Oxycontin, Percocet and Vicodin Prescription Information
Note: The information provided in this article, and any subsequent questions and answers, are not intended to replace or substitute for the advice of your personal physician.
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WHY WRITE ABOUT THESE DRUGS?
Maybe the title of this article seems a bit strange to you. Why would I write about Oxycontin, Percocet and Vicodin information?For those who are only infrequently acquainted with pain, or who have never had to consider treatment with narcotics, these drugs may seem unimportant. Worse than that, they may conjure up in your mind stories about drug addiction and abuse, pharmacy robberies, and stolen prescription pads. But for those of us who work in pharmacies (I am a pharmacist), we are aware that questions about these 3 medications are an almost daily occurrence. I give, therefore, the following reasons for specifically writing about Oxycontin, Percocet and Vicodin:
1) They are very commonly prescribed narcotics for pain. If you have ever had major surgery or even dental work, suffered from bad back pain or headaches, had a serious and painful injury, or have a painful disease or condition like cancer or severe arthritis...you have heard of these drugs. You probably have a bottle of 1 or more of them in your cabinet right now.
2) They are frequently interchanged over time, and thus patients often wonder things like "What is the difference between Oxycontin and Percocet?" Maybe you were wondering that yourself. "Why did they tell me NOT to take Tylenol with Vicodin?" "How come my Oxycontin said 20mg but my Percocet just says 5mg?" Questions like this come up all the time. I would like to help you get some answers.
3) Due to the stigma and image created by the media, I believe many patients are reluctant to ask important questions about these medications. Some people are embarrassed by the fact that they need these pills. They have been made to feel, albeit unintentionally, that they are committing some sort of crime simply by taking Oxycontin, Percocet or Vicodin. You don't want anyone to find out. You are afraid what they might think. By writing about these drugs, hopefully I will be able to answer some of the questions which you may have been unable to ask.
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NOTE: THESE MEDICATIONS CAN ONLY BE PRESCRIBED BY A DOCTOR
MORE REASONS TO WRITE ABOUT THESE MEDICATIONS
4) Information on these drugs is not as easy to come by as one might think. Many other prescription drugs have a whole website devoted to information about them. But for a variety of reasons, you will not find the manufacturers to provide any such website for information about these products. I won't go into all the reasons right here, but suffice it to say that doing your own research on these products is far from easy.
5)Finally, I have decided to write about Oxycontin, Percocet and Vicodin because they are powerful drugs which are dangerous if mis-used, and often have a variety of side effects even when used appropriately. I am grateful for the education and experience I have received as a pharmacist, and consider it a privilege and duty to pass along what I know to help patients use their medication safely and effectively.
The focus of this article will be on PRACTICAL INFORMATION. If you are a pharmacy or medical student, hoping that this article will help you cram for your pharmacology exam, you may be sorely disappointed. You will need to turn to your textbooks for information about the kinetics and mechanisms of these drugs. I want to focus upon REAL life, not the half-life (sorry, that was a bad joke that probably only the students will get...).
I will discuss each of these 3 products individually, and then provide some "Advice and Commentary" information at the end of each section. So, basically, this article looks like this:
I. Oxycontin Information
II. Percocet Information
III. Vicodin Information
Oxycontin is a narcotic pain reliever manufactured by Purdue Pharmaceuticals and is indicated for moderate to severe persistent pain. Oxycontin is not used for pain on an "as needed" basis, but only for pain that needs regular (constant) treatment. In other words, your Oxycontin prescription should NEVER say something like "take as needed for pain." It is only used for pain management that requires regular (in this case every 12 hours) dosing.
- Active Ingredient: Oxycodone. What is Oxycodone? Well, think of it as a sleeker and stronger version of codeine. It is a synthetic drug. Oxycodone is the ONLY active ingredient in Oxycontin. This is significant. There are other prescription narcotics for pain that contain oxycodonebut Oxycontin is the only "long acting" product with JUST oxycodone. There are, by the way, short-acting products that contain just oxycodone, like "Roxicodone" or "Oxy IR" for example.
- Note: The fact that Oxycontin has only 1 ingredient is also a reason why dosages of Oxycontin can slowly, and under supervision by you doctor, be raised much higher than with other drugs like Percocet or Vicodin. These other drugs have acetaminophen (Tylenol) which limits the amount that can be safely taken in a single day.
- Strengths Available: 10mg, 15mg, 20mg, 30mg, 40mg, 60mg, 80mg.
- Schedule: Oxycontin is a Schedule II Controlled substance. The practical significance of this is that prescriptions for Oxycontin are subjected to more regulations and restrictions than other prescriptions. Schedule II substances have the highest potential for addiction or abuse, so they have to be managed carefully. For example, doctors cannot write refills on an Oxycontin prescription. You must obtain a new prescription every time. They may only be written for a 1 month supply in most circumstances. Additionally, prescriptions for Schedule II drugs need to be hand-written and cannot be phoned in except under special circumstances.
