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Narcotics and IBS-D (percocet/codeine/oxycodone)


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#1 JeffnSD

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Posted 27 February 2008 - 05:40 PM

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Hey All,I've been suffering with chronic IBS-D now for nearly two years. Its been so debilitating I haven't been able to work or even go out. I've had all the tests (everything is always normal) and have even tried the psychiatrist route with no help. I'm on Klonopin which helps with nerves but not the diarrhea at all and have been on a variety of anti-depressants which dont help at all.I'm at a loss here so I'm grasping at anything. I heard that narcotics slow the gut motility and some have had success with Tylenol #3 (with codeine) and want to know if anyone has had any luck with slowing/stopping the diarrhea with codeine, morphine, oxycodone or Percocet or whatever else I might not know. All my doctors are baffled too to I'm sure they're open to anything too. I'm sick of going to the doctor and nothing working!!Thanks for your advice.ps: I've also started taking L-Glutamine and Peppermint Oil capsules cause I heard that helps. Anyone tried those?JeffnSD


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#2 Kathleen M.

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Posted 27 February 2008 - 05:55 PM

Narcotics (anything derived from opium) tends to slow the gut.Imodium (OTC) and Lomotil (prescription) have the gut slowing activity without the pain killing or mind numbing effects of narcotic pain killers.The problem with long term use of narcotics to control diarrhea is that some people will get Narcotic Bowel Syndrome which is more painful than IBS and it is hard to get off the narcotics to break the cycle of them causing additional abdominal pain.Have you tried Imodium or Lomotil?They don't hit the pain receptors the same way as the narcotics so usually aren't a risk for narcotic bowel syndrome.You might look at Calcium Carbonate (LNAPE's info OTC) or Questran (prescription) to control the diarrhea before risking the narcotics. Questran is in the list of things in a review of medications for IBS in the New England Journal of Medicine back about 2000 or 2001 I believe in June or July if they have a problem trying that and need a source of information about it.K.
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#3 code9

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Posted 28 February 2008 - 05:41 AM

Yes, Kathleen is right. Codeine works, 120mg + Lomotil works for me. I've taken hydrocodone and morphine and just plain old codeine.From what I have found, after using Codeine for many years, is that I believe it affects my memory. Long term memory specific to the times I was on it. Also, it will be damn hard for you to get codeine that doesn't have tylenol or ibuprofen. I had a prescription for a while and had a hard time find a pharmacy that could even fill it. Tylenol #3s have a lot of tylenol for not much codeine. I think they tend to hurt the gut as much as they help. Depending on your genetics, it's possible to become addicted as well. (Some people have no problem with opiates while others will be nearly hopelessly addicted, it's not something doctors like to chance. I don't really agree with them or the DEA on that, but such is the country we live in, or at least I live in anyway.)They do work, but they are far from ideal, I gained weight, had memory problems, and they would only work for 8-10 hours, as soon as they wear off the D is back. For me Lomotil and Zofran work much better, all things considered. If lomotil doesn't work on it's own, opiates also have a tranquilizing/calming effect, but you can get that from librax or klonopin, or even valium.I have read Lomotil has a much less powerful effect on the brain than other opiates, although I think you slowly gain tolerance to it, like you would an opiate. But I've taken it for years.Overall, considering how hard it will be to get an opiate that's not full of a gut harming adulterant (tylenol, ibuprofen), I would try Lomotil first, see if you can stop it with that, maybe add one of the new drugs. I'm trying to move to lotronex if possible

#4 JeffnSD

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Posted 16 March 2008 - 02:38 AM

Yes....I use Imodium all the time. Its the only thing that stops me up...but I've noticed I'm growing immune to it effectiveness. I've also tried both Lomotil and Questran and they did nothing for me.I've been doing that Calcium Carbonate thing for quite awhile too. It might somewhat form the stool cause my diarrhea is never water but more of a sludge or loosely formed. But I question whether the Calcium is doing it for me. I even switched from the Caltrate brand that has the evil magnesium in it to a pure Calcium carbonate 1000mg gelcap and take that after every meal.I'm still at a loss here. I asked the doctors about the narcotics and none of them would even consider treating me with that. Right now I'm back to the Klonopin and slowing increasing that to 3x a day and just started the anti-depressant desipramine. But so far no results. My GI doctor, which is apparently one of the best, is now considering me a candidate for Lotronox. The one that killed all those women and the FDA pulled it but recently put it back on the market for only a select few doctors to prescribe. I'm just hesitant to even go there. That frightens me.

