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Know About the Combo that Can Lead to Liver Failure
Taking medication to relieve severe pain is understandable; but make sure you don’t choose a combination that can stop your liver from functioning.
Maybe you, along with millions of other adults, have fatty liver disease and like to drink alcohol on occasion. Maybe you, along with countless others, take a prescribed medication for some type of painful condition. If you are unaware that you have a fatty liver, take pain medicine and have a drink to relax, you may be putting yourself in a precarious situation.
Pain Medications
Back pain, arthritis, gout or any number of other painful conditions that are not helped by over-the-counter pain medications can lead people to seek stronger drugs for relief. For severe pain, doctors may prescribe an opioid, which is a type of narcotic medication. Not surprisingly, narcotic pain relievers are a big business – whether prescribed by a licensed physician or obtained illegally. If not used correctly, narcotics can have serious side effects.
Because narcotics are so potent, addictive and potentially dangerous, doctors who prescribe these drugs often find themselves entangled in negligence lawsuits. In order to protect themselves and their patients, responsible pain management doctors typically perform intensive evaluations (including drug testing and cross-reference checks) before prescribing prescription pain-relievers. These safeguards are meant to determine:
- If there are any other drugs in the patient’s system.
- If the patient is taking the prescribed amount of the narcotic.
- If the patient is obtaining narcotics from any other physician.
The primary goals of these precautions are to:
- Prevent patients from taking too much of the drug.
- Monitor the patient’s health, including checking liver function.
- Detect patients who are getting prescribed the drug, but not using it. These individuals could be contributing to the illegal trafficking of narcotics.
Regrettably, all of the steps taken to protect people from the misuse of these drugs don’t always work.
Narcotics with Acetaminophen
Prescription pain relievers are frequently combined with acetaminophen (Tylenol) to enhance their effectiveness for pain relief. They include:
- Tylenol with Codeine
- Lorcet, Lortab, Norco, Narvox, Vicodin (hydrocodone)
- Roxicet, Tylox, Endocet, Magnocet, Oxycet, Roxilox, Xolox
- Percocet, Perloxx, Primalev
Any prescribing doctor will warn patients to abstain from drinking alcohol while taking one of these pain relievers, but this warning is often disregarded by people as excessive. Worse yet, there are no warnings or patient monitoring involved when narcotics are obtained without a doctor’s prescription. Unfortunately, underestimating the potential impact on the liver from combining narcotic pain relievers with alcohol is a big mistake – one that an affected person may not be able to recover from.
Fatty Liver Risk and Liver Failure
The combination of a narcotic with acetaminophen and alcohol puts people at risk for severe liver damage. This risk is magnified if a person has a fatty liver, regardless of whether or not it has been diagnosed. An estimated quarter of American adults have fatty liver disease, a progressive liver illness that has no symptoms until it has advanced to significant liver damage. The likelihood of having a fatty liver is greater for those with alcoholism, metabolic syndrome, high triglycerides, diabetes and obesity.
If a person mixes alcohol with a narcotic containing acetaminophen, acute liver failure (fulminant hepatitis) could result; large amounts of the drug or alcohol are not required. In the U.S., acetaminophen is the most common cause of acute liver failure. This is even more likely if the person has an underlying liver problem like fatty liver disease. The combination of these three “evils” can be devastating. Besides developing an acute case of hepatitis, confusion, bruising, coma and bleeding may result. Up to 80 percent of people with fulminant hepatitis die in days to weeks after ingesting this potentially lethal combo.
The information just described is not intended to be a scare tactic, but rather an honest description of what can happen. Despite what we know about narcotics, acetaminophen, alcohol and the liver, accidentally-induced fulminant hepatitis occurs every day. Please share this knowledge with those you care about who are in severe pain, so that their attempts at pain relief don’t become a tragedy.
http://alcoholism.about.com/cs/drugs/a/blum040114.htm, Drinkers Use Pain-Killers Despite Interactions, U. of Michigan Health System, about.com, 2013.
http://ibdcrohns.about.com/library/basics/blharmliver.htm, Harmful Effects of Medicine: The Liver, Retrieved May 12, 2013, about.com, 2013.
http://www.drugs.com/cons/narcotic-analgesics-and-acetaminophen.html, Narcotic Analgesics and Acetaminophen, Retrieved May 12, 2013, Drugs.com, 2013.
http://www.medicinenet.com/drug_induced_liver_disease/article.htm, Drug-Induced Liver Disease, Dennis Lee, MD, Retrieved May 12, 2013, MedicineNet, Inc., 2013.
http://www.webmd.com/osteoarthritis/guide/narcotic-pain-relievers, Arthritis and Narcotic Pain Medication, Retrieved May 12, 2013, WebMD, LLC, 2013.
http://www.webmd.com/pain-management/guide/narcotic-pain-medications, Opiod (Narcotic) Pain Medications, Retrieved May 12, 2013, WebMD, LLC, 2013.
