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Pastimes : Don't Ask Rambi

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To: Gauguin who wrote (42088)	11/18/1999 12:47:00 PM
From: Jacques Chitte	Read Replies (1) of 71178

OK. >Does the effectiveness of these endocetties decrease over time, like building a tolerance? More for same relief? Or is it about constant.< Endocet is the same as Vicodin, my standard narcotic for my migraines. For moderate to intermittently severe pain, it works just fine ... but in my experience there is a "wall" beyond which efficacy of hydrocodone (the active) loses step. This adds to the "tolerance" effect you mention. You're double screwed here - it takes more drug to get the same effect, and the effect is "limited" by the designed-in moderate efficacy of hydrocodone. Your pain has exponentiated (is that the word you sought?) past the service ceiling of the Endocet missile. Percocet is oxycodone; this is considered a "step up" in narcotic efficacy. This is evidenced by the fact that here in CA a Vicodin prescription is "regular" while a Precocet prescription is the hassle triplicate variety that has extra copies and a real narrow fill window. What you need is one of the first-line narcotic analgesics. These are a "step up" from Percocet and thus two steps up from Vicodin/Endocet/hydrocodone. I can think of two excellent ones in tablet form, and one in patch form that may or may not be appropriate. Ask your doc. Top of the heap is morphine sulfate immediate release oral tablets. 15mg tablet has the punch of aboyt 1 1/2 Exocets ... but is slower on, slower off and has the gold standard of efficacy for an analgesic. Close behind is Dilaudid (hydromorphone) ... a little faster on and more consistent than morphine tabs. Ask your doc about these two - one of them should give you a higher level of relief. The morphine also comes in an oral suspension, so if he'll let you you can finely adjust your drug load. There is also the Duragesic patch. This is fentanyl (the premier surgical narcotic) in a transdermal patch. My gripe with patches is a rather variable rate of drug delivery. You don't get the same sort of spike and trough that a pill gives you ... but you get spikes and troughs nonetheless. Think about this one. I'd recommend morphine sulfate tabs, with the Dilaudid as a close second if your doc thinks so. Either one is pretty much full-on smackaroo. They are more definitely and (imo) unpleasantly "druggy" than Endocet, but they are more capable of dealing effectively with big, sustained pain. Please let me know what doc says about all this.

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