Tag Archives: hydrocodone

Quick Hits: Americans Open to Non-Drug Pain Treatments, Psychiatric Drugs’ Impact on Cognition & More

More than three-quarters of Americans — 78% — say they are willing to try non-drug alternatives for pain before turning to prescription painkillers. Results from the Gallup-Palmer College of Chiropractic Annual Study of Americans show that 40% of Americans consider prescription painkillers such as opioids a “crisis” or “very serious problem.” And 55% of those who know about the nation’s opioid epidemic place some of blame on the drug industry’s encouraging physicians to prescribe opioids. Another 53% place a lot of blame on doctors overprescribing painkillers to patients. About 23% of those polled said prescription pain meds such as opioids are not very safe, and 8% said opioids are not safe at all. In 2015, more than two-thirds of the opioid deaths reported involved prescription opioids such as oxycodone, hydrocodone, morphine and fentanyl. Posted Sept. 13, 2017. Via Gallup.

Taking high doses of antipsychotic drugs over an extended period may be associated with poorer cognition in schizophrenia. However, taking low doses of antipsychotics such as benzodiazepines and antidepressants over a long time doesn’t affect cognition, according to a new study published in the journal European Psychiatry. The research also found that schizophrenia patients who took a long break from using antipsychotic drugs tended to see their cognitive function improve. Posted Sept. 5, 2017. Via EurekAlert/European Psychiatry.

Women who take antiepileptic drugs (AEDs) during pregnancy have a higher risk of having premature babies or babies that have a low birth weight for their age in the womb. Women with epilepsy who took AEDs while pregnant had a 9.3% increased risk of having a premature baby, while women without epilepsy who took an AED had a 10.5% increased risk, according to results published in the Annals of Neurology. Women who did not take a medication and didn’t have epilepsy had only a 6.2% increased risk of a premature baby. Compared to women who didn’t take an AED and didn’t have epilepsy, women with epilepsy who took one of the drugs gave birth to a child with a mean lower birth weight of 3.9 ounces. For women who took an AED and didn’t have epilepsy, the figure was 4.8 ounces. Common AEDs include Lamictal (lamotrigine), Topamax (topiramate), Tegretol (carbamazepine), Keppra (levetiracetam) and Neurontin (gabapentin). Posted Sept. 11, 2017. Via Medical Express/Annals of Neurology.

Feeling Anxious? Depressed? Check Your Meds

If you find yourself feeling on edge for no apparent reason while taking a cold medicine or diuretic, you most likely wouldn’t connect the two. However, anxiety happens to be just one of many mood-altering symptoms that can be brought on by certain meds.

“Many medications, whether prescribed or found over the counter, can cause psychiatric symptoms,” says Shiyun Kim, PharmD, BCACP, BCPP, CDE, a clinical pharmacist and clinical assistant professor at the University of Illinois Hospital & Health Sciences System, and a spokesperson for the American Pharmacists Association.

She explains that a wide range of factors influence the way a drug affects each person, including things like metabolism, underlying illness, and interactions with other drugs. “Any variations that occur, such as with improper doses or individual reactions, can result in undesirable psychiatric symptoms,” though they are relatively uncommon.

If you feel that you may be suffering from these side effects, notify your providers immediately. “Keep in mind that some medications can be stopped abruptly, while others need to be tapered to prevent further adverse effects,” Dr. Kim emphasizes. “Your provider can make the best decision with you.”

Take note of the following medications that can have these kinds of effects, and read on to find out how to minimize the risks.

Oxycontin and Similar Pain Medications

“Most prescription pain medication, such as oxycodone (OxyContin) or hydrocodone, can cause drowsiness, which can make one feel ‘cloudy’ and lack motivation — and these symptoms closely mimic depression,” according to Bree Meinzer, PharmD, CTTS, a pharmacy practice resident at Ohio Northern University. Opioids can also lead to more severe symptoms like paranoia, hallucinations, psychosis and dementia, especially at high doses. Signs that you may have taken too much of an opioid include trouble breathing and unconsciousness. People with opioid dependence and those who suffer from HIV, liver or lung disease or suffer from depression may be more susceptible to these effects, according to the World Health Organization. If you are on a pain medication that makes you drowsy or “cloudy” and you do not like how it makes you feel, you should talk to your doctor about other ways to adequately manage your pain.

