Purple
Enthusiast
Reged: 07/15/03
Posts: 233
Loc: Midwest
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How do you know that you are taking too much of your meds? I am worried about a thread I read that 4000mg of APAP a day is damaging the liver. I am taking more than that. I just had a full blood workup and the liver test came back fine. I am getting worried about taking so much APAP and I dont drink alcohol on a daily basis, once a week maybe if I am stressed about work but now I have stopped the alcohol after reading the many many posts here. Maybe Yawkaw3 can shed some light on my ? Please????
My tolerance is very high right now and taking Lortab 10/500 and I see my dosage going up as time is going by and am getting worried. Thanks for your help/replies from anyone here, everyone here is wonderful!  and I mean that, I have never been able to talk to anyone about this before. I have posted this before but being a newbie I did not know to add it to my favorites and never was able to see if anyone responded to my thread. THANKS SO MUCH !
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yawkaw3
Pooh-Bah
Reged: 03/22/03
Posts: 1193
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Well if your ALT wasn't in an abnormal range and the rest of your liver tests were fine, then you're ok. What is a dose that is damaging to the liver varies from person to person, but 4 g a day for a lengthy period of time is, for most people, close to the limit. You should probably switch to 10/325 if you see yourself increasing your dosage.
You might want to also add NAC (n-acetyl-l-cysteine) to your meds regimen. That's what they give you in the ER if you go in overdosing on acetaminophen, but it's also sold in capsule form at health food stores and GNC. Milk Thistle Extract (silymarin) seems to work well from what I've read, but I've never used it myself. The NAC will go a long way in preventing liver damage, believe me.
Ideally, a pain management doctor who will prescribe OxyContin is your best bet, as you cannot remain on high doses of APAP for a long time. In other words, you can be doing a lot of damage without any obvious symptoms.
I'm not a doctor yet, just a med student, but this is what I know so far. I understand how much easier it is to use an OP than to go through the hassle of PM doc after PM doc, but it will save your liver and save you money in the long run.
Good luck, and feel free to PM me if you want to talk in more detail.
-yawkaw
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kittykatbone
Member
Reged: 06/20/03
Posts: 150
Loc: City of lost Angels
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Yak ~ Question... would the NAC counteract the potency of say lorcets or 7.5/750 vicos? since it is breaking down the aceto in the system??? just curious 
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some days you're the windshield, some days you're the bug
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537
Threadhead
Reged: 12/08/01
Posts: 766
Loc: west coast CA
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Another question for you Yaw, I started taking NAC, but I'm also taking L-glutathione. I read that APAP takes away the amount of L-glutathione in your liver. Would you consider this a worthwhile supplement?
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yawkaw3
Pooh-Bah
Reged: 03/22/03
Posts: 1193
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Lemme quickly explain how NAC works, that might answer some questions:
Acetaminophen has a toxic metabolite, NAPQI. When you exceed the dosage of acetaminophen that your liver can handle (and this varies among people, it's determined by a variety of conditions), the extra acetaminophen has to be metabolized by another liver enzyme, and this causes the production of NAPQI. Glutathione is an antioxidant that binds to NAPQI so it doesn't screw up your liver. But if there is too much NAPQI, the glutathione cannot bind to all of it. When you don't have enough glutathione to cover all the NAPQI, the NAPQI will start killing liver cells.
NAC has several functions. It can take the place of glutathione to bind to NAPQI, and as a precursor to glutathione, it also increases the production and effectiveness of your own glutathione.
If you regularly take large amounts of APAP, your ability to destory NAPQI is going to be impaired. This is why, if you're not doing cold-water-extractions (which you're not allowed to talk about on this board), you should be on some kind of liver supplement.
kittykatbone: NAC wouldn't affect how well the lorcets work in your system. It only comes in to play when you are taking too much APAP, and that point you are beyond a therapeutic dosage of APAP anyway. So I would suggest taking it, it won't affect your quality of pain relief.
legan: Glutathione does a LOT of other things in the body besides deal with excess APAP. Were you taking it for another reason initially? It will help manage APAP toxicity, but NAC is more effective if you have to pick one.
