Time-Release Meds

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cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 785
   Posted 1/13/2011 12:48 PM (GMT -6)   
Hi,

I've been using Ultram ER for about 4 years, moving from 200mg to 300mg. It probably is losing its efficacy and also I think my pain is just getting worse.

Since it is so expensive ($800 for a 90 day supply), I'm going to finish what I have before talking to my doctor about trying something different. We've already discussed moving to 400mg, but he won't prescribe it due to the risk of serotonin syndrome.

I typically use 10-15mg of hydrocodone mid-day during the days I'm working as it doesn't interfere with my concentration. Other days, I'll take 5-7.5 mg of oxycodone.

I'm now also taking these break-through meds about 15x per month, whereas a year ago, it was more like 8-10 times per month.

So, I'm wondering about what time-release opioid I should move to? Would the next step be oxycontin, or are there others somewhere between that and the Ultram?

I'd appreciate hearing about your experience with the time release options.

Thanks.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs)
RT hip and SI joint damage from car accident
Current meds: Ultram ER 300mg daily, daytime breakthrough - hydrocodone 10-15mg, nighttime breakthrough - tapentadol (nucynta) 5-10mg.

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 11301
   Posted 1/13/2011 1:07 PM (GMT -6)   
Hi Cogito and welcome to Healing Wells chronic pain forum. I am sorry that you have to be here but glad that you found us. It is nice to know there is a place to go to when suffering with CP and know there are many just like you out there. Sometimes our pain tends to isolate us.

You know this question about medication change is asked a lot and really no one here can answer your question. None of us are drs for one thing. Another thing is we all react so differently to medication and it is an individual thing for us. There are many different pain medications on the market for your dr to pick from and many very good ones too. What may work for me may not even touch your pain. You mentioned Oxycontin, many of the people we hear from have difficulty finding a dr willing to write a script for it or the dr will flat out refuse to rx it to a patient. Really that is up to the dr. I would not ask for a medication by name that usually is a red flag for a dr when a patient comes in asking for a certain one.

Anyway I wanted to pop on and tell you welcome aboard. Good luck on your next dr appt and hopefully your dr can come up with something that will help you out.
Moderator Chronic Pain Forum

All-Seeing Eye
Regular Member


Date Joined Oct 2010
Total Posts : 183
   Posted 1/13/2011 1:15 PM (GMT -6)   
My doc was prescribing me vicoprofen 7.5/200 as needed for neurological lyme. They were only lasting a couple hours so he switched it to oxycontin 15mg. He considered it the next step up. He didn't want to give me any combo product as the ibuprofen/tylenol/aspirin is counterproductive by inducing pain in my digestive tract.

spinal soldier
Veteran Member


Date Joined Dec 2009
Total Posts : 618
   Posted 1/13/2011 2:10 PM (GMT -6)   
hello, i just typed up almost my whole reply and my computer rebooted, so i'm condensing this. people are giving up OxyContin and switching to morphine, methadone, Opane ER, or the Duragesic patch because OxyContin is a new formulation that is supposed to be more abuse deturrant. i took the 80mg three times a day and it was not as potent as the 40mg from what i remember. i like the generic MScontin made by Watson or Endo Pharma. i take 100mg 3x per day and it is steady and i never feel it wear off early and you can go a few hours before you realize you missed a dose. morphine and dilaudid are the best pain killers for me and depending were you live you may have HydromorphContin or Exalgo as a option. with what you take you could start at 15 or 30mg Morphine Sulfate ER every 8 or 12 hours and keep your Vicoden for breakthrough. in fact the Lortab or Norco would be better because they have less acetaminophen: 500-lortab, 325-norco. they also go to 10mg of hydrocodone. you still have many rungs on the ladder before you become " tolerant ". best wishes!

Dagger
Veteran Member


Date Joined Apr 2008
Total Posts : 1522
   Posted 1/13/2011 6:48 PM (GMT -6)   
I have read that others find regular Ultram to be more effective than the ER version. This might be worth a try if your doc doesn't want to go to narcotics. Generic tramadol is $4.00 at Walmart and Target so it won't cost much to try it.

Alcie
Veteran Member


Date Joined Oct 2009
Total Posts : 3459
   Posted 1/13/2011 10:31 PM (GMT -6)   
I'm one of those who didn't get much relief from tramadol ER, but I get good relief for 4-5 hours from the regular one. I've gone back to the regular version. The only thing is to take it at the same times each day and not wait until you are in pain because it takes 45 minutes or so for it to start working.

I don't take tramadol at night because it keeps me awake. It's great for getting up and going in the morning.
Alcie
 
 

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 785
   Posted 1/14/2011 9:40 PM (GMT -6)   
Thanks for the replies.

During the first few years of taking Ultram ER, I though it was great. Not only did it help with the pain, but also broke through my depression.

I've used immediate release tramadol but it doesn't do much for me anymore.

My PM is militant about having his patients on a time-release med, so if I wanted to try something other than the Ultram ER, it will probably be Oxycontin or MS contin.

Too bad there's so little else, not even time release hydrocodone.

Also, does anyone take oxycontin or MS Contin just once a day? It seems that standard formulations are for 2x daily?
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs)
RT hip and SI joint damage from car accident
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .5mg ativan as needed for sleep.

Alcie
Veteran Member


Date Joined Oct 2009
Total Posts : 3459
   Posted 1/15/2011 2:56 PM (GMT -6)   
BTW Cogito,
There is no reason to be spending $800 for Ultram ER. It's available as generic tramadol ER.
Alcie
 
 

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 785
   Posted 1/16/2011 10:49 AM (GMT -6)   
Alice,

There's a generic for the 100mg and 200mg doses, but not the 300mg :(
But even the generic prices are fairly high -- about $350 for 90 days... though I know it is much cheaper in Canada.
Do you know of any generic versions of the ER that are available in the U.S. and are truly cheap?
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs)
RT hip and SI joint damage from car accident
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .5mg ativan as needed for sleep.

stingray
Regular Member


Date Joined Oct 2009
Total Posts : 174
   Posted 1/16/2011 3:02 PM (GMT -6)   
Hi Cogito
I take oxycotin once a day in the evening. I have never had much luck with oxycotin working as well as oxycodone. So I take the oxycodone 3 times during the day and than take the oxycotin with some oxycodone in the evening. Every pain doc I've been to wanted to treat me with the oxycotin and use the oxycodone just for break through pain. However that combo never has worked well because the pain relief just isn't the same. If I take 80mg of oxycotin, it is only as effective as taking about 40 or 50mg of oxycodone. Everyone seems to react a little different so having a good pain doc who is willing to work with you is a big plus. Good luck. Hope you find the right combo for you.

.Stingray
Chronic Back Pain, Anxiety, A little Depression
Meds: Oxycodone, Oxycontin, Clonazapam
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