Opioids Going to miss two days of Hysingla ER

[SummerWinter]

Hello. I have chronic pain in my back and neck. I have been on prescriptions painkillers for about five years now. I was prescribed Hysingla ER (hydrocodone-extended release) six months ago and now take a daily 80mg tablet. Whenever I have been tapered up or down, I always get about a day and a half of severe headache. I misused several this month and will have a two day gap between my last pill and my refill. They're supposed to last 24 hours but sometimes don’t. Even taking them at the same time everyday, totally as prescribed, I sometimes wake up suffering mild to medium withdrawal symptoms. I have Narco 10/325 for breakthrough pain. I was planning on taking 8 Norco a day every few hours to mitigate withdrawals, but I am very afraid that I will still experience harsh withdrawals from whatever other chemicals are in the Hysinglas. Do you think the Norcos will keep me from having w/d without the Hysingla for two days? Or am I in for a rough time? Anyone have experience with these or similar ER drugs?

 

[Fiori di Bella]

Yes! The Norcos (also Hydrocodone) should absolutely be able to keep you from getting into withdrawals from your extended-release Hydrocodone.
I don’t know how much Norco you have, but I would start with 20mg/4xday for the days you’re out of your Hysingla ER.

 

[Electrum1]

I have Narco 10/325 for breakthrough pain. I was planning on taking 8 Norco a day every few hours to mitigate withdrawals

Be careful to not take too much acetaminophen. Those norcos are 325mg of acetaminophen each, so don't go above ~3,000mg per 24 hours or it can cause liver damage

 

[negrogesic]

Yeah 20mg 4x a day is prudent advice (2 tabs every 6 hours). I think the acetaminophen limit/day was once 4g, not sure what it is now. On a side note I once took ~90 tablets of 5mg/500mg vicoden (45g acetaminophen) in a single evening after breaking my ankle in a gruesome manner (they just immobilized it and discharged me and told me I'd need to find an orthopedic surgeon to fully repair it). However I was 19 and young males can handle alot of abuse. But toxicity of any toxin is both acute and cumulative; I didn't experience the first one but I bet my odds of liver cancer, cirrhosis, fulminant hepatic failure etc is higher than average. Long story short it is probably ok for most people to take 8 norco/day in terms of acetaminophen exposure. It should also eliminate the withdrawal, with perhaps some very minor nuances.

 

[Keif' Richards]

As others have said, they are the same substance, so you shouldn't have a problem. Just note that one has Hydrocodone and Acetaminophen whereas your extended release pill is just Hydrocodone. They Hydrocodone is the Opioid; the drug that is going to cause and mitigate withdrawal for you. The acetaminophen is playing the same role for your that it would play for any other person, in that it will relieve pain. I don't want to overload you with information, but there is a very easy way of removing Acetaminophen from these tablets. It really shouldn't be a problem for you, as you're only going for a couple of days on these things, but if for any reason, you find yourself needing to take large amounts of these Hydrocodone/Acetaminophen pills in the future, make sure you familiarize yourself with the Cold Water Extraction method of separating Opioids from Acetaminophen.

 

[SummerWinter]

Thank you for your responses everyone. I know the acetaminophen in not good, but I figure its the lesser of two evils for two days. Your responses provide some comfort. I don’t want to go through heavy withdrawals (I’ve done it), especially since it’s summer time and I don’t want my young daughter to see me. I just had a nerve ablation so I’m praying this will help enough that I can cut down on the ER. Or just stop it altogether.

 

[Survival0200]

On a side note I once took ~90 tablets of 5mg/500mg vicoden (45g acetaminophen) in a single evening [...}

Wow, and you lived to tell the tale. You can consider yourself lucky.

 

[negrogesic]

Wow, and you lived to tell the tale. You can consider yourself lucky.

Yeah I should reinforce that no one should ever try such a thing simply because I didn't personally experience immediate liver failure. Acetaminophen overdoses are one of the most commonly encountered drug overdose and it's a nasty one. I've got an uncanny ability to survive poisonings, but I bet if I tried that same stunt these days I wouldn't handle it as well.

 

[plumbus-nine]

You might consider doing a cold water extraction (CWE) to get rid of the acetaminophen in your pills.

That said, did you ever challenge your tolerance/'physical addiction' by skipping one or two days of your medicine? I've been on 600mg/d morphine XR and found that it took 2 full days (48h) for withdrawal to really kick in, before it was just anxiety off turkey in my head but nothing too bad and I've been on it for 3 years. But I didn't have an underlying physical pain condition so it might be different for ya.

I too knew somebody who did packs of acetaminophen in suicidal intention and had no real side effects but this are exceptions to the rule I guess and it's certainly strongly urged not to push the boundaries too far here.

 

[SummerWinter]

Thank you for your responses. I must say I’m kinda surprised at everyone’s urging against acetaminophen. I know it’s not good for one’s liver but it seems the lesser of two evils when we’re talking heavy narcotics. I appreciate the info and concern, I guess I’m just ignorant to how dangerous it really is.