Lasix, Microzide and Other Diuretics

Medications that reduce fluid retention and swelling, including furosemide (Lasix) and hydrochlorothiazide (Microzide), increase urination. This can lead to dehydration, especially in the elderly, and can result in hallucinations and dizziness, says Dr. Meinzer. SGLT2 inhibitors such as canagliflozin (Invokana) and empagliflozin (Jardiance), which are drugs used to treat diabetes, can also increase urination and cause dehydration. If you are taking these types of medication, be sure to drink plenty of water to stay sufficiently hydrated. The amount of water to drink should be discussed with your doctor and is dependent on your weight. “These medications should also be taken in the morning or early afternoon to avoid frequent urination at night,” which could disrupt sleep, she advises.

Ask your doctor to take a look at your current medication regimen to rule out potential drug-drug interactions that could cause psychiatric side effects.

Requip and Other Dopamine Agonists. Medications like ropinirole (Requip), often prescribed for restless leg syndrome and Parkinson’s disease, increase the brain chemical dopamine, which helps regulate mood and behavior. Too much dopamine can cause hallucinations, notes Dr. Meinzer, and more extreme potential side effects include confusion, mania, depression and impulse control disorders like compulsive gambling or eating. “There are other options for restless leg syndrome that don’t increase dopamine, though medications like ropinirole typically work best.” There are also different medications for Parkinson’s, though you and your doctor should carefully consider your particular treatment needs. If you experience these kinds of symptoms while taking this type of medication, it may be that your dose is too high.

Ritalin, Adderall and Other Stimulants

Drugs that are commonly used for the treatment of attention-deficit hyperactivity disorder (ADHD) include those sold under the brand names Ritalin and Adderall. Although these stimulant medications “help children and adolescents focus and stay on task, side effects include increased heart rate and insomnia, which can often cause anxiety and restlessness,” says Dr. Meinzer. Stimulants “excite the central nervous system and can disrupt normal communication between cells in the brain,” adds Dr. Kim. “This class of drugs may also cause bizarre behavior, agitation, mania, paranoia and nightmares.” Dr. Meinzer suggests talking to your healthcare provider if you feel extremely restless and anxious while taking this type of medication. Again, it is possible that your dose is simply too high.

Corticosteroids

Medications like prednisone, cortisone and methylprednisolone are often prescribed “to help respiratory symptoms and decrease inflammation with chronic diseases,” Dr Meinzer explains. They are typically only “used for a short term to help alleviate symptoms, but if you are on these medications for a long time, they can cause some unwanted side effects.” Use of these drugs for more than a few months can increase the chances of experiencing mania, anxiety, depression, paranoia and psychosis, which have mostly been reported by patients using high doses or abusing the medication, says Dr Kim. Though experts are unclear about the exact reasons for such side effects with these drugs, research suggests that it may have to do with the way steroids work in the area of the brain that influences memory and emotion. It is also possible that “high levels of steroids result in brain damage and cause cognitive dysfunction.”

Zarontin and Other Anticonvulsants

Medications such as ethosuximide (Zarontin), which are used to control seizures in people with epilepsy, can cause symptoms resembling depression. These drugs have also been found to increase suicidal thoughts and behavior. “If you start to experience these symptoms on an anticonvulsant, you should talk to your doctor about other regimens,” Dr. Meinzer recommends. “There are other medications in the same class that are less likely to cause this side effect,” though your doctor may want you to stay on the medication because it may be the one that is most effective for you. “Anticonvulsants are usually tricky to dose and may need lab monitoring to make sure they are in the proper range.”

Dr. Kim offers the following general tips to help prevent or deal with these side effects:

  • When you are prescribed a drug, ask your provider about potential side effects that are commonly noted and reported.
  • Ask your provider to take a look at your current medication regimen to rule out potential drug-drug interactions that could cause psychiatric side effects.
  • Withdrawal of some drugs can cause symptoms such as anxiety, agitation or depression. Therefore, call your doctor before stopping medications on your own.
  • When purchasing an over-the-counter (OTC) medication, take the time to read the instructions on the package. If anything is unclear, ask the pharmacist for guidance.

