Hydrocodone APA - Kidney problems

[RLSDaisy]

Okay I have been fortunate to have a dr who has been willing to work with me and has consulted with Dr. B. in the past. I have been on hydrocodone apa for three years after experiencing all kinds of adverse reactions to the requip, mirapax, lyrica, klonopin, neurotin...I could go on... but won't.

My problem, I was trying to write an email to Dr. B as I am concerned that I am beginning to have signs of kidney damage. My father died of kidney failure. My doctor went over my most recent blood work... stating that my vit d levels were low... vit d that the body makes not something that can be taken over the counter so he put me on 50,000iu yes 50,000ius the nurse said I must be mistaken so this upcoming visit I am taking the darn bottle in to show her ... oka y I digress... also forgive me I am not all that coherent or can recall as I have cut back on my dosage and that is why I am up at this hour... something about the red blood cells which carry oxygen show that I'll be on an oxygen pack if I don't quit smoking... also one other thing which escapes me at the moment.

Well I have been slowly quitting smoking and am down to five packs a week from ten. I have for several months been experiencing extreme flank pain, water retention, and extreme I mean totally uncontrollable fatigue.

I did some research online and the same blood work results are an indicator of kidney problems.

My dr is young, I am old to him...but not to me or my grandchildren... and I appreciate he took the time to help treat the RLS... yet he is not as thorough as I'd like. My ferritin levels were low as which seems to be the norm for people with RLS and he put me on iron therapy yet neglected to consistantly do blood work to check on levels unless I reminded him... well after a year and an insignificant rise I quit the iron...

I am just bitchy right now.

Honestly I am frightened beyond measure at trying a different medication, yet I am even more frightened to destroy my kidney function.
I did try ultram at one point but suffered from migraine headaches while taking it.

My rls is genetic... it is full body... primarily legs and arms, yet my toroso can also be affected.

I tried to email Dr. B. yet the stupid email program crashed in midst of my doing so. So I was hoping that someone here might be able to offer a suggestion.

Thanks, Zoe

[Neco]

Well if you have a history of kidney problems within your family, then you may be at high risk for failure as it is, and something a normal person could tolerate safely, you may not be able to.. There were times when I was on/abusing vicodin where I would have up to 7 - 8 grams running through my body, and I am always paranoid about discomfort or short pains in my stomach/side areas so believe me I feel your pain.

I have experienced edema in the legs when taking higher amounts of hydrocodone, so I guess depending on your dose and where your water retention is, it might help explain things or help point to a kidney problem.

That being said, what is your daily prescribed dose of Hydrocodone?

There are other opiate medications that contain no tylenol in them that you could try, such as Oxycodone or Oxycontin (time released), Morphine / Morphine ER (time released) and methadone.

They are all much more powerful, but I don't think its legally possible to get Hydrocodone in the USA without an additional OTC additive like tylenol. You CAN get 10/325 hydrocodones, or if you know of a compound pharmacist you might be able to have your pills made with as little tylenol as allowed.

Have you informed your doctor of these symptoms? I assume that was what the blood work was about, but does he know you are specifically concerned about kidney failure?

[Aiken]

Just to confirm what Zach said:

Having once been given a prescription for pure hydrocodone, I can confirm that it is not possible to have it filled, because there's no such thing. Believe me, I checked thoroughly. You have to step up to oxycodone to get it without acetaminophen.

[RLSDaisy]

Thank you for your input... I have been mulling over this... and apologize for not responding sooner. My husband's medical problems have taken presidence (sp) the past month...

My pharmacist said they would be able to do a compound but at a much greater expense. He did say that my doseage of up to 6 10/500 a day is not excessive... Normal day I take 3 to four... we did discuss having the dr prescribe the 10/325. the pharmacist did say it would be possible that I metabolize differently so it is important to have regular liver and kidney function testing.