#5 Kathleen M.

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Posted 16 March 2008 - 05:31 AM

There was a handful of women, and it isn't even clear if Lotronex was the cause. Some people get Ischemic Colitis anyway (and it has been associated with a lot of medications over the years, some that are available over the counter) and there is some thought it may trigger it if you are prone to it. Just some people prone to it anyway may show up as potentially having IBS (and it was also being prescribed to people with IBS-C because doctors weren't paying attention to the "only for diarrhea" thing, which probably didn't help).In any case the percentage of people that get IC taking Lotronex is extremely low. If you catch it early it is a very treatable condition. First sign of bloodiness in the stool stop taking it and go to the doctor or ER to be checked.It isn't significantly more lethal than anything else. Lots of drugs everyone thinks are "safe" kill way more people. They didn't pull it because it is too deadly to be on the market (and it was pulled by the company voluntarily) They pulled it because the only thing every IBSer ever needs to be 100% better is to eat more fiber and anything riskier than eating a bowl of bran flakes in the morning was an unacceptable risk. A lot of people from this board were involved in educating the FDA that IBS is, in fact, a serious disease and the only way they could testify before them was in diapers because they didn't have the one drug that ever worked.The patient response to the removal of the drug was unprecedented because IBS is serious and there needs to be treatment and not having any treatment at all specifically for IBS was something the patients weren't going to put up with anymore.All treatments for all diseases have risks (and almost all of them can kill people). IBS was being held to a completely different standard of no risk at all is allowed because too many people want to believe the lie we'd all be right as rain if we'd just eat some fiber.Honestly, if Lotronex was treating acne it would have never been pulled for the very small number of deaths, it would have just gotten a rewrite of the warnings with a strong see your doctor if in the instructions..K.
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#6 celestin

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Posted 16 March 2008 - 05:38 AM

A lot of people from this board were involved in educating the FDA that IBS is, in fact, a serious disease

Really? When, how, officially? Could you give some details?Thanks..

#7 Kathleen M.

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Posted 16 March 2008 - 07:58 AM

If you look at the Diarrhea specific medication part of the board: http://www.ibsgroup....hp?showforum=30Back around 2001-2002 you will find a lot of the discussion going on back then about the voluntary withdrawl and the fight to get it back on the market.Jeff, the owner of the board, also started the Lotronex Action Group. Here is the webpage with that with information about the struggle.http://www.geocities...up/mission.htmlThe one thing I remember most was when the FDA said how many complaint letters they got. Usually if something is withdrawn (either by the FDA or by the company that makes it) they get a handful of letters of complaing. However, usually there are several other treatments people can try. With the removal of Lotronex they got over a thousand which was like 1% of all people who had used the drug. K.
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#8 celestin

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Posted 16 March 2008 - 09:39 AM

Thanks, but this is mainly related to Lotronex. I had understood IBS-D and FDA.

#9 code9

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Posted 16 March 2008 - 10:14 AM

JeffnSD,Knowing what I do now, I would try Lotronex. (Still waiting on mine). Or you could try Zofran and see if it works, it would be an indicator I believe, since they work in a similar manner, only I'm told Lotronex is much better.You'll basically never get narcotics out of a GI. I mean, sure if you visited 300 of them, one might consider it. But the general rule is that they'll never give you narcotics. One did for me for 6mos, un-adulterated codeine. I printed out reams of info on codeine, ibs and diarrhea and got into a shouting match with him over whether he should even read the info or not. It is basically never going to happen long term.There are other sources of opiates, if all else fails, pain clinics, online doctors/pharmacies in the US. (Although all the ones I know of have been shut down.) And these places are not particularly cheap or reliable, they get shut down.How much lomotil did you try in the past? I take up to 9,10,11 a day at times, it's been cut down because the Zofran helps a lot, but it's a low dose, I still use lomotil to supplement it. I think you can basically take lomotil till the D stops. It's probably as close as you will get to an opiate, legally.But given all the stuff I've tried, i'd go for the lotronex. I'd be willing to bet acetaminophen has killed more people that lotronex ever will. I mean that seriously, i'd be willing to bet money on it, a lot. Anyway, if you can get lotronex, I would try, just follow the instructions, Kathleen laid out all the things to look out for. Most of the people who got ill, from what I have read, continued to take it long past when they should have stopped.There's an old saying, the only difference between a poison and a medicine is dosage. And that applies to pretty much any medicine, especially for IBS when they are throwing in atropine, and hysocyamine, things that come from the deadly nightshade, for instance. If it doesn't work, or seems to be making you ill, do what Kathleen says, stop and go to the ER.If you are still worried, I've been taking Zofran for a quite a while now, it doesn't last long, (6 hours) but it is fairly cheap, and would probably be an indicator, since it is a 5-ht3 antagonist as well. But it has stopped the D for me when combined with lomotil and klonopin. (Not sure the Klonopin plays much more than an ancillary role, there's no doubt in my mind : IBS causes anxiety; Anxiety does not cause IBS.)