- Dosing: Oxycontin is designed to be dosed every 12 hours. It is a "slow release" or "timed release" product. It is very important to NEVER break or crush an Oxycotin tablet, as this could cause a dangerous amount of oxycodone to enter your blood stream too quickly.
- Generics: Oxycontin is not available generically at the moment. There have been some patent issues that have been contested, and there was a generic on the market for a short time. But presently only brand name Oxycontin is available. This product is quite expensive. Maybe your insurance covers it, and so this cost is somewhat hidden to you. But if you have to pay for it yourself, you may want to investigate other options, like immediate release oxycodone, which comes generically and is far more affordable.
General Commentary & Advice: Okay, so here are my thoughts on Oxycontin. Oxycontin is not evil. Yes, it has been the opportunity for some pretty scary stuff. Yes, it is sold on the streets and people use it inappropriately and unsafely. But these facts only remind us that good things can be turned to bad uses. Don't throw out the baby with the bathwater.
I advise you to use the lowest effective dose, as this will make stopping the drug easier. Yes, if you do eventually stop taking Oxycontin, you will need to be slowly tapered down so as to avoid withdrawal symptoms. Remember, even caffeine can cause withdrawal symptoms.
Other OTC products for pain, like Tylenol or Advil, can generally be used with Oxycontin if necessary. Check with your doctor or pharmacist to be sure these will not interfere with anything else you are taking.
NEVER crush or chew Oxycontin. NEVER give Oxycontin to someone other than for whom it was prescribed. I don't mean to scare you, but someone who is not used to taking it could die from the same dose that you take safely. This is very serious. Don't do it. Not to mention, doing so is also illegal.
Stick with 1 local pharmacy. Hopping around to different pharmacies and filling prescriptions for Oxycontin looks suspicious. Not only that, but your prescription insurance plan might raise a fuss about this as well.
NEVER allow yourself to run out of Oxycontin before trying to obtain a new prescription. Always discuss with your doctor, or his/her office, exactly how you should obtain your next prescription. If possible, pick it up in person. If they mail it, just be sure you have it in time. Trying to persuade a covering physician to call you in an emergency Oxycontin prescription at 8:30PM at night will NOT be fun...and probably NOT successful.
Never wait until the last minute to fill your Oxycontin prescription. My advice: Have the prescription in your hand and get it filled exactly 5 days before you run out. Not 6 days. 5 days. If you will run out on the 30th of the month, then fill it on the 25th. Most insurance plans will allow you to fill it within 5 days of running out. Also, getting it filled 5 days early allows some "wiggle room" for issues like:
- the pharmacy runs out of your strength or..
- your insurance company rejects due to the need for prior approval or...
- your doctor forgot to write some critical piece of information on the prescription or...
- just about anything else!
Organize your medication in a pillbox. It is very easy to forget if you actually took your pill, especially if it is part of your daily routine. You must find some method to remember you took it, and a pill organizer is an easy and effective way to do so.
Finally, keep a pain diary. Write down some reflections on your pain levels every day. Bring this with you to the doctor. Your physician will be better able to help you manage your pain if you have something like this available to show them. Keep it brief and as objective as possible.
Percocet is a prescription narcotic pain reliever manufactured by Endo Pharmaceuticals. Percocet is used to treat moderate to moderately severe pain. Percocet is typically prescribed to treat "acute" (short-term) pain, although it is sometimes prescribed for chronic pain also. Percocet was originally approved for marketing in the U.S. by the FDA in 1976.
- Active Ingredients: Percocet is a combination drug. It contains 2 active ingredients for pain: Oxycodone and Acetaminophen. Yes, oxycodone is exactly the same oxycodone which you find in Oxycontin (see above). Exactly the same ingredient. And the Acetominophen found in Percocet is exactly the same as you get in the local pharmacy, also known as Tylenol. Exactly the same. So is Percocet just like taking Oxycontin with Tylenol? Not exactly. The difference with Oxycontin is that it is a slow release formulation and dosed only every 12 hours. Percocet is an immediate release product, and is dosed more frequently.
Because Percocet has Acetaminophen (which becomes very dangerous to your liver at high dosages) it is important not to exceed the recommended amount of Percocet in any given day. This is very important! Also, be very careful to not take any other pain reliever that may also contain acetaminophen (like Tylenol, Exedrin, some cold and flu products). As a rule, you do not want to exceed 4,000mg of Acetaminophen per day. This works out to about 6-8 tablets of Percocet maximum per day, depending on the strength you take (see below). Overdosing with Acetaminophen is the second most common cause for liver failure requiring liver transplants in the U.S.A according to a medical review study in 2009.