Oxycodone or Oxycontin (time released), Morphine / Morphine ER (time released)
We did try the Morphine ER several years back yet I had problems with it wearing off long before it was time to take another pill. Could you give me some insight as to the difference between Oxycodone and Morphine...is the Morphine sulfate a generic version of the oxycodone?

My pharmacist suggested going to the 10/325, being more assertive in requesting regular testing... My dr is a GP as well as serving as the director for a multi county hospice and while he is genuine and helpful I often feel as if he is too busy to really give me the time to answer questions... saying we will get you better come back next month. he has rescheduled my last two appts, and this happens often. so I am trying to place my health concerns in a priority concept of writing down more specific questions so I can have them addressed.

I was diagnosed with fibromyalgia... while trying to get a diagnosis of RLS... It has been a life long problem...increasing in intensity when I entered menopause. It seems that often times my concerns are dismissed as fibromyalgia which seems to have no treatment protocal other than antidepressants which the dr keeps giving me samples even though I mention that I have had problems with all of them even wellabutin in the past ... after my initial experience of taking medications not knowing what worsened the rls I am fairly adamant about not taking those meds I know cause me problems. Last visit he wanted me to try Klonopin again and some new antidepressant ... well I did teh klonopin against my better judgement knowing what happened when I had tried it before and became lathargic within 20 minutes, slept for two hours and woke with my legs flailing in the air in excrutiating pain as if they had been chopped off from my body. Similar to the reaction I had four years ago. I do get frustrated that he does not remember from one appt to the next what does or does not help. And it is my fault that I take them and come back to my next appt repeating the symptoms that I experienced when given the medication few years back. He does have a list of meds known to worsen RLS in my file.

If it were not difficult to find a qualified dr in this area Id be looking further. Hopefully in a year I will be able to travel to Dr B...

The pharmacist said that the ratio should we decide to go with the Oxcodone would be 5mg to the 10/500. Does this sound correct. I trust my pharmacist, and have given him my Nightwalker issues when I have finished with them. However he is a big believer in homeopathic solutions and while I have tried his suggestions of magnisium chelate and mucinex (gule heck I can't spell the chemical name) at 600mg a day it does not help with the rls pain or sensations.

The intensity does vary from time to time... with no rhyme or reason. I am unable to drink any type of teas, certain foods etc tend to increase my problems. I try to maintain a regular sleeping pattern... lately the medication is wearing off or my symptoms are increasing as normally I would wake between 5-6am, now I am waking 3-4am with terrible rls pain and sensations... I use heat and a hand held massager to help reduce the pain/sensations and take half a pill. Over the years I see that my body tends to cycle like this... and in a few weeks to a month or two it will probably change... I used to keep a journal but with my husbands health problems... I just figure the stress is contributing to it also.

I just do not want to go to a stronger medication till absolutely necessary.

My husband and I are going to begin a whole food diet, ie juicing and limiting all bread pasta dairy intake... to see if this helps.

I appreciate your feed back and it has been in my mind during the last month working out a questionaire for reassessing my treatment protocal between all the drs appts relating to my husband.

Two weeks ago the drs office called as I was driving to the appt to reschedule... it is about 85 mile round trip and I was so depressed as I didn't feel that well... I had made an appt for a massage in the same town so I did go to it... Before I had to quit my job I did go in for massages two to three times weekly for three years and that did gradually help. It is just too expensive to continue with them on a regular basis.

I do try to exercise on a regular basis and do tai chi.

Rambling rose instead of a daisy today! Once again thank you for your responses. They are appreciated. Zoe

[Neco]

It really sounds like you need to find a new doctor..

This is inexcusable.. You have concerns of kidney failure and they have reschedules you HOW may times? 3? 4?

No.. this is inexscusable and wrong.. You could have died by now. Kidney failures is absurdly painful and an acute case of acetaminophen poisoning, can only take a week.

You're still alive so that is good.. But please, PLEASE consider finding a new doctor. You have all this free time from not going to your other doctors appointments, you could be calling doctors offices and asking if they might take you on and continue to prescribe your medications. You can get a lot of sympathy by relaying your kidney concerns and telling them how badly this place has been treating you with constant rescheduling.

