How do i talk to my doctor about switching my medications?
June 8, 2012 11:33 AM   Subscribe

How do i talk to my doctor about switching my prescription from Vicodin(hydrocodone)/Tramadol to oxycodone?

I am in a lot of pain from numerous accidents occurring and catching up to me over the years, I am prescribed Tramadol because I had a reaction to the Vicodin prescribed which was prescribed to me first. How can i get a different pain killer such as ,oxycodone, because the Tramadol is not working and I am worried about taking so much tylenol because of my liver (I used to be a very heavy binge drinker in college). How do i talk to my doctor about switching from hydrocodone to oxycodone?
posted by isopropyl to Health & Fitness (17 answers total)
I'm not advocating taking tylenol because it isn't great for your liver, but if you've stopped drinking, your liver isn't likely suffering any chronic effects from your college days. Might want to get a panel done just to be sure, but livers are great healers. Still, tylenol is terrible for your liver, deadly at high enough doses. It's worth noting that all meds, however, are going to have non-negligible effects on your liver.

I think the only way is to just tell your doctor that the Tramadol isn't working. I also think you should talk to your doc about how to address this long term, because oxy may not be something you want to be on for the rest of your life. Can you take the meds in combination with physical therapy or yoga or some other treatment that might get to the core of the issue? I realize that there may not be options, depending on your situation. But if you have a good relationship with your doc and he knows you're not a drug-seeker, then I think just asking is the only way. Keep in mind that dependency is a risk with all of these types of meds, so you might experience the same tolerance build up with oxy as well (or at least this is my understanding, having never taken it).
posted by Lutoslawski at 11:42 AM on June 8, 2012

I'm not a medical professional, but I am a long-term tramadol user. Tramadol is actually the generic form of Ultram and doesn't contain acetaminophen (Tylenol) at all. Tramadol is considered to be non-habit-forming and so doctors are more likely to prescribe it than other controlled drugs, especially for long-term use. That being said, if you aren't getting adequate pain relief, you should let your doctor know that. There are likely things he/she can do, whether it's complementary therapies or a change in medications.
posted by SweetTeaAndABiscuit at 11:54 AM on June 8, 2012 [3 favorites]

Tramadol doesn't work on some people, yours truly included. Seriously, one ibuprofen would have worked better (and I don't really think a single ibuprofen is very effective, mind you). Your doctor will probably be aware that some people just don't get good effects from Tramadol, so tell him or her about it, and s/he will probably prescribe something else. Whether that will be Oxycodone or not, I can't say, but unless you have a longstanding relationship with the doctor, I wouldn't ask for it -- seems like it would be too likely to set off red flags about drug-seeking. (This isn't fair, of course. But doctors seem to be coming under a lot of pressure from the DEA lately in regard to pain control methods.)
posted by artemisia at 12:12 PM on June 8, 2012 [1 favorite]

Yeah, I would talk to your doctor about changing meds if your current ones aren't working and approach it solely from that angle. I wouldn't ask for anything by name (for the reasons artemisia mentioned) and I would probably not mention binge drinking either, even if it's in the past.

If you aren't being seen at a pain care clinic, that would be my first recommendation. They'll have better options than a primary care physician and are more likely to get you medicated appropriately for your pain level.
posted by guster4lovers at 12:28 PM on June 8, 2012 [2 favorites]

My wife spent a couple of years living with chronic pain. We felt lucky she was prescribed Tramadol, rather than Oxycodone, which seemed like a seriously hardcore drug.
posted by KokuRyu at 12:34 PM on June 8, 2012 [1 favorite]

By all means, let your doctor know that the Tramadol isn't sufficient for your pain needs. But like artemisia says, a specific request for oxy - or even the word "oxycodone" coming out of your mouth - will very, very likely be seen as drug-seeking behaviour.
posted by DarlingBri at 12:40 PM on June 8, 2012 [1 favorite]

Tramadol has no Tylenol in it.

I'm a doctor and it irks the heck out of me when people ask me for "oxys" or "Vikes" (although the worst is "that one that starts with a D").

All you need to do is say the tramadol is not working for you and you want to try something else.

