Morphine and Vicodin.....Pros vs Cons (Opioid Tolerance, Respiratory Depression and Analgesic Nephropathy)

[Vanessa]

Can anyone give me any experience help on either of these? I have taken morphine before and had a wicked ride after having to stop cold turkey for my surgery. My doctor has now recommended that I go back on the extended release morphine PLUS vicodin for breakthrough pain. I really need the pain relief right now, but I am just so uneasy about the morphine again plus adding in vicodin now. I don't know if the two combined could give me respiratory depression etc. I did discuss all this with my dr, and he thinks this is the best course for right now. He said if I have to come off of the morphine, he will take me off of it over a few months period. Reassuring, but still.... What do you all think?

[KBear]

If it is the same doctor prescribing both medicines, then I would not worry about the respiratory depression (unless of course you had symptoms to cause worry). I was worried about that when I was put on Fentanyl and Lortab, I was pretty sure I was going to die from taking both. I was reassured by both my pm dr and family dr that since I was opiate tolerant that adding the 2nd was not going to be a problem, as long as I took it as prescribed. I would also say the withdrawal is going to depend on what dose the morphine is and what else (if anything is in it). I was on Kadian 20mg (which is time release morphine) and Lortab 10 mg (Hydrocodone 10 mg with Acetaminophen 325 mg). I had no problem and the Kadian really helped the pain, where I didn't have to take as much Lortab. I did have withdrawal, but not bad, as I weaned slowly from it. Honestly, I had more withdrawal from my antidepressant that either the Kadian or Lortab.

[Vanessa]

If it is the same doctor prescribing both medicines, then I would not worry about the respiratory depression (unless of course you had symptoms to cause worry). I was worried about that when I was put on Fentanyl and Lortab, I was pretty sure I was going to die from taking both. I was reassured by both my pm dr and family dr that since I was opiate tolerant that adding the 2nd was not going to be a problem, as long as I took it as prescribed. I would also say the withdrawal is going to depend on what dose the morphine is and what else (if anything is in it). I was on Kadian 20mg (which is time release morphine) and Lortab 10 mg (Hydrocodone 10 mg with Acetaminophen 325 mg). I had no problem and the Kadian really helped the pain, where I didn't have to take as much Lortab. I did have withdrawal, but not bad, as I weaned slowly from it. Honestly, I had more withdrawal from my antidepressant that either the Kadian or Lortab.

It is the same doctor that is prescribing the meds, so I would guess he would know about the interactions LOL! He put me on 15 mg of the Morphine twice a day, so that's not nearly as much as I was on before. The Vicodin I think is 5/325? I have to look at the rx again. I think really, I'm just terrified to go through the withdrawls again. It was the WORST pain/sickness I have ever gone through in my life. There really is no comparing it at all. It makes me feel better that I can come off of it slowly this time, but yeah, I just don't want to go through that again. I know the reality though, without these meds right now, I'm going to end up frying my liver with as much medication I am taking. Blah......

[Justin]

Can anyone give me any experience help on either of these? I have taken morphine before and had a wicked ride after having to stop cold turkey for my surgery. My doctor has now recommended that I go back on the extended release morphine PLUS vicodin for breakthrough pain. I really need the pain relief right now, but I am just so uneasy about the morphine again plus adding in vicodin now. I don't know if the two combined could give me respiratory depression etc. I did discuss all this with my dr, and he thinks this is the best course for right now. He said if I have to come off of the morphine, he will take me off of it over a few months period. Reassuring, but still.... What do you all think?

Hi Vanessa,

You ask very good questions. The medications you are on are "standard fare" for many Spine Patients dealing with chronic pain. The extended release morphine is usually scripted every 12 hours and the Vicodin is for breakthrough pain (as you've stated above).

All opioids will inherently cause respiratory depression. If you are opioid-naïve (meaning currently not on opioid therapy), then the doctor you are seeing for management of your pain will start you slow. Also, opioid-naïve patients administered opioids intravenously (IV) is a concern and can lead to respiratory depression. However, Spine Patients that are opioid-tolerate (taking opioids regularly for pain) develop tolerance to respiratory depression. People that overdose on opioids usually do so by taking a significant dose that their body cannot compensate for the profound respiratory depression.

I hope this helps.

It is the same doctor that is prescribing the meds, so I would guess he would know about the interactions LOL! He put me on 15 mg of the Morphine twice a day, so that's not nearly as much as I was on before. The Vicodin I think is 5/325? I have to look at the rx again. I think really, I'm just terrified to go through the withdrawls again. It was the WORST pain/sickness I have ever gone through in my life. There really is no comparing it at all.

Withdrawals are inevitable for any patient on opioid therapy.

It makes me feel better that I can come off of it slowly this time, but yeah, I just don't want to go through that again. I know the reality though, without these meds right now, I'm going to end up frying my liver with as much medication I am taking. Blah......

