Why some opiates mixed with Acetaminophen for pain relief?

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In summary: The vast majority of people do not know that Tylenol is even lethal at all. In fact people who are prescribed opiate pain killers are not told that it's mixed with Tylenol. So how is it related to abuse?In summary, opiates are considered to be the archetypal analgesics and are often combined with acetaminophen (Tylenol) in pain relievers. The inclusion of Tylenol in these hybrid pills is believed to be a way to discourage abuse, as taking large doses of Tylenol can lead to liver damage. However, the reasoning behind this decision is still unclear and it is questionable why other more addictive and dangerous substances are not treated in a similar manner
  • #1
Flatland
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Whether it's Hydrocodone, Oxycodone, Codeine or any other opiate derived pain relievers are almost always combined with Acetaminophen (Tylenol). Why would they do this considering that Tylenol is actually more harmful for you. Are opiates even a proper analgesic? They seem to be more like sedatives to me. The only conclusion I can draw from this is that the Tylenol is the ACTUAL pain reliever and that the varies strength of opiates are only there to knock you out so you can sleep through the pain.

Please correct me if I'm wrong
 
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  • #2
Good question.

I looked at the Wki page for codeine
http://en.wikipedia.org/wiki/Codeine
(not coming up as a link ?? )

but it does say
Codeine is marketed as both a single-ingredient drug and in combination preparations with paracetamol (as co-codamol: e.g., brands Paracod, Panadeine, and the Tylenol-with-codeine series, including Tylenol 3 and 1,2,4); with aspirin; (as co-codaprin); or with ibuprofen (as Nurofen Plus). These combinations provide greater pain relief than either agent alone (drug synergy).
 
  • #3
Is Codeine by itself an analgesia or is it a sedative?
 
  • #4
Flatland said:
Please correct me if I'm wrong

You are wrong. I will correct..

Flatland said:
Are opiates even a proper analgesic?

Opiates are the archetypal analgesic. Opiate and analgesic are pretty much synonymous terms.

Flatland said:
Whether it's Hydrocodone, Oxycodone, Codeine or any other opiate derived pain relievers are almost always combined with Acetaminophen (Tylenol).

That's pretty much true, although there do exist pills that are pure Hydrocodone and Oxycodone.

Flatland said:
Tylenol is the ACTUAL pain reliever and that the varies strength of opiates are only there to knock you out so you can sleep through the pain.

This is actually incorrect. The opiate is the principal pain killer/analgesic in these hybrid pills. I don't know if the pharmaceutical makers have ever said this or would admit it, but the conventional thought behind why they add acetaminophen (or less frequently ibuprofin) is to discourage abuse. The thought being that the tylenol is going to make you sick if you take too much of it. Which it does. Other than that, its inclusion in these pain pills makes little sense, as you have mentioned. The analgesic effect compared to the opiate portion is negligible. Tylenol does have an anti-inflammatory property to it that opiates might not have, but that's really not a justifiable reason to include it in the pills. You could just take tylenol over the counter separately if you needed that.
 
  • #5
That makes absolutely no sense. The vast majority of people do not know that Tylenol is even lethal at all. In fact people who are subscribed opiate pain killers are not told that it's mixed with Tylenol.

So how is it related to abuse?
 
  • #6
Flatland said:
The vast majority of people do not know that Tylenol is even lethal at all.

What does that have to do with the discussion?

Flatland said:
In fact people who are subscribed opiate pain killers are not told that it's mixed with Tylenol.

It typically says it right on the bottle, e.g., Vicodin, hydrocodone/acetaminophen 5/500. The 5 being the hydrocodone, the 500 being the tylenol.

Flatland said:
So how is it related to abuse?

It's related to abuse because once you've developed a tolerance to opiates, you can take handfuls of hydrocodone pills that don't have tylenol in them and not get physically sick. The same is not true for the 5/500 hybrid pills. You will get nauseated from the tylenol and/or your liver will shut down at some point from the tylenol, so there's a limit to the level of tolerance you can attain. Again, I don't know for sure that this is the reason they make the pills hybrids in this fashion, but it's the prevailing theory, at least in the "junkie" community. There is no other reason to include it otherwise, unless it was some clever marketing scheme concocted by the Tylenol company in the early days.
 
  • #7
Yeah it's to prevent massive abuse. Tylenol poisoning is the number one reason for ER poisoning visits in the U.S. And UK. People need to watch their Tylenol intake. Swallow a bottle and avoid the hospital and you'll be dead from liver damage.
 