-yawkaw
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537
Threadhead
Reged: 12/08/01
Posts: 766
Loc: west coast CA
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Thanks for the great reply. I started taking the glutathione at the same time I started taking NAC. I just went to GNC to try and save my liver. The glutathione is actually part of an antioxidant supplement. I just thought I'd cover all my bases.
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Purple
Enthusiast
Reged: 07/15/03
Posts: 233
Loc: Midwest
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Thanks Yawkaw3 for your response. I will try the stuff you suggested. I am going to go for the holiday soon, I am feeling like a I am a "pill head", taking pain meds for the pain, wellbutrin for the depression, Benicar 40mg for high blood pressure (job stress related that I am working on going into another job w/less stress) Flexirel when I throw my back out and Valium 10mg to sleep, not everyday, I have been very careful with those. I hear the talk shows on the radio and today they talked a lot about this and I came to thinking that I take a pill for everything that ails me.
I want to get off everything so I am not so dependent on them but since society has made taking prescription drugs are better than street drugs (never went that route) I just don't want to head down that road. I appreciate your feedback as I kow you are a student and know more about this and I trust your judgement. Thanks so much. I am sure I will be posting to you soon. Thanks !!!!!!!!!!! 
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rex
Enthusiast
Reged: 01/29/03
Posts: 219
Loc: U.S.
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yawkaw3 - I've been taking NAC (with my 10/325's) that I purchased from an online vitamin store. Do you happen to know how similar the vitamin store NAC is to the Emergency Room NAC? I just wonder about the quality of vitamin store NAC and if it is actually doing the same thing that Emergency Room NAC does.
I'm pretty sure the FDA does not regulate vitamins and supplements, so I just wonder how well the vitamin store NAC works. I realize you might not have the answer to this.
Thanks . Are you sorry you ever revealed that you are a med student? (By the way, once you have your med licence, are you allowed to Rx for yourself for your ailments?  )
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yawkaw3
Pooh-Bah
Reged: 03/22/03
Posts: 1193
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What you will get in the hospital is Mucosil, which is a drug that is also used to destroy mucus. If you can't or won't swallow it, the ER staff will give you activated charcoal and possibly give it to you through an IV, though that is technically not FDA approved for the treatment of APAP overdose.
Btw, if you ever suspect an APAP overdose, please go to a hospital; you have a very good prognosis if you treat it early on. Wait too long and you might need a liver transplant.
I personally have been taking NAC with my meds for some time and have never shown any loss of hepatic function on any blood test. I've always used GNC, and because of the lack of any real regulation of dietary supplements, you cannot be guaranteed of any specific potency. I would say if you use a "reputable" brand, you will be fine. In Europe, NAC is a common prescription drug, so that's always another option if you'd rather have pharmaceutical company peace of mind.
rex- I'm just glad to help, and hopefully make a difference in someone's health, but I always tell people I give advice to that I'm still just a student. And yes, once I get my license to practice medicine, the FIRST thing I am going to do is RX myself, it is completely legal, though not considered ethical by some jealous pharmacists. I am just waiting for that one day when I am not at a doctor's mercy any more, and I can finally decide what I want and get it legally.
-yawkaw
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537
Threadhead
Reged: 12/08/01
Posts: 766
Loc: west coast CA
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Way to go!!! 
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Sky_Queen
Fly Girl
Reged: 12/03/02
Posts: 1962
Loc: Texas
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Yawkaw....are you married?
Seriously, thank you for all of your excellent info, very educational.