Quick Hits: Teething Tablets Warning, Cutting Back on Opioid Painkiller Production, & More

Parents should avoid giving infants homeopathic teething tablets and gels due to potential risks, including seizures. The FDA, which issued a safety alert about the products in 2010, said that medical attention should be sought immediately if a child experiences seizures, difficulty breathing, lethargy, excessive sleepiness, muscle weakness, skin flushing, constipation, difficulty urinating or agitation while using the pills or gels. The FDA also notes that the products have not been evaluated by the agency for safety and efficacy, and there is no proven health benefit associated with them. In 2010, an FDA analysis found that Hyland’s Teething Tablets contained inconsistent amounts of belladonna, a plant that has sedative properties. The agency noted at the time it had received reports of serious adverse events in children that took the Hyland’s product consistent with belladonna toxicity. Posted September 30, 2016. Via FDA.

The DEA (Drug Enforcement Agency) is mandating a cut in the production of opioid painkillers in the U.S. Beginning in 2017, 25% fewer pills of drugs such as OxyContin (oxycodone), fentanyl and morphine will be manufactured. Vicodin (hydrocodone) production will be reduced by 34%. The DEA noted that although the number of prescriptions for opioids has declined in recent years, abuse of the drugs has increased. The 2015 National Survey on Drug Use and Health, released last month, found 6.5 million Americans aged 12 and older took controlled substance medicines for non-medical purposes in the past month. Posted October 4, 2016. Via DEA.

The FDA is requiring a “black box” warning for certain hepatitis C drugs amid reports that the medications can lead to reactivation of hepatitis B. The agency says it has identified reports of at least 24 people who received the hep C drugs between November 2013 and July of this year who saw a resurgence of hep B that had been eliminated after taking the medications, such as Harvoni (ledipasvir and sofosbuvir), Epclusa (sofosbuvir and velpatasvir) and Viekira. Of these 24 cases, 2 patients died and 1 required a liver transplant. The FDA is recommending that doctors screen patients for current or prior hep B infection before starting hep C therapy and monitor patients on the drugs for hep B flare-ups with blood tests. Posted October 5, 2016. Via FDA.

Lower Doses and No Refills Can Curb Long-Term Opioid Use

When doctors order an opioid for a patient for the first time, they should prescribe a short-acting one without fills to reduce the chances of long-term use or addiction.

That’s the conclusion of a new study out of Oregon that examined prescription data from more than 500,000 patients in the state who were considered opioid-naïve, meaning they had never been given an opioid before a physician prescribed one.

About 5% of these patients became long-term opioid users, meaning they received 6 or more refills of an opioid medication within a year, the researchers reported in the Journal of Internal Medicine. Rural residents were more likely than urban ones (6.1% vs. 4.4%) to be long-term users, and older people were more likely to engage in long-term use.

Researchers then looked at patients who were younger than 45 who did not die within a year of receiving their first opioid prescription. This eliminated most cancer and palliative care patients, but left around 243,000 patients. Of those who had a single prescription fill, only 2% became long-term opioid users. But the odds were 2.5 times higher for patients who received 2 fills as opposed to 1.

Also, patients receiving initial doses of between 400 and 799 cumulative morphine milligram equivalent dosages within 30 days were nearly 3 times more likely to become long-term users compared to those on lower doses.

“The increasing risk of long-term use even at low cumulative doses supports the Centers for Disease Control recommendation of limiting therapy to 3 to 7 days for most patients,” Richard A. Deyo, MD, MPH, a professor of evidence-based medicine at Oregon Health and Science University, said in a statement.

Opioids Often Given in Excess to Patients

A majority of people prescribed opioid medications for pain said that they were given more than they needed, according to a recent survey, making it easier for some people to abuse the drugs or share them with others.

Just as disturbing, more than 20% of the 1,055 patients surveyed by researchers at the Johns Hopkins Bloomberg School of Public Health in Baltimore said they shared their pain meds with others.