Tapering down off of opioids will help mitigate the withdrawal symptoms.

The 5/325 Vicodin means that it contains 5 mg of hydrocodone (an opioid) and 325 mg of APAP (acetaminophen). The acetaminophen is what actually causes liver damage.

A lot of Spine Patients on Vicodin exceed the maximum daily dose of acetaminophen (4000 mg or 4 g). This is very easy to do, especially when patients are scripted 7.5/750 or 10/625 (these doses are used as examples). These doses are not only hard on your liver, but they can cause analgesic nephropathy (kidney damage that leads to irreversible kidney failure).

[Vanessa]

Justin,

Thank you for the insight and information! I have heard alot of people talk about being "opiod tolerant", does that mean that you have simply been on an opiod and are able to handle it? I know that might sound stupid, but sometimes I get confused which medications are opioids vs. non-opioid medications. One major reason being, I was on Tramadol for about 3 months at one point when this pain started. It is not listed currently as an opioid, but I can tell you I went through withdrawls after getting off of that medication. I argued with two doctors in regards to the fact that Tramadol was not an opioid, but it DOES act like an opioid to your brain and will sometimes cause you to withdrawl from it. Now I hear that they are going to label it AS an opioid drug LOL! Sometimes I get a little confused which drugs are derived from what. Also, the morphine, that does not contain acetaminaphine right?

I've been talking alot to my family and my husband in regards to the vicodin and the morphine. For right now, I am going to just take the morphine every 12 hours. I am going to see how that works without adding the vicodin in. I know my family and hubby are very concerned about the mixture of the two, as am I, so I am going to see how I do without adding the vicodin in. With all the issues I have with just my leg, I don't need a liver and kidney issue as well LOL!

Thanks again Justin ( and all the others) for this site, the information and the patience in helping others. I am so happy to have found others on this site who have already taken me in, messaged me and reached out to me. This place is priceless!!

[Justin]

Justin,

Thank you for the insight and information! I have heard alot of people talk about being "opiod tolerant", does that mean that you have simply been on an opiod and are able to handle it? I know that might sound stupid, but sometimes I get confused which medications are opioids vs. non-opioid medications.

Opioid-tolerant usually refers to patients that have been on opioid therapy. Although some technical definitions require a patient to be on at least 60 mg of opioid medication daily.

One major reason being, I was on Tramadol for about 3 months at one point when this pain started. It is not listed currently as an opioid, but I can tell you I went through withdrawls after getting off of that medication. I argued with two doctors in regards to the fact that Tramadol was not an opioid, but it DOES act like an opioid to your brain and will sometimes cause you to withdrawl from it. Now I hear that they are going to label it AS an opioid drug LOL! Sometimes I get a little confused which drugs are derived from what. Also, the morphine, that does not contain acetaminaphine right?

Tramadol is actually an opioid and works like an antidepressant as well (it inhibits the uptake of norepinephrine). The morphine does not contain acetaminophen. (However, they do make drugs that contain both morphine and acetaminophen.)

I've been talking alot to my family and my husband in regards to the vicodin and the morphine. For right now, I am going to just take the morphine every 12 hours. I am going to see how that works without adding the vicodin in. I know my family and hubby are very concerned about the mixture of the two, as am I, so I am going to see how I do without adding the vicodin in. With all the issues I have with just my leg, I don't need a liver and kidney issue as well LOL!

This is not medical advice or medical "opinion." Mixing morphine and Vicodin is not problematic. The "problem" is actually exceeding or being close to the upper limit of the 4000mg (or 4g) dose of acetaminophen a day.

Thanks again Justin ( and all the others) for this site, the information and the patience in helping others. I am so happy to have found others on this site who have already taken me in, messaged me and reached out to me. This place is priceless!!

Sure thing, Vanessa. It is my pleasure to help--remember, I was once in your shoes. SPS is pretty great, isn't it? I might be a little biased.

[Katie]

Morphine was/is the only pain medication that I tolerate. I have been taking the short acting (Statex) for almost four years now, and before surgery, I was up to 340 mg + a day. Now I'm down to between 30-60 mg depending on my activity level. I can walk for a long time plus sit for extended periods, just not on hard surfaces.

I was never taken off the medication for surgery, and it was over seven hours long. I was able to take what I needed the morning of, and post-op I just didn't need it nearly as much.

I only took the long acting occasionally, as it metabolized very quickly. Instead of twelve hours, I got maybe six hours relief, and had to take more than of the short acting. But dental anesthetic runs out quickly too. Breaking in a new dentist is tough, as they never believe that they have to top me up half way through

KBear has the same issues I think. It has been linked to those who have a gene for red hair.

I have learned that every person is so very different in what drugs they tolerate and how. It bothers me when doctors insist on treating us all like cookie-cutter versions, assuming that an average dose works for all.