#10 Kathleen M.

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Posted 16 March 2008 - 10:42 AM

The conversations with FDA were primarily about Lotronex, but the point was that IBS requires treatment http://www.geocities...ormactiongroup/ is the sister group for Zelnorm.I'm not sure what else the question you are asking has to do about.This group, especially Jeff has worked hard to educate those that make the decisions about what medications are allowed on the market (the FDA in the USA) that IBS deserves to be treated and not just blown off as something so insignificant that there should not be any drugs at all ever available for it.http://health.groups...m/group/ibspag/ is the yahoo group (they were combined into the IBS patient action group awhile go) is still a resource people can use.If this isn't answering your question (people here are involved with the FDA about decisions concerning medication, which to me is in part educating them that fiber alone is not nearly enough) can you tell me more about what you are looking for.K.
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#11 celestin

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Posted 16 March 2008 - 12:27 PM

can you tell me more about what you are looking for.

First of all I am looking for a good treatment.. :( Actually it was more a surprise than a question. I did not know that patients (groups of) had contacts with the FDA at a high level. Good thing of course.But if it is so, why are the gastroenterologists so negative with IBS/D ? In my country with an IBSD sufferer they do the usual tests (usually forgetting the Giardia...) and after it's done. When you come back -still complaining- they look at you 2 minutes and they give anything. And as soon as you are out they start laughing with the nurse (or the student) : 'hé hé again one of those patients with psychological problems..". And Belgium is supposed to have a (very?) good level in medicine.Do you know how many gastroenterologists read -regularly- this board?And yes, fiber alone is not nearly enough...!!!Thanks

#12 eric

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Posted 16 March 2008 - 01:04 PM

FYINarcotic Bowel article in GI & Hepatology News NEWhttp://www.gastro.org/user-assets/document.../GIHEP_0108.pdfCelestin"Fibromyalgia and irritable bowel syndrome: How real must they be?http://www.aboutibs....commentary#Realhttp://www.ibsgroup....showtopic=92806http://www.aboutibs....iffgd/advocacy/http://www.aboutibs....r/video-corner/http://www.med.unc.e...n_materials.htmhttp://hopkins-gi.nt.../...3&lang_id=1
I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

#13 Kathleen M.

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Posted 16 March 2008 - 01:06 PM

Unfortunately even with our efforts (which took finding the right people to talk to who will listen) and the efforts of other organizations (like the IFFGD http://www.iffgd.org and the doctors on the Rome Committee, which is a group of researchers who are experts in Functional GI disease) a lot of doctors are at least 10-30 years behind in their understanding of IBS and other functional GI diseases.Hopefully more doctors will finally see the light, but it is a slow process and the "IBS is no big deal" idea can be very hard to change. I think why the patients got the attention of the FDA here in the USA is that there were so many people and a lot of hard work by those who were ready to fight for the cause that they really couldn't ignore us anymore.Unfortunately it seems doctors aren't even keeping up well with the medical literature (some are, a lot are not) much less reading boards for patients.K.
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#14 code9

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Posted 16 March 2008 - 03:40 PM

Celestin, They do the same thing in this country, believe me. It's very hard to get IBS-D treatment, there just isn't that much they can do really. Unfortunately. I've mentioned it several times before, but Michael Gershon's book, "The Second Brain", holds quite a bit of information about IBS and the malfunction of the large intestine.Eric,I have taken codeine and various opiates for years, every day for years. I have never experienced narcotic bowel. The point is to maintain regular bowel function. The amount of opiates it would take to cause severe long-term constipation would be quite large, and as far as I know, is seen amongst addicts attempting to achieve a high in the brain, not normality in the gut.

