Brief Answer:
Stop tramadol within a week. No other medicines.

Detailed Answer:
Hi Mr XXXXXXX

Welcome back to Healthcare Magic!

Your liver is steadily worsening because of your opium use and use of medicines. I had clearly explained it to you in your last query too that ideally you should not take any medicine and try to tolerate the withdrawal symptoms, but if you are insistent on using medicines, then Dr Mahajan's prescription was better than the other doctor's.

The medicines for withdrawal are to be used only for a few days and then tapered off. You need to do the following under your doctor's care:
1) Stop opium immediately
2) Tramadol should be reduced in dosage every two days and stopped within a week. It is simply to help you quit opium and not to be continued for long.
3) Lopamide is to be taken only if the loose motions are unbearable. Do not take more than a tablet a day. After ten days, do not take Lopamide again. If you take lots of fluids including oral rehydrating solutions (ORS), you will not need to use Lopamide.
4) I feel you need not take Normaxin or Stelbid as I do not think you have irritable bowel syndrome, for which these medicines are given. I had explained this in my last answer as well. From the history your wife had given, it had appeared to me that you were having opioid withdrawal symptoms. If this is not the case, then rather than taking opium for loose motions, consult the doctor who did the liver transplant.

Stop opium immediately and Tramadol within a week. You will have some discomfort for the next few days but then you will have to tolerate it rather than taking medicines for it. Once your body gets used to functioning without opium, it will start getting better. You should not take any other medicine without consulting the doctor who did the liver transplant.

Hope you have understood this clearly this time. Feel free to ask if there is any confusion.

Best wishes.

Dr Preeti Parakh
MD Psychiatry

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Brief Answer:
Both Tramadol and paracetamol can harm you.

Detailed Answer:
Hi Mr XXXXXXX

All medicines, whether it is tramadol or paracetamol, that are metabolized by the liver have the potential of harming your liver. Though single doses of both will not be harmful, but when continued for long, both can harm your liver.

The other thing is I do not know why your doctor has asked you to take tramadol for so long. Tramadol is used to manage the withdrawal symptoms of opium and should be taken only till the withdrawal symptoms are troublesome, and then tapered off. If taken for long, one may become dependent on it just like opium.

Regarding Olanzapine (Consern 2.5 mg), which is an antipsychotic, I do not know why your doctor has prescribed it. My guess is that he thinks you are suffering from Irritable Bowel Syndrome (IBS) and wants to use it in place of Stelbid which is another antipsychotic that has been found useful in IBS but didn't suit you.

My suggestions to you are:
1) Take as less medicines as possible. Almost all medicines are metabolized by the liver and can harm you.
2) Stay away from all substances which can make you dependent on them, like alcohol, opioids including opium, tramadol, Addnok etc. All these harm the liver.
3) If there are frequent stools, let them occur rather than using opium or medicines to stop them. Just take lots of fluids and avoid dehydration. No one dies from having to go to the toilet frequently, but one may die from liver failure.
4) Consult your hepatologist if frequent stools are troublesome. He may suggest changes in the diet which can help you. Even taking fibrous items like isabgul may be helpful.

Hope this helps you.

Best wishes.

Dr Preeti Parakh
MD Psychiatry

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