But please remember, you have chronic pain and narcotics are a terrible solution for chronic pain. They create addiction and tolerance. So please be open to other options for treating your pain if your doctor recommends then, because being on escalating doses of opiates for the rest of your life is not likely to be in your best interests.
posted by treehorn+bunny at 12:54 PM on June 8, 2012 [12 favorites]

Response by poster: I've been on Tramadol for few days now, how long should i keep taking it before i ask for something else. My doctor is usually fully packed at all times and it takes a while to get an appointment. Should I go ahead and call to set one up? I just can't take this pain anymore.
posted by isopropyl at 12:59 PM on June 8, 2012

Yes, call now.
posted by DarlingBri at 1:00 PM on June 8, 2012

Response by poster: The office is closed till Monday so I'll have to wait out the weekend.
posted by isopropyl at 1:03 PM on June 8, 2012

Best of luck asking for oxys. i have chronic pain and asking for anything from my PCP is like pulling teeth. I can't take tramadol either, makes me incredibly ill, like feels like I am dying. i wish my doctor would give me adequate pain medication, I wouldn't need to hoard medications, be in pain, and seek anything and everything to get relief. Oxycodone is probably one of the best medications I've tried (spliting a 20 mg iIR into 5 or roughly), but I know if I ask for it she will say no and put me on some drug seekers list despite my 8 year relationship with her. my suggestion if you really want oxy is to go to a pain clinic. not one in your immediate circle, but a standalone one. basically was my plan after she told me 'some people doctor shop...' and all i wanted was adequate pain relief.

such is life and you gotta do what you gotta do. best of luck.
posted by handbanana at 1:18 PM on June 8, 2012 [1 favorite]

It is a huge red flag for medical professionals when people make specific requests for controlled substances. Tell your physician that you are experiencing pain issues and that the current prescription doesn't work. Ask them for alternatives to help manage the pain.
posted by Hylas at 1:40 PM on June 8, 2012 [1 favorite]

Response by poster: I'm only trying to get the Tylenol off for my livers sake. He has me on upwards of 4000 mg a day for vicodin then abruptly changed it to 400 mg of tramadol once my bad reactions happened. I just believe and know oh after our discussions they're medications out there with no "APAP" in it. Could you give me more information about the pain clinic you speak of handbanana? Are they easily accessible all over the states and do they take insurance? Mostly i'm concerned because my pain if from a slipped disc in my upper thoracic vertebrae, two right lower ribs that manage to re-break yearly and a smashed hand that suffered multiple fractures on the bottom of my hand where it would meet the table if one was writing. I tend to ramble and any advice would be amazing! I'm going broke on tubes of icyhot and buckets of NSAIDs
posted by isopropyl at 2:11 PM on June 8, 2012

Are you actually taking any tylenol? There is no tylenol/acetaminophen/APAP in Tramadol. There is some in Vicodin, but it sounds like you aren't taking that anymore.
posted by vytae at 2:43 PM on June 8, 2012

Ultracet has tramadol/acetaminophen in it. maybe it's that.

I would simply say what your getting is not alleviating the pain, be prepared to explain how the pain is changing your quality of life with your current level of pain management.
posted by couchdive at 2:56 PM on June 8, 2012

Was the Vicodin adverse reaction to the paracetamol? They make "mix" drugs with ibuprofen as well -- both for hydrocodone and oxycodone.

I would call and ask to speak to your doctor to express your concern about paracetamol and to explain that the tramadol isn't working for you. Ask how long it should take and if there's anything else you can try. I would not come out and say "can I get oxycodone instead."
posted by J. Wilson at 4:38 PM on June 8, 2012

I've run into the same problem with Tylenol 3 (after Vicodin made me ill). All I did was tell my doctor at the pain management clinic that I was concerned about waning relief I was getting from the T3 and if there was anything else we could try. That's really all you need to tell your doctor.

As far as I know, pain management clinics are a nationwide thing in the US. I'm going to one for my back pain and they do take my insurance (although my cortisone injections have to be pre-approved). If you Google for a pain clinic, you should be able to come up with something local - or ask your GP for a reference. A pain clinic would be more dedicated to managing chronic pain than your GP, and can refer you to another (orthopedic?) specialist as needed.

If you do end up on something containing APAP, stay under 3g (3,000mg) per day - that was the rule given to me by my pain guy when I expressed concern for my liver.
posted by youngergirl44 at 7:18 PM on June 8, 2012

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