Your doctor may truly care about you, but he is clearly in over his head and irresponsibly running his practice(s). This is how people end up dead for no good reason at all. Because something was caught too late or not at all... Imagine someone having to explain to their family "Well the doctor was too busy to see her and kept rescheduling, so they never found out what was killing her, but the good news is the coroner did!".


Now I'm not suggesting your gonna die.. I'm just trying to make a point. Your health is clearly important to you, and you have to take care of your husband on top of that it seems. Don't be like your doctor. Take charge and find a new one. Please, not for me, do it for you.

Now to answer some of your other questions.

Oxycodone is not the same as Morphine.. Morphine is a naturally occuring opiate which is harvested from poppy plants. Morphine is used to treat extreme acute pain from massive injuries, or even when little or no injury is present but something in the body is happening to produce massive amounts of pain (like certain spider bites).

Morphine is extremely addictive and really not an ideal candidate for RLS patients unless nothing else works for you.

Morphine ER is the name for an extended release forumla which releases small amounts of morphine into the body over time.

Oxycodone is either a synthetic or semi-synthetic opiate, I can't remember which. It is also a powerful pain killer in the top tier and has addiction pitfalls. However it is widely used to treat all kinds of pain from a pulled tooth / root canal, to cancer.

Oxycontin is the brand name of a time released 12 hour version of Oxycodone. Oxycontin is a brand name and no generic is available from what I can tell. It's been so heavily abused and diverted to the street I wouldn't be surprised if that's the sole reason a generic was discontinued.

Although I would first argue that your pharmacist has no business telling you what is and isn't an appropriate amount of medication (THAT is your doctor's discretion, within the normal limits of sanity) his conversion from hydrocodone 10mg to 5mg oxycodone, per dose, sounds about right. Oxycodone is much more powerful than hydrocodone, but plain old Oxycodone can wear off just as fast as your hydrocodone does, requiring multiple doses per day. I have decided recently to never recommend Oxycodone to RLS sufferers because I think the stuff is dangerous, especially if you require multiple doses of medication per day. The risk for addiction is increased with each additional dose you take, in my eyes.

As you may know, many of us on the forum take Methadone for our RLS. I am a recovering addict also, so it has helped me tremendously, to kill two birds with one stone. Methadone has a half-life of 72 hours in the body, however it only roughly translates to about 24 hours of relief if you are lucky. I only take one dose every day, 15mg in the morning. Three 5mg pills. Sometimes all at once, sometimes spaced out every hour or two. Even with my 24/7 refractory RLS I have virtually no trouble sleeping at night, although I do have bad nights. I recently received 10 more pills a month, to begin a bedtime routine of an additional half a pill.

On average you should get at LEAST 12 hours of relief from methadone, and at best a full 24 hours, or very close to it before you need to redose.

Another new member to the forums has had success with Subutex, another therapeutic opiate replacement used like methadone, for addiction rehabilitation and chronic pain / cancer, etc.


These are the strongest time release medications you will find above Hydrocodone. So let's recap.. Morphine ER, Oxycontin, Methadone, Subutex/Suboxone (buprenorphine). Its worth noting Buprinorphine is stated to be 25 to 40 times as powerful as morphine.

The only other extended release option you can try is extended release Tramadol, branded Ultram ER - no generic available. It carries a seizure risk especially with anti-depressants and a few other meds. I had a seizure because of this. I wouldn't reccomend it to you in your case either.

[RLSDaisy]

Thank you thank you... stating so clearly the information... I will print this out and review review review.

Following my drs appt which I left in tears... finally convinced that I need to find another doctor... my husband who has commented on my drs office management refrained from the I have been telling you so... Instead he said to call and make an appt with Dr. B and we will fly to California.

The Dr did put me on the morphine er (that is the time released?) several years ago to take at night lortab during day ... I just felt nauseous and after three days discontinued taking it.