Researchers asked more than 1,000 people who were prescribed opioids in the past year about the use of the drugs, how they stored them and whether they shared them with others. Almost 60% said they had leftover medications from their prescription or expected to, the authors reported in JAMA Internal Medicine.

Among people who shared their meds, about 8% gave them to a friend and 14% gave them to a relative. And about 75% gave their extra pills to someone they knew suffering from pain.

Another problem identified in the survey was proper storage of the medication. Among those who said they received information about storage, just one-third said it came from a doctor or nurse. A pharmacist or drug package inset was the source about 45% of the time.

Less than 10% kept their opioids locked away, and about 20% said they stored them in a “latched” location. In addition, relatively few survey participants knew how to properly dispose of their unused pills.

A separate study in the same issue of JAMA Internal Medicine found that in many cases, long-term use of opioids starts with short-term hospitalization.

This study, which included more than 600,000 Medicare recipients, found that 15% of hospital patients get a new opioid prescription when they leave the hospital. And of these patients, nearly 43% were still taking opioids more than 3 months later.

Quick Hits: Warnings on 2 OTC Drugs, Yes to Experimental Cancer Drugs, & More

Despite warning labels, the FDA is receiving reports about bleeding associated with over-the-counter (OTC) antacids that contain aspirin. The medications, which are sold under well-known brand names such as Alka-Seltzer, Medique Medi Seltzer and Bromo Seltzer, are used to treat heartburn, sour stomach, acid indigestion, or upset stomach. The FDA warns that consumers may have a higher risk of serious bleeding when taking the aspirin-containing antacid products if they have one or more risk factors such as being 60 years or older, have a history of stomach ulcers or bleeding problems, take a blood thinner or steroid medication, drink alcohol or take pain medications known as NSAIDs (non-steroidal anti-inflammatory drugs). Posted June 6, 2016. Via FDA.

The OTC anti-diarrhea medication Imodium can lead to serious heart problems that can be fatal if abused, the FDA is warning. Combining a higher dosage of loperamide with other medications, as well as intentionally abusing and misusing the drug can trigger life-threatening side effects, such as abnormal heart rhythms. Most of the reported heart problems were found in people who were deliberately taking higher doses of Imodium. and consciously misusing the drug in order to achieve a feeling of euphoria. Posted June 6, 2016. Via FDA.

The FDA has made it easier for patients with life-threatening illnesses to receive experimental drugs more quickly. The release form for the agency’s “compassionate use” policy on experimental drugs initially consisted of 26 questions. Now it is down to 11 questions, and should now take physicians only 45 minutes to complete. The formatting of the application has been redesigned from an all-purpose format that aimed to evaluate a large group of patients to a simpler version that aligns with individual patients. Doctors may have initially been deterred from applying for the compassionate access policy due to its complicated nature, according to an FDA spokeswoman. Posted June 8, 2016. Via Kaiser Health News.

Many patients are continuing to take powerful opioid painkillers (such as OxyContin, Vicodin and Percocet) months after joint replacement surgery. With opioid overdoses in the United States increasing at a rapidly fast rate, the findings are significant because joint replacement surgery is becoming increasingly common. A new study examined 574 patients undergoing knee or hip replacement surgery. Before their surgery, approximately 30% of those patients were taking opioid painkillers. Despite improvements in their knee and hip pain, 53% of knee patients and 35% of hip patients were still taking painkillers 6 months after their surgery. Posted June 3, 2016. Via HealthDay.

A patch to treat migraines may leave some people at risk of serious burns or permanent scars. The FDA said it has received reports of reporting from users who experienced burns or scars on the skin where the Zecurity (sumatriptan) patch was applied. Some descriptions included in the reports were, “severe redness, pain, skin discoloration, blistering, and cracked skin.” While the FDA investigates this safety issue further, they encourage users to remove the Zecurity patch immediately if they are experiencing side effects and contact their health professional. Posted June 2, 2016. Via FDA.

Need to Know: Opioids

Opioids are used medically to relieve pain, but this medication is commonly misused and abused. Learn the facts about prescription opioids.