So today begins my two day marathon with no Hysingla. I’m scared. As to your question, plumbus-nine, sometimes I can go til the afternoon before I feel any withdrawal symptoms from my normally 9:30am dose. Other times I wake up in a sweat at 8am, runny nose, can barely walk. So I think it’s less my tolerance/physical addiction and more that particular medication. Which is why I’m nervous about replacing it with Norco until I get my refill Wednesday.

Sometimes I think about just cold turkey-ing everything and just get off all this. Then I’m hit with the reality of actually needing the pain relief. But I just had another ablation so I am praying this will work and I’ll get my life back to a substantial degree. I have to believe that. I am missing my child’s childhood and feel like such a drain on my family. Sorry, I’m rambling. I appreciate this community. Thanks for being there.

 

[Xorkoth]

The amount of acetaminophen in 8 10mg norcos for just 2 days isn't going to be a problem, it's under the max daily limit. Cold water extractions should be done if you're dosing more than that in a day, or if you're chronically using opioid pills with acetaminophen in them. The cumulative liver damage is a real problem for people who dose pills regularly for long periods of time. Cold water extractions are very easy, though, you just crush the pills up in a glass of cold water, and stir for a few minutes. Then let the white powder that doesn't dissolve settle to the bottom, so that the water is clear and there is a layer of cloudy stuff at the bottom, and drink off the water. You can then filter the rest through a coffee filter to get the rest of the opioids and not the acetaminophen. Using this method, you can avoid the acetaminophen but still take the hydrocodone. But like I said, at 8 pills a day, for only 2 days, it doesn't matter and you don't have to worry about it. However, 8 pills at 500mg acetaminophen per pill, that is right up at the max daily dosage, so if you take more, you should do a cold water extraction.

But yeah, norcos will completely substitute, both of the drugs only have hydrocodone in them, as far as the drugs that you will be addicted to. In fact the norcos might even work a bit better because they'll hit you faster and reach peak plasma levels faster. But of course you'll need to redose every 6 hours.

 

[SummerWinter]

Hello. Quick update. I woke up this morning in withdrawals, but that’s just because I didn’t take any Norco in the middle of the night. Last dose was maybe 9:30pm. Looking forward to having my Hyslinglas again tomorrow morning.

 

[Pashta]

Hello. I have chronic pain in my back and neck. I have been on prescriptions painkillers for about five years now. I was prescribed Hysingla ER (hydrocodone-extended release) six months ago and now take a daily 80mg tablet. Whenever I have been tapered up or down, I always get about a day and a half of severe headache. I misused several this month and will have a two day gap between my last pill and my refill. They're supposed to last 24 hours but sometimes don’t. Even taking them at the same time everyday, totally as prescribed, I sometimes wake up suffering mild to medium withdrawal symptoms. I have Narco 10/325 for breakthrough pain. I was planning on taking 8 Norco a day every few hours to mitigate withdrawals, but I am very afraid that I will still experience harsh withdrawals from whatever other chemicals are in the Hysinglas. Do you think the Norcos will keep me from having w/d without the Hysingla for two days? Or am I in for a rough time? Anyone have experience with these or similar ER drugs?

I take a long-acting hydrocodone like you, mine is Zohydro, though. They DEFINITELY do not last the time they state. Mine only last 6 hours, every single time. I have to take 4 a day. The palliative care NP I saw actually prescribed me 2 100mg Hysingla ER twice a day, since the Zohydro only last half the time, he knew that the Hyslingla would likely only last half the time, and he even said that MANY people have complained that they do not last 24 hours. You are not alone. (I am taking 4 50mg Zohydro a day right now instead of the 2 100 Hysinglas because they were unavailable anywhere near me, hopefully once I get my new doctor they will put me on what he wanted me on now that I found a compounding pharmacy that can make them for me.)

These pharmaceutical manufacturers are ripping us off, declaring these to last longer than they actually do. Maybe they are in cahoots with the insurance companies, since mine won't pay for my Rx because they say I can only have what the manufacturer recommends, NOT WHAT MY DOCTOR SAYS! I just can't believe how corrupt and crooked the entire system is!!

 

[Pashta]

Yeah 20mg 4x a day is prudent advice (2 tabs every 6 hours). I think the acetaminophen limit/day was once 4g, not sure what it is now. On a side note I once took ~90 tablets of 5mg/500mg vicoden (45g acetaminophen) in a single evening after breaking my ankle in a gruesome manner (they just immobilized it and discharged me and told me I'd need to find an orthopedic surgeon to fully repair it). However I was 19 and young males can handle alot of abuse. But toxicity of any toxin is both acute and cumulative; I didn't experience the first one but I bet my odds of liver cancer, cirrhosis, fulminant hepatic failure etc is higher than average. Long story short it is probably ok for most people to take 8 norco/day in terms of acetaminophen exposure. It should also eliminate the withdrawal, with perhaps some very minor nuances.

Our livers self-repair and even grow back if we cut off some of it! I think you can lose MOST of your liver and it will grow back. They can handle a lot of abuse.

Have you not heard the story of the god that was being tortured by another god for giving fire to humanity, an eagle comes and eats most of his liver every day (since it grows back, get it?) I forgot the names, sorry, but I think they were Greek gods.