Expert: Caroline West - 7/30/2010

Question
Hi Caroline...I've been taking Tylenol with Codeine since 1993. At first I just used it when my fibromyalgia or migraines were not responding to anything else. Slowly over the years it has built up to now taking 6-7 per day. I've been trying to wean myself off this med for the past 10 days or so...I'm down to 5 a day. I do have 5 chronic pain conditions with no other real treatment besides these painkillers (which really don't provide any relief...they just keep me from going into WDs now). Do you think tapering down is a good thing for me? I seem to be backsliding some. I told myself this last prescript for 100 was the LAST...but found myself ordering another refill just yesterday. I can't get them for a few days and I'm not out...just trying to continue to taper down. My question really is, is tapering down for a month too short of time? In other words, I immediately started taking 5 a day for 5 day, then 4 a day for 5 days, and I'm supposed to be on day 3 of my 3-a-day taper and have backslid. Maybe I'm tapering too fast? I don't want to fail this time! People practically laugh in my face when I tell them I'm trying to get off Tylenol 3...but they don't realize how difficult it is to get off the codeine part of it.
Thanks for any help,
Marguerite

Answer
Hello Marguerite. I will give you my honest advice because I am all too familiar with coming off from Codeine based painkillers and there Is a right way to go about it and this I will explain to you.

Firstly,30mg Codeine is quite a high amount and basically,yes you are going way too fast,but I do understand why you want to come off it which is because frankly you have had enough of being on them and you want to be free of them. Unfortunately,this is no easy task and you have to do it very,very gradually or you will definitely fail,but not all hope is lost as it can be done and I am going to give you a brief frame of time in how you should go about doing this.

Scrap your current plan of action all together,it's not going to work,it is too fast. Start from fresh as of now. Go back up to a starting point that you are most comfortable with,6 or 7 tablets daily. Personally I would say start at 7 only because you have backslid and your body now needs that extra bit to compensate for the shock you have just put your body through by cutting down so quick. Stabilize for 2 weeks and then cut down to 6. Stay on 6 for 1 month. This has to be done like this,trust me,I have done this before and succeeded. Then cut it to 5 for a further month. Just to let you know,the lower you get down,the slower you have to go and the more you are going to feel it. Then cut down to 4,again for a month. Don't forget,you have been on Tylenol 3 for seven years,you are Not going to be able to come off it in a few weeks,that is the reality of it and the plan I am giving you Is the best way to do it (you can always print this information off to show to a Doctor for a 2nd opinion). You are now down to 4 and you should still be feeling comfortable as you have 120mg Codeine to hold you than when you started at 210mg,so congratulate yourself when you get to this point.

Now,you are going to have to slow it down even more. Take 3 tablets now for a month,but,buy yourself some Tylenol 2 which has 15mg Codeine in it and take one of these as an extra on alternate days for 2 weeks of that month and then stay just on 3 a day for the rest of the month. You may start to feel uncomfortable now,and if you do then stabilize on 3 a day for another month. This is The only way to do this,it's slow but the right way to do it bearing in mind you have been on them 7 years,trust me on this. Once you are stable and at ease on 3 a day then you cut them down again. If you are Not stable,then maintain for another month.

So,you are now on 90mg Codeine daily and much,much better than at the start of 210mg. Marguerite,please bear in mind that you have physical conditions that required you to take these in the first place and when you have fully reduced,you will still have these problems so how will you cope having nothing to ease the pain? You are going to want to take something again and before you know it,you will be straight back on Tylenol and back at square one. There is Nothing wrong with taking pain killers and the right amount for valid medical reasons. It actually would be better for you to use the plan that I have outlined for you and just stay on Tylenol 3 three times a day. That in itself is a massive achievement and you will be doing yourself a favour in the long run. You still have reduced by more than half and 3 daily is acceptable. Please think about this seriously and realistically.

I want you to think about what I have said,take my advice and just do the plan offered and then stop at 3 tablets a day and see how you feel. You will have a much higher rate of success if you want to reduce again in the future,but it is going to take a long while. If you don't want to do this and you are adamant on coming right off of them totally,send me a follow up and I will write a reduction plan up for you to get you completely off them. But first consider what I have said. There is Nothing wrong with taking medication and 3 Tylenol a day is far more less damaging than 7 a day.

I know how hard it is with Codeine,I really do,but like I said you still have medical conditions that Need pain relief. So do you want to give what I've said a try? I think you should. However,as I also said,if you seriously want off them completely and you have really thought this through and got a 2nd opinion if you want one,then write to me again and I am more than happy to continue to give you a safe and as painless as possible reduction plan. I do have your best interests at heart. Best wishes,Caroline.