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Reel_X_4U
Enthusiast
Reged: 04/24/03
Posts: 255
Loc: Queens, New York City
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I've read somewhere that damage to the liver cause by taking large doses of tylenol over a long period of time can damage the liver and would not show up on the standard liver enzyme blood tests. You can't solely go by lab tests, you have to be aware of the symptoms too. Like loss of appetite, Ascites (fluid in the abdomenal cavity), weight loss, slow and dull thinking processes, and throwing up of blood (due to esophageal varicose veins), poor digestive function and jaundice (which may not always be present). If you notice the symptoms listed above but yet your liver enzyme tests are normal. You may want to get a liver biopsy. Which involves taking a small sample of liver tissue and examining the structure of the individual hepacytes (histologically). That would give an individual a more clearer picture about their current liver structure and function. But you have to be careful with liver biopsy(s) can sometimes cause complications. It should only performed if there are collaborating symptoms that are occurring concurrently. Better yet take herbals that have been proven to prevent or lessen liver damage like milk thistle, green tea, Schisandra fruit. Milk thistle being the best. Yawkaw, You've done a geat job by writing posts about liver damage, nothing can be more informative and cause people to think about what they are doing to their bodies. Luckily the liver has exellent regenerative capabilities, once the offending substance is removed from a person's dietary intake. The two worse liver-damaging substances are Alcohol and Tylenol. I stay away from both. Kewl!!
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Some men see things as they are and say "WHY"!!
Some men see things as they are and say "WHY"!!
I've dreamt of things that never were, and say "WHY NOT"!!
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maria
Journeyman
Reged: 07/07/03
Posts: 92
Loc: nowhere
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Yawkaw, I don't know if you've taken your law classes yet, but if you're talking about prescribing narcotics for yourself, you can't do that. Federal law says that docs can prescribe anything for themselves, including C-IIs. However, the majority of state laws do not allow docs to prescribe narcs to themselves or family members.
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yawkaw3
Pooh-Bah
Reged: 03/22/03
Posts: 1193
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What you are referring to are state medical boards, who universally claim it is unethical, as does the AMA. That does not make it illegal. All it means is that the medical board disproves of it. State medical boards disprove of lots of things doctors do regularly. You cannot get into legal trouble because of it.
I worked as a pharmacy technician in two nearby states and regularly filled prescriptions for doctors who wrote prescriptions for themselves and their family members. The pharmacist may tell you it's not considered ethical, but there is absolutely no legal restriction aginst it.
On top of that, I have done my rotation with several doctors who have discussed giving family members cold medication (cough syrups) and psych meds.
-yawkaw
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maria
Journeyman
Reged: 07/07/03
Posts: 92
Loc: nowhere
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If you go back and read my post, you'll see I was speaking of narcotics.
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lolajones
Newbie
Reged: 02/04/03
Posts: 39
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I worked for a doc who was visited by the DEA a couple of times, very scary, they come in suits with FBI looking badges, because he was giving away opened samples of Vicoden in blank RX pill bottles to patients, then another time for prescribing 2 schedule 1 meds for one patient on the same day. The pharmacy turned him in the second time. He was VERY hesitant to prescribe for himself or family members after that, 3 strikes you are out, he would loose his DEA license in this state. Also they are not supposed to prescribe meds out of their "scope of practice" which draws immedate attention to the pharmacist who taddles to the DEA on the doctor. Walgreens is good for that, they like the brownie points of taddling on doctors and having patient's arrested for having "faked" looking prescriptions. If the police cannot get contact with the doctor to verify the prescription when the pharmacy calls them on you, off you go to jail to be arrested for RX fraud!
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yawkaw3
Pooh-Bah
Reged: 03/22/03
Posts: 1193
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Right. Schedule I meds. A doctor expected a pharmacy to fill a class of drug THAT ISN'T EVEN MADE BY PHARMACEUTICAL COMPANIES.
