Posted by ed_uk on May 12, 2005, at 11:48:29
In reply to Question for ed_uk, posted by Nickengland on May 12, 2005, at 9:16:42
Hi Nick,
>This added 8 mg of codeine makes me feel very relaxed indeed lol...
Carbamazepine is thought to interfere with the metabolism of codeine and might theoretically increase its effects. Carbamazepine increases the formation of various active metabolites of codeine. (Codeine has many metabolites- morphine is one of the most important metabolites of codeine).
It sounds like you are extremely sensitive to codeine, 16mg of codeine is too low for most people. Because of this, co-codamol 8/500 is rarely any more effective than paracetamol alone. In general, the only people who find co-codamol 8/500 more effective than paracetamol alone are people who are very sensitive to codeine. Carbamazepine might have potentiated the codeine, increasing its analgesic effect.
Dosage requirements for opioids such as codeine are *extrememly* variable and must always be determined on an individual basis- opioids do NOT have a 'standard dose'.
The fact that you were very relaxed after 16mg suggests that 16mg was in excess of the dose required to control your pain- you could try taking 8mg next time. If paracetmol alone is effective for your headaches, please don't take co-codamol :-)
A codeine dose which adequately controls your pain without causing any feelings of relaxation or euphoria is a suitable dose. If the pain completely disappears, the dose is too high. Try to find a dose which reduces the pain to a tolerable level. If your headaches can be treated with non-opioids alone, codeine should not be used.
>Also taking this codeine could it upset or make bipolar anyworse?
If you consistently take the minimum dose required to adequately control your pain, you are unlikely to run into problems. If you regularly take doses which make you feel very relaxed, completely pain-free or euphoric, you are likely to develop an addiction. Regular use of codeine at appropriate doses commonly induces physical dependence ie. withdrawal symptoms will occur when the drug is stopped or if the dose is substantially reduced. Pure physical dependence is *not* the same as addiction. Addiction may occur when a person takes an opioid at doses in excess of the dose required to control their pain. If powerful feelings of relaxation are present, the dose is too high.
Here are some features which suggest addiction (as opposed to pure physical depedence).....
Loss of control over drug use
*Frequently* taking a drug for its euphoric effects
Craving a drug for its psychological effects
Drug use takes priority over work, family or social life
Forging prescriptions
Large amount of time spent aquiring a drug or using a drug
Deceiving others (including doctors) or stealing in order to obtain a drug
'Doctor shopping' in order to obtain large quantities of a drug for recreational purposes
Some people use opioids recreationally without bocoming addicted. Addiction implies loss of control over drug use.
...................................................................................
*Pure physical dependence* is characterised by the occurence of withdrawal symptoms when the drug in stopped or the dose reduced. The above features of addiction are not present. Tolerance may or may not be present.
Opioid addicts are usually physically dependent as well as being addicted.
People who have taken *appropriately titrated* doses of an opioid on a long-term basis (generally for the treatment of severe pain) are usually physically dependent yet they are NOT addicts. An opioid addict is a person who displays definite features of addiction (as listed above) IN ADDITION to being physically dependent.
Some of the opioids used medicinally in the UK include.......
Codeine
Morphine (MST Continus, Zomorph, MXL, Oramorph, Sevredol etc)
Dihydrocodeine (DF118)
Fentanyl (Sublimaze, Durogesic) Seriously, what were they thinking when they named it Sublimaze!!!!
Pethidine
Oxycodone (OxyContin, OxyNorm)
Hydromorphone (Palladone)
Methadone (Physeptone)
Diamorphine (aka heroin)Here is a list of common opioid withdrawal symptoms..........
mental distress, anxiety, agitation, restlessness
nausea/vomiting
muscles pain
runny nose, watery eyes
sweating
goose bumps
diarrhoea
yawning
fatigue
insomnia
exacerbation of underlying pain (rebound pain)>Am i right in thinking you can get this 8/500 mix over the counter in pharmacys without a prescription?
Yes. Codeine/ibuprofen combinations are also available.
>id only be using it for as needed haed aches though, not everyday use lol
For certain types of pain, long-term daily use of opioids can be useful. Long-term opioid use may be useful in carefully selected patients suffering from severe arthritis pain, severe pain due to intervertebral disc disease, severe pain due to vertebral crush fractures and cancer pain. Opioids are also useful for some patients with severe neuropathic pain. Opioids are *not* suitable for the treatment of mild pain.
Unfortunately........ regular use of opioids can sometime aggravate headaches. Occasional headaches can be *transformed* into a chronic daily headache which may be severe and difficult to treat. Because of this, opioids are best used sparingly in the treatment of headaches unless the headaches are extremely severe and there is no alternative. Preventive medication is often useful for people who suffer from frequent severe migraines. Specific anti-migraine drugs such as sumatriptan can be a useful treatment for acute migraine attacks which have not responded to paracetamol or NSAIDs such as ibuprofen.
Kind regards,
Ed.
poster:ed_uk
thread:496818
URL: http://www.dr-bob.org/babble/20050510/msgs/496861.html