opiate too, even though it's a little different)

Is this something I should be dashing off to the hospital about or can it wait till I see the surgeon on Monday (tomorrow)?

What you're having (hives) is likely an allergic reaction. Allergic reactions can range from mild to life threatening. If your reaction stays limited to skin only, you can take Benadryl for the itching and see your doctor tomorrow. Since Benadryl and the narcotics can both cause drowsiness, be aware you may be drowsy, and do not drive after taking these. If you experience any indication that your reaction is progressing to a more severe allergic reaction (anaphylaxis), i.e.:
- shortness of breath
- difficulty swallowing
- swelling of the mouth or tongue
- lightheadedness or fainting

then please call 911 to be brought to the ER immediately. Either way, do not take any further Vicodin or Percocet. Just because your initial symptom was hives, doesn't mean that further exposure would not lead to full-blown anaphylaxis. IANYD and this is not medical advice!
posted by treehorn+bunny at 9:48 PM on January 29, 2012

A lot of doctors are switching from Vicodin to Norco due to concerns about overdoses of acetominophen. The difference is Norco has less of it. Maybe you'd react differently to it? Perhaps not likely, but at least possible.

rhizome: " an ibuprofen-based version called something like "Vicobon" (can't seem to find it in the Google, natch)"

One name for hydrocodone + ibuprofen is Vicoprofen.
posted by IndigoRain at 12:00 AM on January 30, 2012

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