-yawkaw
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kewlone4u
Enthusiast
Reged: 03/26/02
Posts: 233
Loc: Tennessee
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I found this surfing, I believe you are correct Yakaw- KO
U.S. Schedule 1 Drugs
A. OPIATES
1-methyl-4-phenyl-4-propionoxypiperidine (MPPP)
1-(2-phenethyl)-4-phenyl-4-acetoxypiperidine (PEPAP)
3-methylfentanyl,N-3methyl-1-(2-phenylethyl)-4-piperidyl-N -phenylpropanamide
3-methylthiofentanyl,N-3-methyl-1-(2-thienyl)ethyl-4-piperidinyl-N-
phenylpropanamide
Acetyl-alpha-methylfentanyl,N-[1-(1-methyl-2-phenyl)ethyl-
4-piperidinyl]-N-phenylacetamide
Acetylmethadol
Allylprodine
Alphacetylmethadol [except Levo-acetylmethadol (LAMM)]
Alphameprodine
Alphamethadol
Alpha-methylfentanyl,N-1-(alpha-methyl-beta-phenyl)ethyl-4-
Piperidyl propionanilide,1-(1-methyl-2-phenylethyl)-4-(N-propanilido)piperidine
Alpha-methylthiofentanyl,N-1-1-methyl-2-(2-thienyl)ethyl-4-piperidyl N -phenylpropanamide
Benzethidine
Benzylfentanyl,N-1-benzyl-4-piperidyl-N-phenylpropanamide
Betacetylmethadol
Beta-hydroxyfentanyl,N-1-(2-hydroxy-2-phenethy)l-4-piperidinyl-N -phenylpropanamide
Beta-hydroxy-3-methylfentanyl,N-1-(2-hydroxy-2 phenethyl)-3-methyl-4-piperidyl-N-phenylpropanamide
Betameprodine
Betamethadol
Betaprodine
Clonitazene
Dextromoramide
Dextrorphan
Diampromide
Diethylthiambutene
Difenoxin
Dimenoxadol
Dimepheptanol
Dimethylthiambutene
Dioxaphetylbutrate
Dipipanone
Drotebanol
Ethylmethylthiambutene
Etonitrazene
Etorphine (except the HCl salt)
Ethoxeridine
Furethidine
Hydroxypethidine
Ketobemidone
Levomoramide
Levophenacylmorphan
Morpheridine
Noracymethadol
Norlevorphanol
Normethadone
Norpipanone
Para-fluorofentanyl, (N-(4-flurophenyl)-N-1-(2-phenethyl)-4-piperidinyl propanamide
Phenadoxone
Phenampromide
Phenomorphan
Phenoperidine
Piritramide
Proheptazine
Properidine
Propiram
Racemoramide
Thenylfentanyl,N-1(2-thienyl)methyl-4 -piperidyl-N-phenyl-propanamide
Thiofentanyl,-N-[1-(2-(2-thienyl)ethyl -4-piperidinyl]-N-phenylpropanamide
N-phenyl-N-1-(2-thienyl)ethyl-4-piperidinylpropan-amide
Tilidine
Trimeperidine
B. OPIUM DERIVATIVES
Acetorphine
Acetyldihydrocodeine
Benzylmorphine
Codeine Methylbromide
Codeine-N-Oxide
Cyprenorphine
Desmorphine
Dihydromorphine
Drotebanol
Etorphine
Heroin
Hydromorphinol
Methyldesorphine
Methyldihydromorphine
Morphine Methylbromide
Morphine Methylsulfonate
Morphine-N-Oxide
Myrophine
Nicocodeine
Nicomorphine
Normorphine
Phenylcodeine
Pholcodeine
Thebacon
C. HALLUCINOGENIC SUBSTANCES
1-1-(2-thienyl)cyclohexylpyrrolidine (TCPy)
2-Methylamino-1-phenylpropan-1-one(including, but not limited to, methcathione,Cat, and Ephedrone)
2,5-dimethoxy-4-ethylamphetamine (DOET)
2,5-dimethoxyamphetamine (2,5 DMA)
3,4 methylenedioxy amphetamine (MDMA)
3,4-methylenedioxy amphetamine
3,4-methylenedioxy-N-ethylamphetamine (N-ethyl-alpha-methyl-3,4(methylenedioxy) phenylethylamine,N-ethyl MDA,MDE,MDEA
3,4,5-Trimethoxyamphetamine
4-bromo-2,5-dimethoxy amphetamine (4-bromo-2,5-DMA,4 bromo-2,5dimethoxy-alpha-methylphenethylamine)
4-Methoxyamphetamine (PMA) 4-methoxy-alphamethylphen-ethylamineparamethoxyamphetamine)
4-Methyl-2,5-dimethoxyamphetamine
5-dimethoxyamphetamine
5-Methoxy-3,4 methylenedioxyamphetamine
Alpha-ethyltryptamine (alpha-ethyl-1H-indole-3-ethanamine,3-(2-aminobutyl)indole)
Bufotenine
Diethyltryptamine
Dimethyltryptamine
Ethylamine analog of phencyclidine (N-ethyl-1-phenylcyclohexylamine, cyclohexamine, (1-phenylcyclohexyl) ethylamine, N-(1-phenylcyclohexyl)ethylamine PCE)
Hashish
Ibogaine
Lysergic Acid Diethylamide
Marijuana
Mescaline
N-ethyl-3-piperidyl benzilate
N-hydroxy 3,4-methylenedioxyamphetamine (N-hydroxy-alpha-methyl-3,4(methylenedioxy)phenethylamine,N -hydroxy MDA)
N-Methyl-3-piperidylbenzilate
Para-fluorofentanyl,(N-(4fluophenyl)-N-1-(2phenyl)-4-piperidyl propanamide)
Parahexyl (Synhexyl) 3-Hexyl-1-hydroxy-7, 8, 9, 10-tetrahydro-6, 6, 9 trimethyl-6Hdibenzo b, d pyran)
Peyote
Phencyclidine
Psilocybin
Pyrrolidine analog of phenyclidine (1-(1-phenylcyclohexyl)-pyrrolidine, PCPy, PHP)
Tetrahydrocannabinols
Thiophene analog of phencyclidine (1-(1-(2-thienyl)cyclo-hexyl)piperidine, TCP, TPCP)
D. DEPRESSANTS
Gamma Hydroxybutric Acid
Mecloqualone