Common Names

Oxycodone (OxyContin, Percoset), hydrocodone (Vicodin), fentanyl (Actiq, Duragesic), morphine (Kadian, Avinza), codeine.

Side Effects and What to Do About Them

Constipation and Nausea: The two most common sides effect of opioids. However, other reported side effects include sedation, dizziness, vomiting, physical dependence, tolerance and respiratory depression.

By slowing down the digestive system, opioids are well known for “opioid-induced constipation.” Increasing fiber and water intake can give some relief. Many people find they need more medicines to relieve the constipation, potentially setting off a cascade of one drug side effect leading to another drug for relief and so on.

Slowing the Respiratory System: Opioids also slow down the respiratory system (aka respiratory depression) which has led to death, especially if combined with alcohol or other meds that depress your breathing or slow your heartbeat. If you feel woozy, dizzy or just “out of it,” get help immediately.

Reaction Times and Sedation: Opioids also slow down reaction times and can increase sedation. Driving a car or even taking a shower can result in a bad accident.

Overuse of opioids can lead to tolerance, requiring higher and higher doses to receive the same therapeutic effects. As a result, they should be taken for a short period of time and not considered a long-term solution.

Opioids are known for their addictive properties. The general consensus is that they are safe for a couple of weeks. Use the lowest dose for the shortest time period that you can stand.

Addiction: People that take opioids over the long term run the serious risk of becoming addicted to them. In many cases, people taking the drugs over long periods of time can become tolerant to them, requiring higher and higher doses. In addition, they can become physically dependent on opioids.

Of the 21.5 million Americans 12 or older that had a substance use disorder in 2014, 1.9 million had one due to prescription pain relievers, according to the American Society of Addiction Medicine.

Drug Interactions

An estimated 70% of people taking opioids also take at least 1 over-the-counter medication, and a majority also take at least 1 other prescription drug.

Opioids, including, codeine, hydrocodone, oxycodone, tramadol, fentanyl and methadone, are all metabolized by the same group of enzymes. What this means is that is that if a person takes 2 of the same opioids mentioned above close to each other, they are at risk of succumbing to an opioid overdose.

In the case of fentanyl, taking that opioid with 1 of several antibiotics (e.g. clarithromycin, ketoconazole) or antiretrovirals (e.g. ritonavir) can results in potentially dangerously high concentrations of fentanyl. If this is the case, a doctor should adjust the dose of fentanyl accordingly. With codeine and oxycodone, using those drugs in combination with another prescription pain reliever, Celebrex (celecoxib), or an SSRI antidepressant such as Prozac (fluoxetine) or Paxil (paroxetine) can lead to decrease analgesic effects.

Methadone, an opioid commonly used to get people off of opioid dependence, interacts with a large number of drugs and even herbal remedies and food, such as St. John’s wort and grapefruit juice. Depending on the substance taken with methadone, it can either increase or decrease methadone concentrations in the bloodstream.

A complete list of drug interactions with opioids is available here.

Always discuss with your doctor or pharmacist all the medicines, herbal supplements and even vitamins you are taking to avoid drug interactions.

Effectiveness & Considerations

Ironically, opioids aren’t great at pain relief for chronic conditions. Multiple studies show that non-steroidal anti-inflammatory drugs (NSAIDs), better known as over-the-counter analgesics such as Tylenol (acetaminophen), physical therapy, and even mindfulness is as good or better for chronic pain.

Further, opioids should not be taken for headaches as they are not indicated for that purpose.

Alternatives to Opioids

Scientists have recently discovered there is a non-opioid pain pathway into the brain. In a nutshell, this means that mindfulness meditation could be used as another way to relieve pain since it uses a different pathway. The researchers say a combination of opioids and meditation may provide the best pain relief.

How They Work (Method of Action)

Opioids work by attaching to proteins in the brain, spinal cord, gastrointestinal tract and other organs known as opioid receptors. When the drugs attach, they reduce the perception of pain. Since opioids can also affect parts of the brain involved in reward and pleasure, the drugs can have a euphoric effect, which is why some people abuse them.

What Worked for You?

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MedShadow Coverage on Opioids

Further Reading

How do opioids affect the brain and body? (National Institute on Drug Abuse)