When do you take your Breakthrough Med's?

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Screaming Eagle
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Date Joined Sep 2009
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   Posted 12/16/2010 2:04 PM (GMT -6)   
 
   Hello all!
 
       I'm just curious as to when you're supposed to take the breakthrough med's?
 
           Since I have been scripted the Oxycontin again, I no longer suffer the steep decent at the end of my IR released med. (Percocet) They only lasted 2.5 hrs or so then I started down hill quickly. It used to be a challange to make the 5hr mark for each of them I had set for my work day (6:00am, 11:00am, 4:00pm, & 9:00pm) It was the 6:00am that really had me struggling, as it was around 9hrs since my last med.
 
      My schedule is now the same for my Percocet, and I'm now adding the Oxycontin at 10:00am and 10:00pm.
I'm on the downward cycle for the Oxycontin by 6:00am, but there is enough in my system that it makes the mornings much eaiser on me, especially since I take the Perc at 6:00am.
 
       Any comments or suggestions that I may not have thought of will be appreciated. It all seems to work at the moment, but I know that my Dr wants to reduce my Percocet intake, and at the moment I don't feel that I can do that without an increase of the Oxycontin. That should take place here shortly after the first of the year when I'm scheduled for a check up with him. Maybe #20's X2 should do it, and then I could reduce the Perc's by 2 pills. Then they would truly be used as breakthrough meds, and I would be taking them just prior to the daily Oxycontin intake.
 
         SE wink
 
 
 
 

Post Edited (Screaming Eagle) : 12/16/2010 1:43:12 PM (GMT-7)


Pete trips again!
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Date Joined Nov 2006
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   Posted 12/16/2010 7:47 PM (GMT -6)   
Hey there big feller! For me, I takes methadone #10's three times a day and my break tru is oxicodone #15's. I start w/ my methadone, nurontin (sp?) and a oxi at 6:00am along w/ 7 other meds> thyroid, H.B presure, efecsor, one to make me pee less, stomac acid reducer, a tylonol (for my morning headache) and one I'd rather not talk about. Around noon I take an oxi, nurontin and 1/2 a methadone. Then between 5 & 6 when things are really hurting I take the other 1/2 a methadone, two oxi's & a tylonol. This doubling up was OK'ed by my long time pain Dr. when I lived down south and I've used it ever since evan though my presant dr. doesn't know I do it. It took a long time to figure out what worked for me so I figure why change something that works? Then at bed it's a full methadone, muscle relaxer and the the rest of the pills again.
So Mikey, what I'm saying really is I take the bigest breakthrough dose when I need it the most after hurting myself all day! By 5pm I'm really hurting the most> Dig it? It's taken years to figure out what was so easy> never acuse me of being the sharpest pencil in the light bulb (or something like that?) Take the most when you hurt the most!!!>>> DA!!
Datz all I gotz fo Yuze my Brudda!
Man hugz and all dat Jazz!
Pete
When I was young & stupid I broke almost every bone in my body and I'm paying a heavy price now but I'm still here and so glad to see my two sons grow up to be fine young men, both are in the Navy. I'm so proud! My biggest health problem>> I'm a certified Luny~Tune!!

Screaming Eagle
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Date Joined Sep 2009
Total Posts : 5005
   Posted 12/16/2010 8:08 PM (GMT -6)   
Got it!....and makes sense as well!

Thanks!

SE wink

denoli82
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Date Joined Apr 2010
Total Posts : 35
   Posted 12/16/2010 11:31 PM (GMT -6)   
I take my extended release medication, along with my break through medication at the same time in the AM hours. Midday I'll take another break through med and then I'll repeat what I did in the AM at bed time.

spinal soldier
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Date Joined Dec 2009
Total Posts : 687
   Posted 12/17/2010 11:18 AM (GMT -6)   
maybe it is just me but as far as a steady-state med. i think oxycodone sucks. it has a shorter half-life than morphine, methadone, or oxymorphone and the way it works on the receptors it seems to cause a hightened sensitivety or hyperalgesia in some people i have known. i would try to switch to a different ER med.
L4,L5,S1 bilateral Laminectomies, Foraminotomies 2002
L4-S1 PLIF with instumentation 2008,

current Rx: OxyContin 80mg q8hrs. , MSIR 30mg prn qid,vistaril50mg prn nausea, Lyrica 150mg 2x,Adderall 20mgs 1x A.M. 10mg PM prn, Soma 350 mg 3X, Relafen 1000mg 1x, lorazepam 1mg bid prn, Supplements: CO-Q10 100mg, Vitamin D 2000IU, Fish-Oil1000mg EFA, B-Complex50 3x/day, GABA 750mg,

Screaming Eagle
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Date Joined Sep 2009
Total Posts : 5005
   Posted 12/17/2010 12:21 PM (GMT -6)   
 
      I think everyone is different with each med. Are you suggesting to switch the Oxycodone (Percocet)? It is an IR med. .......Or you refering to the Oxycontin (ER med)? Both have Oxycodone in them.
 