About the Author
Nicole Cutler, L.Ac., MTCM is a long time advocate of integrating perspectives on health. With a Bachelor's degree in Neuroscience from the University of Rochester and a Master's degree in Traditional Chinese Medicine from Five Branches Institute, Nicole has been a licensed acupuncturist since 2000. She has gathered acupuncture licenses in the states of California and New York, is a certified specialist with the National Acupuncture Detoxification Association, has earned diplomat status with the National Commission of Chinese and Oriental Medicine in Acupuncture and Chinese Herbology and is a member of the Society for Integrative Oncology. In addition to her acupuncture practice that focuses on stress and pain relief, digestion, immunity and oncology, Nicole contributes to the integration of healthcare by writing articles for professional massage therapists and people living with liver disease.
That’s not what I have researched – they mixed acetaminophen into opioid pain killers to reduce drug abuse but this ended up causing liver failure in some patients. Go figure that logic ! A person is better to get addicted to acetaminophen-free opioids than to take the combo pill and lose their liver. There is too much bull surrounding drug use, and in fact prescription drugs kill more people than the so-called street drugs !
what about Vicadin?? I don’t drink, but have chirossis , is ok in small amounts ocassinonly , like 125 mg. ? or less. I only need
it for SEVERE Leg cramps so I cut up a 500 mg Please help.
Vicodin has a whole lot of Acetaminophen. Not a good idea. I probably have beginnings of cirrhosis (from HCV) and I try to avoid it as much as I can.
The maximum amount of acetaminophen allowed PER 24 HOURS for people with cirrhosis and whose liver disease is FULLY COMPENSATED is 2000-mg (compared to 4000-mg/day w/o liver disease). That doesn’t mean you can take 6 Norco 10/325 (or 6 tylenol 325-mg) at once and you are cool for the day. Everyone with liver disease is wise to take the smallest amount that is effective and ALWAYS talk it over with your doctor or better yet a gastroenterologist or best, a hepatologist. If you are not fully compensated, you MUST talk to your medical specialist!!!
I know what you mean but the sad fact is more people die from the hydrocodone than they do from liver failure and this will be shown more now that the FDA has approved Zohydro ER which is the 1st tylenol free hydrocodone and is easy to crush up and snort unlike the the new Oxycontin formulation.
So after all of that what is a person suppose to take for pain if not these products?
new pain med approved by FDA. Name is Zohydro ER. Pure hydrocodone no tylonol or other meds mixed. Check out on FDA website, drug approved in october, 2013.
On the list of prescription pain meds they omitted Oxycodone without Acetaminaphen. Supposedly this will not harm the liver as much as the others do. However, I have taken this variety (without the Acetaminaphen) and it still made me sick as a dog. So, if you’re liver is already compromised by Hepatitis or other ailment, you probably should take no pill type pain relievers. However, you would be wise to use Cannabis for pain instead, because then you have the added benefit of its anti-cancer properties. Hepatitis can lead to liver cancer, so you’d be best to protect yourself, get pro-active and take an anti-cancer, natural medicine that may be the best anti-cancer substance on the planet– Cannabis. For more information go to the site topdocumentaryfilms dot com and look up a film called “Cannabis Science: How Marijuana Affects Health.”
I have stage 4 NASH cirrhosis of the liver. I don’t drink. However, I’ve had a severe back issue since I was 14. Despite 2 back surgeries, the pain comes back and the cycle starts over again. I’ve been on disability now since 2003 and have been taking Vicodin, and now Norco since about 2001. If I don’t take it, I can’t walk. Even with the meds, I still have bed-ridden days. I live in Florida, which just approved medical marijuana in the November election. Yay, right? Wrong. The state has already said that the only people who will have access to cannabis are people with AIDS or cancer. I’ve got a friend who supplies me with it from time to time, but it’s rare that he gets it anymore. I’ve considered the cannabis “vape”. I was in Atlanta last year and a friend had it and gave it to me to try. It worked quite well. Of course, we can’t have it in FL. Also, my only insurance is Medicare and they don’t cover it at all even if chronic pain was added to the list. What’s wrong with people?!