  • #8
DiracPool said:
What does that have to do with the discussion?
It typically says it right on the bottle, e.g., Vicodin, hydrocodone/acetaminophen 5/500. The 5 being the hydrocodone, the 500 being the tylenol.
It's related to abuse because once you've developed a tolerance to opiates, you can take handfuls of hydrocodone pills that don't have tylenol in them and not get physically sick. The same is not true for the 5/500 hybrid pills. You will get nauseated from the tylenol and/or your liver will shut down at some point from the tylenol, so there's a limit to the level of tolerance you can attain. Again, I don't know for sure that this is the reason they make the pills hybrids in this fashion, but it's the prevailing theory, at least in the "junkie" community. There is no other reason to include it otherwise, unless it was some clever marketing scheme concocted by the Tylenol company in the early days.

I tried doing some research but could not find any official explanation. The most common explanation is basically what you said. But it still makes little sense to me why they would mix a more harmful substance with a less harmful one in order to discourage abuse. That's like putting a little bit of cyanide into every bottle of alcohol in order to discourage people from abusing it. Besides if that's really the case why don't pharmaceutical companies do something similar to substances that are much more addictive and dangerous than opiates like Xanax or Valium? And since when did pharmaceutical companies care about people abusing their products?

Eric L said:
Yeah it's to prevent massive abuse. Tylenol poisoning is the number one reason for ER poisoning visits in the U.S. And UK. People need to watch their Tylenol intake. Swallow a bottle and avoid the hospital and you'll be dead from liver damage.

That makes it sound like Tylenol was intentional put in there in order to kill junkies rather than them being a burden to society.
 
  • #9
Thread closed for Moderation...
 
  • #10
Thread re-opened.

An important reminder to all -- conspiracy theory discussions are not allowed on the PF, so let's all lose the "Tylenol did this on purpose" angle. Thank you.

And given the 5/500 ratio and the LD50 levels of Tylenol, it would seem pretty hard to get Tylenol poisoning without a serious opiate overdose, but I'm not that familiar with patients with high levels of opiate tolerance...

http://www.nlm.nih.gov/medlineplus/ency/article/002598.htm

.
 
  • #11
Eric L said:
Yeah it's to prevent massive abuse. Tylenol poisoning is the number one reason for ER poisoning visits in the U.S. And UK. People need to watch their Tylenol intake. Swallow a bottle and avoid the hospital and you'll be dead from liver damage.

Can you post a mainstream medical reference for that? I don't work in the ED, but in the field that is not my experience.
 
  • #12
Tylenol is known as Paracetamol in the UK and it is the most common drug overdose here at 48% of overdose cases:

Paracetamol overdose: an evidence based flowchart to guide management
http://emj.bmj.com/content/19/3/202.full
 
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1. Why are opiates and Acetaminophen often mixed together for pain relief?

Opiates and Acetaminophen are often combined because they work in different ways to relieve pain. Opiates, such as codeine and oxycodone, bind to opioid receptors in the brain and spinal cord to block pain signals. Acetaminophen works by inhibiting the production of prostaglandins, which are chemicals in the body that contribute to pain and inflammation.

2. What are the benefits of combining opiates and Acetaminophen for pain relief?

Combining opiates and Acetaminophen can provide more effective pain relief compared to using either medication alone. The two drugs work synergistically to target different pain pathways, resulting in a stronger and longer-lasting effect. Additionally, the use of a combination medication can reduce the amount of each individual drug needed, which can lower the risk of side effects and potential abuse.

3. Are there any risks associated with using opiates and Acetaminophen together?

There are potential risks associated with using opiates and Acetaminophen together, particularly if the medications are not taken as directed. Acetaminophen can cause liver damage if taken in high doses, and combining it with opiates can increase this risk. There is also a risk of developing a dependence on opiates, which can lead to addiction and other negative consequences.

4. How do doctors determine the appropriate dosage of opiates and Acetaminophen for an individual?

The dosage of opiates and Acetaminophen will vary for each person depending on factors such as the severity of their pain, their medical history, and any other medications they are taking. Doctors will typically start with a low dosage and adjust it as needed based on the individual's response and any potential side effects. It is important to follow the prescribed dosage and not increase it without consulting a doctor.

5. Are there any alternative medications for pain relief besides opiates and Acetaminophen?

Yes, there are several alternative medications for pain relief besides opiates and Acetaminophen. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin can be effective for mild to moderate pain. Other options include antidepressants, muscle relaxants, and topical treatments. It is important to consult with a doctor to determine the best treatment plan for an individual's specific pain condition.

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