Prescribing Tramadol and Norco together!

[Albo]

Just wanted to know you guys thought on this increased habit of physicians prescribing Tramadol and Norco together. I see this more and more often and technically being both short acting pain medications that work by similar mechanism it is not a proper treatment for pain. I don't think it was this bad when tramadol was a non controlled but since it became controlled doctors for some reason keep overprescribing it with other short acting pain stuff. Would you fill Tramadol and Norco together?

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[hye345]

I remember getting scripts like this on occasion. It does seem a bit overkill, but then again, I've never suffered with chronic pain, so...

 

[lapharmacienne]

Maybe you can ask the prescriber for level of pain for each (i.e. mild, moderate, or severe) so they are not being taken at the same time

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[Wickett]

Just wanted to know you guys thought on this increased habit of physicians prescribing Tramadol and Norco together. I see this more and more often and technically being both short acting pain medications that work by similar mechanism it is not a proper treatment for pain. I don't think it was this bad when tramadol was a non controlled but since it became controlled doctors for some reason keep overprescribing it with other short acting pain stuff. Would you fill Tramadol and Norco together?

I saw this today actually. I always call and confirm the doc wants them on both, as well as ask for justification/dx codes and document all this on each script. It's technically a category c combination, so I'll fill it if there's no other red flags and they provide all the info I ask for.

 

[Rockinacoustic]

Depends on the indication and how the patient was instructed to take the combination.

 

[rph3664]

I saw this occasionally when I worked in retail, 15-plus years ago. Chances are, both drugs work for the person's pain, but one makes them sleepy and the other doesn't, so they take whichever one is more appropriate based on this.

 

[BidingMyTime]

Just wanted to know you guys thought on this increased habit of physicians prescribing Tramadol and Norco together. I see this more and more often and technically being both short acting pain medications that work by similar mechanism it is not a proper treatment for pain. I don't think it was this bad when tramadol was a non controlled but since it became controlled doctors for some reason keep overprescribing it with other short acting pain stuff. Would you fill Tramadol and Norco together?

What rph have said.....this is commonly done, but patients aren't supposed to take them together. They take the tramadol during the day or when they have lesser pain, and the Norco at night or when they have greater pain. If there is any question, or if the patient's usage would suggest they are taking them together, then call the physician. Yes, I have filled both together & would do as long as was apparent that the patient was not taking the 2 together.

 

[ldiot]

I see this every single day of the week.

 

[guitar25]

This trend seems to be based on incorrect notion that Tramadol is less addicting or harmful than hydrocodone. Nothing could be further from the truth. Physicians need to be educated regarding this myth.

 

[iphetamine]

This trend seems to be based on incorrect notion that Tramadol is less addicting or harmful than hydrocodone. Nothing could be further from the truth. Physicians need to be educated regarding this myth.

so you, the Mr. Rph, want to educate the divine Dr. MD?

;-)

 

[guitar25]

so you, the Mr. Rph, want to educate the divine Dr. MD?

;-)

Actually, this is a very serious problem. This is why the FDA rescheduled Tramadol from C-IV to C-III. Pharmacists need to be just as vigilant. Everyone needs to be educated.

 

[zelman]

Actually, this is a very serious problem. This is why the FDA rescheduled Tramadol from C-IV to C-III. Pharmacists need to be just as vigilant. Everyone needs to be educated.

They did what now?

 

[zelman]

so you, the Mr. Rph, want to educate the divine Dr. MD?

;-)

The reason I think Ultram flew under the radar so long is that it isn't a major opportunity for abuse in people with wild-type CYP450 genes. But, once you get someone with less active 3A4 and overactive 2D6 enzymes it's a whole 'nother ball game. Look at this metabolic pathway and read the last sentence of the description: https://www.pharmgkb.org/pathway/PA165946349

 

[guitar25]

They did what now?

Pharmacists and physicians need to 1) warn patients about potential for addiction 2) watch out for patients getting both medications. 3) explain the problem of narcotic induced hyperalgesia to patients

 

[zelman]

Pharmacists and physicians need to 1) warn patients about potential for addiction 2) watch out for patients getting both medications. 3) explain the problem of narcotic induced hyperalgesia to patients

My response was insinuating that you got your schedules mixed up. It went from non-scheduled to schedule IV.

 

[VA Hopeful Dr]

This trend seems to be based on incorrect notion that Tramadol is less addicting or harmful than hydrocodone. Nothing could be further from the truth. Physicians need to be educated regarding this myth.

Umm... it is absolutely less addicting than hydrocodone. Its more addicting than, say, tylenol but less than hydrocodone.

I'd agree its more harmful, saw lots of tramadol-induced seizures in residency.

 

[maria1oh]

Gabapentin will start being listed in ohio PMP starting december. I wonder when that will be control.

 

[guitar25]

My response was insinuating that you got your schedules mixed up. It went from non-scheduled to schedule IV.

Yes...my error.

 

[ldiot]

Gabapentin will start being listed in ohio PMP starting december. I wonder when that will be control.

I imagine it won't be long. People eat that stuff like candy and even snort it

 

[rph3664]

My response was insinuating that you got your schedules mixed up. It went from non-scheduled to schedule IV.

It may be C-III in their state.

 

[zelman]

It may be C-III in their state.

Even if it is, "the FDA" wouldn't have done it.

 

[rph3664]

Tramadol came out shortly after I graduated in 1994, mainly as a substitute for Toradol after it went to 5 days' use only. Yeah, I know they aren't in the same class. There was even some discussion about making tramadol OTC until the abuse potential was revealed.

I know some of you find that a little hard to believe. Hey, lithium was a C-II for a while. That's more than a little weird to me.

 

[NateRobinson]

What is the issue?

Hydrocodone is a true opiate. Tramadol is opiate-like, but it works on serotonin levels as well. It's not a true opiate. It will not cause respiratory depression- because the dose required for that would be over 400 mg, and 400 mg is the seizure threshold, so you simply DO NOT take more than that in a day.

 

[Lnsean]

What is the issue?

Hydrocodone is a true opiate. Tramadol is opiate-like, but it works on serotonin levels as well. It's not a true opiate. It will not cause respiratory depression- because the dose required for that would be over 400 mg, and 400 mg is the seizure threshold, so you simply DO NOT take more than that in a day.

Yo Nate!!!! how's cvs man.