#15 Kathleen M.

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Posted 16 March 2008 - 04:34 PM

The problem with narcotic bowel isn't that you take doses so high you severely constipate yourself on some sort of long term, post drug time frame.The problem is that for SOME people (not every single person, but more than just a few) the narcotics after some period of continued use change something in the nerves of the GI tract so that you have much more pain, and much more difficult to control pain than the IBS-pain you had before you started taking narcotics regularly.Now some people will never get this, but you don't have to be an addict on extreme doses for decades. It happens to some people in the sorts of doses and time frames you see after an injury. The problem is then they are given more narcotics for the additional pain which just increases the problem and it escalates. Once a doctor finally realizes what is going on it takes time and the right treatment to break the cycle of sensitization and get someone back to the levels of pain they would have (and treat that pain) if they had never taken narcotics.The pain sensitization problem is why they sometimes don't even want to use them "just" for severe diarrhea unless there is no other way to treat it. Making the problem much worse in the long run isn't helpful.Hopefully you are one of the ones that this never happens to. From what I've heard it can be extremely painful.K.
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#16 JeffnSD

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Posted 16 March 2008 - 05:55 PM

After reading all the posts in response to my question...the fact comes down it all depends on your doctor/GI specialist or whomever to write a prescription for you if they understand or not. I saw a GI doctor for 7 months and he basically shoved me to a psychiatrist and then he sent me back to a GI doctor. I followed up with my old GI doctor (since I had this long relationship with him...and he basically said there isn't anything he can do anymore). Just shows you he doesn't understand or keeps up to date with the latest and how debilitating it is. So onto the next doctor.I checked with my insurance and I'm not even covered under Lotronox since its a brand name unless I want to pay hundreds of dollars. Just isn't an option for me.I think right now I will do my best and revisit the Lomotil and maybe try higher quantities and toggle back and forth between that and Imodium. (My old GI doctor said to take 1 lomotil a day) Now I'm understading what a moron he was so maybe a higher dose can help. I recently read about Motofen (which is apparently now out of stock until 1/09) but I live in a major city and called a few pharmacies and they still have it on their shelf. So I might attempt that and see if I can manage. I do agree with the previous poster that anxiety doesn't cause IBS...IBS causes anxiety. So the Klonopin I take helps ease my worries..but it doesn't help the diarrhea, urgency or knowing where every bathroom is or the fact I rarely leave me house. Its sad when you're a single 37 year old guy who cant even go on a date. How do you explain that to a potential mate? Hello...baggage and their onto the next one. LOLThanks for everyones comments!!!JeffnSD

#17 eric

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Posted 16 March 2008 - 06:26 PM

IN IBS there is pain because of a lowered threshold to pain from specific cells in the gut. Narcotics also effect those receptors and lower the pain even further, it is a big problem although as mentioned not every single person perhaps, but even some people may go from discomfort to mild pain or to sever pain on long term narcotics on top of the pain already generated with IBS."IBS causes anxiety; Anxiety does not cause IBS"Its extremely important here to understand this more fully which some of the posts above do and although just anxiety by itself if you don't have IBS will not cause IBS anxiety on top of IBS is a big part of the picture in triggering symptoms. Its important to step back and look at this from the bigger picture as well as the fine details. Anxiety can trigger the hpa axis and the fight or flight and directly effect mast cells in the gut that can contribute to the symptoms. They are an extremely important area of IBS research as well as enterochromaffin cells. The brain and the gut are in constant bidirectional communication with each other constantly. This is really important.This helps explains things"Brain-gut – The brain plays a role as well. The brain and the gut are connected. Thinking and feeling can have affects, influencing release of proteins that interact with the nervous system (neuropeptides), which can affect motility, secretion, blood flow, and inflammation. Stress may influence inflammatory pathways causing a dysregulation that can lead to emotional conditions and more stress – a vicious cycle. It is not a question as to whether this cycle begins in the gut or in the brain. The problem is that both systems are effected concurrently thus producing a disturbance of the regulation between the brain and gut; a “vicious cycle” with no beginning or end. Understanding this will open the door to more specific treatments. We can see examples of brain-gut interactions by looking at post-infectious IBS (PI-IBS) or dyspepsia. A study done after a salmonella infection outbreak showed that 10–15% of patients continued with their symptoms of either dyspepsia or IBS after the initial infection subsided. Some recent studies show that this is associated with greater levels of immune cell activity. In IBS, the subgroup of patients with diarrhea as the predominant bowel symptom is the group where more of this inflammatory response is seen; there is also increased psychologic distress occurring at the time of the initial infection, which may be enabling the post-infectious response. In the gut we see infection followed by an inflammatory response, altered motility, and increased sensitivity. But these factors alone are not enough – the brain has a role in regulating these factors. If there is psychological distress around the time of the initial infection, it can result in the expression of the post-infectious symptoms. Thus, the brain and the gut are interacting so with this disorder the brain can influence the inflammation in the bowel while the bowel inflammation can produce psychosocial – emotional and social – distress. Similarly the pain experienced may occur more when there is psychological distress. Both factors are predictive of post-infectious IBS. Since post-infectious IBS has inflammation in the intestine, it challenges the concept of functional vs. structural, since there are features here of both. "http://www.ibsgroup....showtopic=92806Both the brain and gut brain are operational to cause the symptoms of IBS. The systems that are connected to the mast cells and enterochromaffin cells and the cells themselves are very important players in the puzzle of IBS both of which can basically cause all the symptoms of IBS although it is not all completely and fully understood yet.A persons emotions effect their gut function and gut function effects peoples emotions. But its a lot more complicated.
I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