Methaqualone
E. STIMULANTS
3,4-methylenedioxymethamphetamine (MDMA)
4-methylaminorex(2-amino-4-methyl-5-phenyl-2-oxazoline
Aminorex (aminoxaphen,2-amino-5-phenyl-2-oxazoline,4,5-dihydro -5phenyl-2-oxazolamine
Cathione (2-amino-1-phenyl-1-propanone,alpha aminopropriophenone,2-aminopropiophenone,and norephedrone
(±)cis-4-methylaminorex ((±)cis-4,5-dihydro-4methyl-5phenyl-2-oxazolamine
Fenethylline
Methcathinone (2-(methylamino)-propiophenenone,alpha(methylamino) -propiophenone,alpha (methylamino)-propriphenone-2, (methylamino)-1-phenylpropane-1-one,alpha-N-methylamino -propiophenone,monomethylpropione, ephedrone, N-methylcathione, methylcathione, AL-464, AL-422,AL-463 and UR1431, its salts, optical isomers, and salts of optical isomers
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C' ya---KO
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Anglwink
Veteran
Reged: 04/29/03
Posts: 605
Loc: East coast
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Hi Yakaw,
What field of medicine are you going to specialize in? If its pain managment, then you can start a private practice with all of us here at DB as your patients!! Anglwink
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"Believe"
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Anglwink
Veteran
Reged: 04/29/03
Posts: 605
Loc: East coast
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In the last 10-12 years whenever I had a blood test, my liver enzymes have always been high (i have only used pain meds for the last 2 1/2 years) A Dr. told me that since I didn't drink or (at that time) take a lot of medication, that I probably just had a fatty liver. They also have a blood test that can measure the amount of Tylenol in your system. A friend of mine had this done when she went to the er because she was really sick and she told them what pain meds she took and they gave her the "Tylenol test. (Don't know the official name of that blood test, yawkaw?) but her Tylenol level was a 31! Anglwink
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"Believe"
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Reel_X_4U
Enthusiast
Reged: 04/24/03
Posts: 255
Loc: Queens, New York City
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That's the thing you don't drink which "REELLY" reduces your risk to liver damage. The thing is that alot of people on medication also drink which is a double whammy when it comes to a damaged liver. But there have been cases where a blood tests were done on an individual and all his liver enzymes were in the normal range, which gave them a false feeling that everything was okay with their liver and then all of a sudden they develop liver conditions like cirrhosis or fatty liver and were taken by surprise. Liver enzymes tests only reflect and provide a snapshot on how the liver is functioning. But the liver can withstand alot of damage before actual liver damage signs show-up. And liver function is only one side of the story, the other side of liver function is that the liver must be addressed at it's structural level (histologically) at the cellular level. The structure must be viewed and analyzed by a competent hepatologist and the doctor should take a close look at an individual's health for any hidden or sub-clinical symptoms that might point to liver damage. God has bless humans with providing us with an organ that has excellent regenerative abilities. It's when you destory the liver beyond the body's ability to regenerate it, and the body instead replaces the damaged portion of the liver with scar tissue, which is just connective tissue, it contains none of the specialized cells that are present within liver tissue (similiar to a scar seen on external skin it's there but it contains no hair follicles or sweat glands...etc within in, it's sole purpose is to connect all sides of healthy skin to one another and nothing else). So now the liver loses the ability to neutralize and remove harmful substances from the blood and the digestive contents of the small intestine and now the person is in big trouble and needs a liver transplant pronto. There no need to get stressed about it, just make sure you take the milk thistle, NAC, green tea, dandelions, and schisandra fruit (tea bags) on a daily basis to promote healty liver function. And if you have take painkillers that contain tylenol, ask the doctor to write scripts with the least amount of tylenol like norco 10mg hydrocodone/325mg tylenol, or oxycodone 10mg with 325 mg tylenol. Even if you don't need that high of a dose. you can always break the pill in half, they are scored. Just always remember to monitor your tylenol intake and absolutely abstain from alcohol. Kewl!!!