For my questions relating to kidney pain, he basically refused to address my concerns even after I explained my family history. He prescribed amrix samples... wanted to know if I wanted a lot of them or just a weeks worth... seeming to want to dismiss everything to fibromyalgia.

when I questioned my blood work ... and wouldnt it be wise to just have a standing order for every three months to do so he said he would ...

Asking were any of the tests for kidney, liver function... he shuffled through my paperwork really not articulating anything and could not or would not show me exactly what was there...

So I have an endrocronologist (sp?) recommended by a friend which is about two hour drive but worth it if it will help... she said her husband and sister see this woman and she is extremely thorough. Am calling her today to for an appt.

Once again thank you for the input... your support has been such a boost to my inner self...

[Neco]

Good luck, I hope you do get in to see Dr. B and he can help you.. Make sure and give him a full history of how this other doctor has treated you.

I can understand the nausea problem, a lot of opiates and morphine in particular can do that. Sometimes you just have to give it time, and maybe try taking a reduced dose. Although if you were already on the lowest ER dose then that may not be possible; and yes ER should be extended release morphine.

[Helen518]

After root canal, I've been given hydrocodone/apap 5mg/500mg 1-2 tablets every 4 hours.

What is the dosage for RLS?

I'm having a very bad leg day. The codeine wore off very quickly today so I tried one of the hydrocodone tablets and it also wore off in 3.5 hours. It lasted me about 4 -4/5 hours when I tried it before.

[Neco]

It likely wore off sooner because you now have a constant exposure to opiates. Even if the medications are different, they all effect your tolerance roughly the same way.

From what I recall the standard is supposed to be between 5 - 40mgs per day.

Honestly I'd just do my best to make it lasts. They don't give a lot out at the dentists so maybe one or two spaced out for the day. Or just save them to use in the evening since they are a little stronger than the codeine. Then you can take your usual codeine dose in the day.

Just don't get attached to this... once you run out that's it.

[Helen518]

The neurologist wanted to give me hydrocodone instead of codeine. Maybe I should have agreed? I am afraid of taking these meds with no guidance from the doctor. I'm going to try not to take any more. I hope the doctor calls me back soon.

I'm feeling really terrible right now with 2 hours sleep.

I hate the feeling of being adrift and helpless, waiting for someone to call me back. I feel really afraid.

Maybe this is delayed withdrawal? I must be panicking.

[Neco]

It could be withdrawal. Benzos act to calm you down and such so being strung up and worried/panicky is likely going to be a withdrawal symptom.


I remember you talking about hydrocodone, but I thought one of your doctors had wanted not to because they were worried about the acetaminophen content?

I think that is what set me off on my tangent about codeine basically being the same concern because it has significant amounts as well, and then lead my to suggest you look into methadone.

[Helen518]

That's what I thought - but the psychiatrist says no. I know I read in multiple places that the withdrawal could be delayed as much as 5 days.

The fertility doc didn't want me to take hydrocodone but I never found out why. He was ok with the tylenol #3(codeine/tylenol).

I'm feeling less terrified right now, but I'm predicting another night on the floor curled up with the dogs, watching cartoon network.

The doc is not in until Monday. He will call me back then. I don't get it. This disease is EVIL EVIL EVIL.

[mackjergens]

Codine/tylenol.. is probably very close to hydrocodone, since hydrocodone has acetaminophen, which is tylenol isnt it???

[Neco]

Yes, acetaminophen is tylenol.

Tylenol #3 has 30mg codeine and 300mg acetaminophen. Hydrocodone can be gotten in a combination of 10mg/325mg however the standard dose given out is usually 5mg/500mg.

Either way it can be a significant amount with both meds, but the fact hydrocodone is stronger and can be prescribed with only 25mg more acetaminophen than codeine for a big boost in relief speaks for itself.. Plus if you split a 10/325 in half you'd still get more relief than with codeine and take LESS tylenol. I think the fertility doc is stupid personally, but I'm not a doctor so what do I know