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Re: Pain MedicationFrom: DoctorJoe@aol.comMon Jul 17 11:36:51 2000
In a message dated 7/17/00 10:44:42 AM, ainsron@msn.com writes: << The #1 problem with excessive vicoden is not addiction but hepatotoxicity, which can happen with over 4gm daily. I actually had a patient who died 2 weeks post hysterectomy a few years ago. I had prescribed vicoden, plus she was getting them from other sources and taking OTC tylenol. I had even warned her about the problem. What a waste! Beautiful girl with lots of potential. >> Sounds bad, but the package insert doesn't mention this one way or another as a REASON... it says that you shouldn't go over 5/day. So that makes us OBs, who deal with patients with altered clearance, larger volume of distribution, etc, etc, sort of on the wrong side of the fence... Gee, we're creating a population of ADDICTS, according to the package insert! Your scenario of the lady taking lots of vicoden is complicated by the tylenol. THAT is clearly a co-conspirator in many hepatotoxic insults, including alcohol. I think we underplay the role of acetominophen and liver damage, just like we underplay the role of NSAIDs and kidney damage (although we had a thread on her a while ago about Toradol...). [For my money, narcotics are about the safest medicine there is, when used wisely. Probably, that's why God made poppies... what plant does tylenol or aspirin come from? LOL] Joe P.
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