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Some men see things as they are and say "WHY"!!
Some men see things as they are and say "WHY"!!
I've dreamt of things that never were, and say "WHY NOT"!!
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Anglwink
Veteran
Reged: 04/29/03
Posts: 605
Loc: East coast
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Reel,
I get my liver enzymes screening done twice a year because my Mompassed away from liver cancer at the age of 32 and my sister Debbie (47) passed away last year from pancreatic & Liver cancer. Anglwink
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"Believe"
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Reel_X_4U
Enthusiast
Reged: 04/24/03
Posts: 255
Loc: Queens, New York City
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I'm very sorry to hear about your mom and sister, I hope time has lessen the emotional scars when such events occur, we all know that a person never fully is able to overcome such personal tragic events, but men and women have great emotional reserves that they can tap into to bring about a "HEALING" and a partial "CLOSURE". It's a great thing that you are monitoring your liver on a regular basis. If you ever have to "VENT", feel free to PM me. Not to boast in any way, but I'm a great listener and I have excellent advisory skills that pretty much have come to me naturally over the years (even though I'm only 32), I feel for people. Living in NYC has provided me with situations of enormous tragedy, that provides me an innate ability to peer in one's soul and aid them verbally to come to terms with personal tragedies, that's comes along with the human condition. Once again, please accept my condolences. "GOD BLESS"
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Some men see things as they are and say "WHY"!!
Some men see things as they are and say "WHY"!!
I've dreamt of things that never were, and say "WHY NOT"!!
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sara43
Member
Reged: 05/14/02
Posts: 196
Loc: Mississippi
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I want to thank you!!!!!
Everyone that has posted here!!!
It is helpping me I know you all don't know me, but that is ok, with me.
I am scared I need to find a good MD. I don't know if it is my liver or what it is? I have been on meds for pain for 3 years or so. I have been having weird pains to me or my body. I just want to thank everyone and yes I am going to go and find a MD. hope it is a good one this time???
If not I will go to er in next town over. Thank you for everyones advice and everything!!
Anglewink my heart goes out to you !!!! 
Edited by sara43 (09/10/03 08:40 PM)
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LumbarSpasm
Silent Chaos
Reged: 05/07/02
Posts: 1538
Loc: USA
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Sara, I hope you find a great doctor! Good luck to you.
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LumbarSpasm
Or just a pain in the butt?!
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Caveman6666
Enthusiast
Reged: 01/15/03
Posts: 218
Loc: Earth
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Quote:
I personally have been taking NAC with my meds for some time and have never shown any loss of hepatic function on any blood test.
-yawkaw
Thanks for all the info. Wondering if you have experienced any side effects fron the NAC, or if you know of any?
Since I started taking it, I seem to have developed some joint pain in my hands. Have no idea if it's related, but I stopped the NAC, and they seem to feel better.
Any thoughts?
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