- Strengths Available: Percocet is available in the following 6 strengths. These are typically expressed in a way to show the amount of oxycodone on the left and the amount of acetaminophen on the right. Therefore 2.5/325 means 2.5mg of oxycodone per tablet and 325mg of acetaminophen per tablet.
- 7.5/500 [DISCONTINUED]
- 10/650 [DISCONTINUED]
By far the most frequently prescribed strength of Percocet is 5/325. It is so frequent, that doctors often forget to write the strength on the prescription, assuming that 5/325 is to be understood. However, the strength must be written on the prescription for it to be valid.
- Schedule: Percocet, like Oxycontin, is a Schedule II Controlled Substance. All the same rules and regulations related to prescribing Schedule II drugs apply to Percocet as to Oxycontin. See the comments above, under Oxycontin, to review those details.
- Dosing: The usual dosing for Percocet is 1 tablet every 6 hours. This can be adusted up to 2 tablets every 4-6 hours, as long as the total daily dose of Acetaminophen does not exceed 4 grams (4000mg). See the picture below for the dosing chart supplied by the manufacturer.
Percocet Maximum Daily Dose Chart
- Generics: Unlike Oxycontin, Percocet is available generically. This makes Percocet generally far less expensive and possible a more affordable choice, especially if you do not have a prescription insurance plan. Because you will probably receive the generic Percocet from the pharmacy, you bottle will probably NOT say the word "Percocet" on it. Rather you will have the generic name written in some form or other. Here are some samples of what your generic prescription for Percocet might say for the "name" of your prescription:
- Roxicet (a generic form of Percocet, manufactured by Roxane Labs in Columbus, OH)
- Endocet (a generic form of Percocet made by Endo Pharmaceuticals. Yes...the same Endo Pharmaceuticals who make Percocet! Imagine that!)
- Oxycodone/APAP (APAP is an abbreviation for acetaminophen. The abbreviation is actually derived from the chemical name for actetaminophen, which is N-Acetyl-Para-Amino-Phenol).
- Side Effects: Percocet, like all narcotic pain relievers, may have certain side effects. Common side effects include lightheadedness, dizziness, drowsiness, nausea, constipation and vomiting. Taking your Percocet with food may help reduce stomach irritation. Be sure to drink lots of water to help reduce constipation. An effective OTC remedy for constipation caused by narcotics is Senokot tablets. If you develop hives or a rash, stop your medication immediately and contact your doctor.
- General Advice & Commentary:
Percocet is a powerful painkiller. Be aware that it is likely to cause significant drowsiness. Never drive while taking Percocet until you determine how drowsy it makes you. Never drink alcohol with Percocet, as the added effects of drowsiness and sedation can be dangerous. Also, beware taking other medications which also cause drowsiness, like some antihistamines.
Take your Percocet with food or milk to prevent stomach upset.
Be aware that your Percocet prescription does NOT have refills on it. Additional presciptions must be obtained directly from your doctor. They cannot, ordinarily, call in this prescription to your pharmacy. You must pick it up. Since Percocet is used for short term pain, you may not need additional refills. Be sure to discuss your need for another prescription with your doctor before you actually run out.
Never take more than the recommended dose. Never share your Percocet with someone else. This medication is strong enough to seriously harm someone for whom this medication is not appropriate.
VICODIN VS. NORCO. VS. LORTAB
For a comparison of 3 similar products see my article here:
Vicodin is the last of our 3 pain relievers I will discuss in this article. Vicodin is used for moderate to moderately severe pain. It is a product of Abbott Pharmaceuticalslocated in Abbott Park, IL. Since it's approval by the FDA in 1984, Vicodin has risen to nearly "celebrity status" amongst pain killers in the U.S. However, the addictive potential of Vicodin has been highlighted by the real-life addiction problem of conservative talk show host, Rush Limbaugh, and the fictional TV character Dr. Gregory House.
- Active Ingredients: Vicodin, like Percocet, is a combination pain reliever. Vicodin contains 2 ingredients: Hydrocodone and acetaminophen. Hydrocodone is a powerful narcotic pain reliever, approximately equal in potency to oxycodone. Additionally, hydrocodone has also been shown to be effective as a cough suppressant, and is included in several prescription cough syups like Hycodan. Acetaminophen is the generic name for Tylenol, exactly the same Tylenol you buy on the shelf at your local pharmacy.
- Strengths Available: Vicodin, as such, refers to one specific strength, which is 5mg of hydrocodone with 300mg of acetaminophen. On the prescription label this would look like 5/300mg. However, the makers of Vicodin also have provided 2 additional "Vicodin" varieties known as Vicodin ES and Vicodin HP. Here are the strengths of all three products:
- Vicodin: 5/300
- Vicodin ES: 7.5/300
- Vicodin HP: 10/300
- Schedule: As of October 2014, Vicodin (and all hydrocodone containing products) are now considered Schedule II, just like Percocet and Oxycontin.
