AboutDr. Ravindra Bhaskar Ghooi Expertise I can provide information on drugs and medicines, their actions, uses, interactions and adverse effects. To avoid confusion, generic names of
medicines may please be provided. I am a pharmacologist, having worked
on animal and human pharmacology, and presently I am the Dean of Bilcare Research Academy, where we teach courses on clinical research. We dont work on saturdays and sundays, hence questions reachng me on these days will be replied on Monday, please bear with me.
Question QUESTION: Dear Dr. Ghooi:
I take Tramadol (Ultram) and Hydrocodone (Vicodin) for back pain and
occasional severe headaches. When I began the medications a few years ago,
I immediately noticed that they not only relieved the pain but helped me
sleep, which I realize is natural in opiates, etc. But in the last several months,
both these drugs seem to have the opposite effect on my sleep. While they
still provide pain relief, if I take either one near bedtime (say and hour or two
prior), I can't fall asleep. I feel very rested and tranquil in bed, but it's as
though I'm awake half the night. I find this strange. Can you offer any help
why this might be happening? I need to discuss with my internist but forgot
during my last visit.
Thanks very much for your time.
Ed
ANSWER: Hi Ed,
I am afrad you have developed a lot of tolerance to the opiate's sedative action. This often happens and when it does it is time to take drastic steps. When you use opiates for a long time, initially the sedative action is strong, but it diminishes with time, and at one stage produces the exactly opposite effect.
WHat you need to do is to stop use of vicodin, it will be difficult but it can be achieved with help. Be free of the drug for about 15 days and then restart it, the action will be back.
The trick is not to use these drugs continually for long, but give breaks in the middle.
Ravi Ghooi
---------- FOLLOW-UP ----------
QUESTION: Dear Dr.
A clarification: I do not take Hydrocodone every day--sometimes I'll go
several days or a week or so without needing any. And even when I do, I take
5/325 tablets and usually only one for the entire day. The most I've ever
taken in one day was two tablets and usually do not follow that the following
day with more.
The tramadol I use a little more often, but rarely take more than 1-2 per day.
And sometimes none.
Would this change your assessment? I realize over time one can built a
tolerance, but it's the sleep reversal that confounds me.
Thanks again.
Ed
Answer Hi Ed
It is indeed confounding. But I too have noted such changes with other medications. Some of my patients who drink alcohol report good sleep, on days that they do not drink they take a sedatve, they get good sleep again. But whe ever drnk is mixed wth a sedative the sleep quality and duration is cut down. We really do not know the reason for this, and likewise if you are not taking the drug regularly we do not have a ready explanation for the same.My suggestion is that you change the medication, in any case it is surprising that hydrocodone is so commonly used in your country, in our country we almost never use it to control pain. We find that ibuprofen and paracetamol are adequate for most types of pain. I would suggest you try it.
Ravi Ghooi
