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Re: Vicoprofen

Posted by mattdds on December 25, 2003, at 2:50:00

In reply to Re: Vicoprofen mattdds, posted by Viridis on December 24, 2003, at 21:39:57

>>>...in Vicoprofen is too low for adequate anti-inflammatory effects, and insisted that I supplement the Vicoprofen with an additional 200 mg of regular ibuprofen. This worked very well for pain management.

Wow, crazy. At my dental school, we did the exact same thing during oral surgery rotation! We (well, we and an observing, licenced oral surgeon) would prescribe Vicoprofen, but instruct the patient to take an additional tablet of Advil or Motrin. 200 mg is indeed way too low a dose to have any anti-inflammatory effect. In my opinion 200 mg probably doesn't even have an *analgesic* effect. I take OTC ibuprofen all the time and need at least 600 mg for tension headaches. Some people theorize that hydrocodone and ibuprofen act synergistically rather than additively, but I personally doubt that.

>>>But for psychiatric issues, the low level of ibuprofen in Vicoprofen is probably a good thing.

Exactly my thinking. Probably the next best thing to pure hydrocodone that's on the market (for psychiatric purposes). Sadly, I don't think we'll ever see a pure hydrocodone tablet made though.

>>>BTW, I find hydrocodone a great mood-lifter.

Many people do, and it's too bad that "mood-lifter" has such a negative connotation these days. I mean, shouldn't that be the goal of depression treatment? A lifting of the mood?

I've noticed that there are some "oxy" people, some "hydro" people. For some, hydrocodone really works, while for others oxycodone does. Oxycodone seems to have more euphoria / abuse issues associated with it, than does hydrocodone. Everyone is different. I personally don't really get anything but fuzzed thinking, constipation, and depression from the opioids. Weird.

I am sympathetic, however, because a drug that helps me (Klonopin) is somewhat taboo to some. New York State even requires a triplicate prescription and will not allow refills for benzodiazepines. Some psychiatrists are now prescribing meprobamate (much less safe, very low therapeutic index) instead now, simply because it's less of a hassle.

>>>It's a shame that opioids are such taboo meds in psychiatry, because they really do seem to work wonders for some people.

I totally agree. It's interesting that for centuries, opioids were the mainstay for "melancholia". Now that big pharm has stolen the show, psych doctors seemed to have bought into the whole "addiction" fear 100%.

Even in dentistry, where there is an obvious etiology (e.g. traumatic tooth extraction), and an obvious need for pain relief, some conservative dentists will not write for anything but ibuprofen. They always cite fear of getting the patient "addicted" as the reason.

To me opioids seem great, you solve two problems at once: the obvious physical pain, and also the psychological pain of getting a tooth pulled or worked on. I think patients deserve that. Dentistry is traumatic, both physically and psychologically!

So when I graduate in around 4 months (and actually have a say in my prescription writing), I know what my patients will be getting for moderate to severe pain relief (assuming, of course, that it's indicated).

I think your idea of requesting a small supply for mood breaks is certainly worth a shot. Some doctors seem to be revisiting the idea of using opioids as a treatment for depression.

Happy holidays!

Matt


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poster:mattdds thread:292566
URL: http://www.dr-bob.org/babble/20031219/msgs/293276.html