- Dosing: Like Percocet, Vicodin dosing is primarily limited by the amount of acetaminophen that can safely be taken in any given day. The typical dose for Vicodin is 1-2 tablets every 4-6 hours as needed, not to exceed 8 tablets in any given day. For the higher strengths (Vicodin ES and Vicodin HP) you want to keep it down to just 4-5 tablets per day.
- Generics: Vicodin is available generically. When you bring in your prescription for Vicodin, what you will see on your bottle is probably something like this:
"Hydrocodone/APAP" or "Hydroco/APAP" or something along those lines.
This is the way the generic product is identified. If your bottle says "Vicodin" then you got the brand name product. Is the brand name more effective? No. There is no significant difference between the effectiveness of the generic and the brand. You don't need to pay more to have the word "vicodin" stamped on the pill. It really won't make it work any better.
- Side Effects: Side effects from Vicodin include drowsiness, dizziness, nausea, constipation, vomiting and mental clouding. Taking Vicodin with food or milk should help reduce the irritation to your stomach. More serious side effects like hives or a rash should be immediately addressed with your physician. Stop the medication if you develop a rash.
- General Advice & Commentary: Okay, just a few things about Vicodin. I will focus on the practical stuff. Never take more than the recommended dose, and never take Vicodin with anything else that already has acetaminophen in it. Seriously. Liver failure is not funny, and acetaminophen overdose is far too common. Also, taking too many and then trying to get your refill early from the pharmacy is a pretty sure way to get yourself pegged as an abuser and a problem. If the Vicodin dose you were prescribed is not working to control your pain, talk to your doctor, don't just eat more pills. If pain is still a problem after taking Vicodin, you can safely use Ibuprofen (unless you have some other condition or medication that would forbid this) with Vicodin until you are able to talk about it with your MD.
As for refills, since Vicodin is now a Schedule II controlled substance, it cannot be refilled. A new prescription must be obtained for every filling of hydrocodone products.
Addiction. Yes, it is possible to become addicted to or dependent on Vicodin. If you have been on it regularly for any length of time, you will need to be slowly tapered off to avoid withdrawal symptoms. But just because you take it regularly, does not mean that you will become a narcotic abuser or criminal. It is strong medicine, but it is also very effective to reduce pain and improve the quality of life for those suffering acutely or chronically.
SOME FINAL THOUGHTS & ADVICE
ALCOHOL USE AND NARCOTICS: Is it safe to have a beer, a glass of wine, or some form of alcohol while taking these medications? Let me lay out the concerns and the issues for you:
#1) Alcohol, like narcotics, depresses the Central Nervous System (CNS). Think of your CNS as sort of like your electrical panel in your home, which controls all the electricity going into and through your house. Knock that out...and you are powerless. Your CNS controls things that you have really gotten used to over the years, like breathing, thinking, and the pumping of your heart. Now...you don't want these to stop. So how much additional CNS depression is safe? There is simply no practical way to answer that question. Will 1 sip kill you? Probably not. In the case of a chronic medication like Oxycontin, your body may develop enough tolerance to allow for an occasional drink. But you should be aware of these risks.
#2) Acetaminophen and Alcohol may not be a good combination for your liver. Notice I said "may not be." I am fully aware that the medical evidence seems to suggest that 1 or 2 drinks does not likely pose a threat to the liver of an otherwise healthy, non-alcoholic, individual who takes acetaminophen. Fine. If it were me, and I could, I would skip the Vicodin or Percocet if i intended to have a drink. I'm not laying down a law...just giving my advice.
#3) Driving. Don't do it. If you chose to have a drink, and you also are taking Oxycontin, Vicodin or Percocet...don't drive. Please. There is no way to know for sure you can safely operate a vehicle. Your life and the lives of others are at risk.
COST CONCERNS: Some strengths of Oxycontin are available generically, but not all. Generics of Percocet and Vicodin are available, but they may not be strong enough to manage your pain. One alternative, if cost is a problem, is to ask your doctor about OxyIR which is an "immediate release" formulation of oxycodone. You will need to take more pills, and need to take them more often, but the cost is substantially less. You might also talk to your doctor about switching to something different altogether, like a long-acting morphine product (e.g. MS Contin).
ADDICTION: Addiction to pain killers is not uncommon. In an ABC new report several years ago, Fred Berger, Medical Director of a Drug Rehab Center in CA was quoted as saying "What makes opioids — the class of common pain drugs like Oxycontin and Vicodin — effective pain relievers is also what makes them so highly addictive..."
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