#18 code9

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Posted 16 March 2008 - 07:00 PM

JeffsND,Yes, 1 lomotil will probably not be enough. I think the max recommended daily dose is 8, I'd talk to a different doctor. You might try to find another source of Lotronex, but I'm not sure how you might get it w/o insurance. I'm still not positive mine will cover it. But you might try Zofran, it just went generic, it is normally for nausea, chemotherapy nausea specifically, but you could probably get it if you tried. It's considerably cheaper, and it works better than codeine for me. Still not perfect, but it's alright.How much Klonopin do you take? If you are still that anxious, you may need to up the dose. Valium was incredibly effective for anxiety in me, but it made me too tired, so I am sticking with Klonopin. Of course, when I feel well, anxiety disappears completely. It's all related to how I feel in the gut. If I feel fine in the gut, a situation that would normally be filled with anxiety is completely fine. I know the brain and gut are in constant communication, but it seems to me that the gut is causing anxiety. A very real fear of defecating ones self will probably cause anxiety in anyone, and probably should. Anxiety when you feel well is a problem. Anxiety when you are anxious about something completely normal is not.

#19 code9

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Posted 16 March 2008 - 07:06 PM

Kathleen and Eric,Are you serious in that, say, 120mg of Codeine or 12mg of Morphine for just a few weeks, even if it doesn't cause constipation, can in some people severely lower their pain threshold? I have never heard of this. I've heard of narcotic bowel in long term addicts or high doses of opiates, but never heard of any cases on such a low dose of opiates. How often does this occur? Is it a valid reason for not using Codeine?In my experience, Codeine has just as much gut slowing effect has Morphine or other more powerful opiates. So, a low dose of Codeine can be very useful in the treatment of IBS. I always assumed it was the fear of addicts running around and fear of losing their license to the DEA that stopped doctors from prescribing this.I'd be interested to know if there is any real threat from narcotic bowel at these doses in IBS.I'd also be interested to see some information showing that opiates affect pain tolerance in relation to 5-HT3 receptors or whatever other receptors may be involved in IBS.Thanks.

#20 Kathleen M.

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Posted 16 March 2008 - 08:12 PM

There is some recent articles in the medical literature, prior to the last year or so there wasn't a lot written about it in detail.http://www.ibsgroup....=narcotic bowel is one that I posted about.It can happen to people who are not addicts using 10X what anyone else would use for long periods of time. That sort of abuse of drugs can cause all sorts of problemsBut like any side effect it only happens to some people.You may be one of the ones that would never have a problem and won't get it from the doses you are taking. High short term doses (like after some surgeries/injuries) or chronic uses for IBS/functional pain can trigger this in some people. This is at doses your doctor would prescribe you.I'm not sure what the incidence is, but it seems higher than most people believe in people taking pain medications at doses that are typically prescribed.That is one of the reasons it is a "last resort" sort of treatment rather than something you try first.However, you may be perfectly safe at the doses you take, but if you notice escalating pain it may be a sign you need to do something different, not just take stronger narcotics or a higher dose.K.
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