Comubox

[ntubebate]

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Anyone using Combunox in their practice? If so, in what instances are you using it and what are your results? I ask this because it's my understanding both Combunox and Vicoprofen are both going generic in the next couple of weeks.

Thanks in advance,
ntubebate

 

[Tenesma]

the manufacturer doesn't recommend use for greater than 14 days (if i remember right) so this shouldn't be a chronic med to begin with

 

[ampaphb]

the manufacturer doesn't recommend use for greater than 14 days (if i remember right) so this shouldn't be a chronic med to begin with

Oxycodone can certainly be used for more than 14 days - and given that it is going generic, what the manufacturer says has little bearing on how I would chose to use the product.

As for oxycodone combine with ibuprophen vs Tylenol, if you use Percocet for >14 days, I see no contraindication to using Combunox similarly, assuming you tell patients to eat before taking the product, and the potential elevation in their blood pressure associated with all NSAIDs

 

[lobelsteve]

Oxycodone can certainly be used for more than 14 days - and given that it is going generic, what the manufacturer says has little bearing on how I would chose to use the product.

As for oxycodone combine with ibuprophen vs Tylenol, if you use Percocet for >14 days, I see no contraindication to using Combunox similarly, assuming you tell patients to eat before taking the product, and the potential elevation in their blood pressure associated with all NSAIDs

As with all NSAID's:

1. GI bleed risk exists even if no symptoms are present
2. Cardiac risk exists but how severe the risk we do not know
3. Renal risk exists and BUN/CR need periodic assessment
4. Aseptic meniginitis risk is present in the literature, but appears more likely from case finding than an actual statistically significant risk. Data came out to support an anti-Cox2 agenda with cardiac risk factors.

 

[Tenesma]

it has nothing to do with oxycodone - or ibuprophen for that matter - we all have patients on both for many years --- i am just advising you of what the manufacturer states --- because technically if it went to court (cause patient had a GI bleed) and you didn't address risks/benefits in your documentation then that may be an issue

just an FYI

 

[ampaphb]

the manufacturer doesn't recommend use for greater than 14 days (if i remember right) so this shouldn't be a chronic med to begin with

it has nothing to do with oxycodone - or ibuprophen for that matter - we all have patients on both for many years --- i am just advising you of what the manufacturer states --- because technically if it went to court (cause patient had a GI bleed) and you didn't address risks/benefits in your documentation then that may be an issue

I'm only pointing out that we go off-label all the time with drugs like this,m and as long as you have a reasonable medical rationale for doing so, and cover yourself with good documentation regarding side effects, risks, and benefits, what is on-label vs off-label is not particularly of concern, and does not open you up to any additional liability

 

[Mister Mxyzptlk]

Here's a new combination drug that Art Jordan and I dreamed up 2 years ago. http://www.angelfire.com/biz7/nitro/

 

[Tenesma]

i mis-spoke earlier - manufacturer recommends for 7 days or less - i don't know of any other PO opioid with that recommendation ....

 

[ampaphb]

i mis-spoke earlier - manufacturer recommends for 7 days or less - i don't know of any other PO opioid with that recommendation ....

the 7 days is unique to Combunox, however the "lowest dose, shortest treastment duration" caveat is associated with ALL products that contain NSAIDS, and is not unique the Oxycodone/ibuprofen combo we are talking about

 

[Tenesma]

agreed

but show me any NSAID that has a disclaimer of use less than 7 days...

if there is a complication or issue that becomes a legal issue then this could easily become a point of contention - even though you and i know the science behind opioids and NSAIDs...