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My 19-year-old Daughter Was Diagnosed Several Years Ago With Ehlers-Danlos
Question: My 19-year-old daughter was diagnosed several years ago with Ehlers-Danlos Syndrome and POTS. She is used to living with pain but has been taking a low dose of Tramadol when she has her period (when the pain flares.) For the last six weeks, she has been having a severe flare-up, the worst she has ever had. The Tramadol was not working at such a low dose, so I bought some ampules of Tramadol (available without a prescription in this country.) After reading the dosing for Tramadol, for the last two days, I have given her injections of 100 mgs of Tramadol every four hours. This has taken the edge off her pain enough that if she lies perfectly still, she's not in agony, but she is still in severe pain.
A doctor today prescribed a drug regimen that I want to ask about. Her instructions were as follows:
Take 1 tablet of Oxycodone (20 mg) at breakfast.
Administer one injection of 100 mg of Tramadol at 1 pm
Take one to two tablets of Zaldier at supper. (Zaldier contains 325 mg. of Paracetamol and 37.5 mg of Tramadol.)
Reading up about mixing Tramadol with Oxcodone online, it said it was GENERALLY not done, adding that it increased the risk of seizures. But this is what the doctor prescribed for my daughter's intense pain. Is this safe? My daughter is NOT addicted to Tramadol. In the past, she has always stopped cold turkey because as soon as the flare-up passed, she didn't need to take it because the pain, a daily average of 7 on a scale of 1 to 10, was manageable without it. What about the Oxycodone? I've read that it is inadvisable to stop that abruptly. Any information would be greatly appreciated.
A doctor today prescribed a drug regimen that I want to ask about. Her instructions were as follows:
Take 1 tablet of Oxycodone (20 mg) at breakfast.
Administer one injection of 100 mg of Tramadol at 1 pm
Take one to two tablets of Zaldier at supper. (Zaldier contains 325 mg. of Paracetamol and 37.5 mg of Tramadol.)
Reading up about mixing Tramadol with Oxcodone online, it said it was GENERALLY not done, adding that it increased the risk of seizures. But this is what the doctor prescribed for my daughter's intense pain. Is this safe? My daughter is NOT addicted to Tramadol. In the past, she has always stopped cold turkey because as soon as the flare-up passed, she didn't need to take it because the pain, a daily average of 7 on a scale of 1 to 10, was manageable without it. What about the Oxycodone? I've read that it is inadvisable to stop that abruptly. Any information would be greatly appreciated.
Brief Answer:
Several points.
Detailed Answer:
The dose of tramadol is the larger risk of seizures. 500 mg or more injected is significantly more than the daily upper dose limit. A daily dose that is 1/3 of that is .. 1/3 less likely to cause seizures. the interactions with oxycodone of a total of 30 mg a day is not a big risk in general.
AND in specific, most people find that oxycodone is wearing off after 3 hrs and this is that long or more before the tramadol of 100 mg is given. This would seem to not coincide much with the oxycodone if it is given 5 or more hours previously.
Then, on the stopping of opiates abruptly. It is hard to predict but very very obvious to see if it is a problem. Withdrawal is quite uncomfortable, but is rarely associated with serious problems. WIthdrawal from opiates or tramadol--which has opiate effects and others--does not cause seizures at all commonly. It is an overdose of tramadol that causes seizures. And, a declining dose of tramadol would be expected to be less likely to cause seizures not more.
Signs of withdrawal are either very obvious with yawning, generalized severe pain...especially abdominal pain, with shakes and sweats....or... not there. If there is withdrawal that has to be managed with a slower tapering of opiates. The withdrawal might begin 12 hrs after the last dose but is more likely to begin at 24 hrs, peak between 3 to 5 days after the last dose and to be strongly decreasing after 7 to 10 days. If there is not much withdrawal, then there is not a problem with stopping oxycodone abruptly.
Several other points you have raised. Addiction is NOT pain nor even drug withdrawal. So, if someone is not craving drugs all the time and not using it with it causing bad effects, then addiction is not really demonstrated. The question does not seem to give any evidence of addiction.
Finally, there's a LOT of different drugs that often work with POTS. It doesn't usually have pain, and when it does there are two different syndrome complexes that are pretty obviously different. One is flu like muscle pains that are inflammatory. This is also quite likely to occur with collagen-vascular diseases. Tramadol might work; other controlled substances wouldn't be expected to be a good choice, and anti-inflammatories might be. There are many different chemical classes that work on inflammation. There is ibuprofen, naproxen, celebrex, aspirin that all have different chemical shapes while all working similarly. At least 3 different chemicals should be tried.
THen there is the more common POTS pain which is from sick nerves. This produces often burning feeling, it also has a different distribution--occuring in the feet and maybe hands more than central muscles. Painful nerves are treated by nerve pills. this may include tramadol but gabapentin, lidocaine, amitryptiline and other drugs would be more likely to work.
Several points.
Detailed Answer:
The dose of tramadol is the larger risk of seizures. 500 mg or more injected is significantly more than the daily upper dose limit. A daily dose that is 1/3 of that is .. 1/3 less likely to cause seizures. the interactions with oxycodone of a total of 30 mg a day is not a big risk in general.
AND in specific, most people find that oxycodone is wearing off after 3 hrs and this is that long or more before the tramadol of 100 mg is given. This would seem to not coincide much with the oxycodone if it is given 5 or more hours previously.
Then, on the stopping of opiates abruptly. It is hard to predict but very very obvious to see if it is a problem. Withdrawal is quite uncomfortable, but is rarely associated with serious problems. WIthdrawal from opiates or tramadol--which has opiate effects and others--does not cause seizures at all commonly. It is an overdose of tramadol that causes seizures. And, a declining dose of tramadol would be expected to be less likely to cause seizures not more.
Signs of withdrawal are either very obvious with yawning, generalized severe pain...especially abdominal pain, with shakes and sweats....or... not there. If there is withdrawal that has to be managed with a slower tapering of opiates. The withdrawal might begin 12 hrs after the last dose but is more likely to begin at 24 hrs, peak between 3 to 5 days after the last dose and to be strongly decreasing after 7 to 10 days. If there is not much withdrawal, then there is not a problem with stopping oxycodone abruptly.
Several other points you have raised. Addiction is NOT pain nor even drug withdrawal. So, if someone is not craving drugs all the time and not using it with it causing bad effects, then addiction is not really demonstrated. The question does not seem to give any evidence of addiction.
Finally, there's a LOT of different drugs that often work with POTS. It doesn't usually have pain, and when it does there are two different syndrome complexes that are pretty obviously different. One is flu like muscle pains that are inflammatory. This is also quite likely to occur with collagen-vascular diseases. Tramadol might work; other controlled substances wouldn't be expected to be a good choice, and anti-inflammatories might be. There are many different chemical classes that work on inflammation. There is ibuprofen, naproxen, celebrex, aspirin that all have different chemical shapes while all working similarly. At least 3 different chemicals should be tried.
THen there is the more common POTS pain which is from sick nerves. This produces often burning feeling, it also has a different distribution--occuring in the feet and maybe hands more than central muscles. Painful nerves are treated by nerve pills. this may include tramadol but gabapentin, lidocaine, amitryptiline and other drugs would be more likely to work.
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
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