      SE wink

Monty's Mom
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Date Joined Aug 2010
Total Posts : 664
   Posted 12/17/2010 1:19 PM (GMT -6)   
I am still at the early stages of learning how to balance medication management with meds that acutually work, so I am unsure if what I do is helpful. I am on fentanyl patches every 3 days, and on that last day it is impossible to make it without b/t meds. I take hydrocodone 5/325 every 6 hours as needed. Some days when I overdo it, or am stuck in the car for hours with someone who kindly offered to drive me to an appointment or for an errand who only needed to do one thing and we are at our 5th place, I will take one if needed. I dont like the spacy way I feel with the fentanyl but it does a nice job most of the time. Add the breakthrough med, and I am in bed the rest of the day asleep or drowsy.

Hope that adds something to the topic!
Mindy
The worst sin towards our fellow creatures is not to hate them, but to be indifferent to them. That's the essence of inhumanity. George Bernard Shaw


Pelvic adhesive disease, Irritable bowel syndrome, SI joint pain, arthritis, kidney stones, depression, 7 pelvic surgeries for pain, ovarian cysts, adhesions.

Screaming Eagle
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Date Joined Sep 2009
Total Posts : 5005
   Posted 12/17/2010 2:09 PM (GMT -6)   

 

    Thanks for the tips! I think if I was on an 8hr Oxycontin clock, I would do much better than the 12hr clock.

     I will suggest it to my Dr when I see him in a few weeks.

          SE wink


straydog
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Date Joined Feb 2003
Total Posts : 16302
   Posted 12/18/2010 8:09 PM (GMT -6)   
SE thats the big problem with extended release meds they never make it 12 hours. Instead they last usually 8-10 hours with most people. I don't know anyone that has had true relief for the full 12 hours. Getting a dr to acknowledge this is a another big problem. Once I saw how long the extended release truly lasted, then I took my BT meds around the time I knew extended release was wearing off that way I still had something to cover the pain. With a pump it is totally different because the amount of medication you receive is around the clock. My BT meds now are only if I have increased my activity for things like mopping and running the sweeper or yard work. If I have days I am not doing much then I do not need the BT meds. My liver thanks me for those days.

It will be interesting to see what your dr has to say. Even if he puts you on a 10 hour schedule I guess thats better than nothing.
Moderator Chronic Pain Forum

catahoula
Regular Member


Date Joined Dec 2009
Total Posts : 184
   Posted 12/23/2010 12:06 PM (GMT -6)   
boy do i wish i could reply to this but alas I NO LONGER HAVE BREAKTHROUGH MEDICATION!!! Pain doc sent me to an addictionologist to put me on subutex ( which makes me vomit and does nothing for my pain). This doc does not believe in b/t meds , only more and more of long acting. Now the only thing I have is 8mgs subutex 4 x's a day....period. I have explained twice to this man that the subutex does not work for me. All he did was raise the dose. I finally called my pain doc yesterday to explain what is happening again ( I saw her last week for nerve blocks and told her then but her response was "work with him") and she never returned my call.
I am in horrible pain, sick to my stomach and frankly feel I have been thrown under the bus.

I hope they have a merry xmas!
catahoula

mrsm123
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Date Joined Dec 2007
Total Posts : 1235
   Posted 12/23/2010 10:09 PM (GMT -6)   

The way that I was taught to take my medications is like this- my long acting at whatever the dosages/times are- right now, it is Opana 7 am and 7 pm. If I don't need my breakthrough meds, then I don't take any of course, but if I do, I am allowed up to 6 per day. On a day that I need them, I take them for pain that is above and beyond what my normal base level of pain is, or when I know that my increased activity levels are going to cause a major spike in pain.

I was taught that my long acting meds are to cover my normal, every day levels of pain and breakthrough pain meds are for pain not covered by my base/LA meds. I was told that if I take my breakthrough meds for minor increases of pain, then my body adjusts to that combination of LA/SA or LA and breakthrough meds, and therefore becomes my new baseline pain medication dose, so my breakthrough meds no longer cover that breakthrough pain. So the combined long acting and breakthrough meds are now my new LA base med- and if I have increased pain, then I have nothing to cover my breakthrough pain.

I hope that I explained that clearly, but the reasoning behind not taking breakthrough meds regularly unless there is some reason behind the spikes in pain is because your body quickly adjusts to that new combination of meds as your baseline and then you are left with breakthrough meds that will no longer work for those spikes.

If that was all as clear as mud to you, I will try to explain it again, but I think that I confused myself trying to explain......LOL
Sandi

mrsm123
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Date Joined Dec 2007
Total Posts : 1235
   Posted 12/23/2010 10:14 PM (GMT -6)   
Cathoula,
It may be that you are on far too much subutex. My understanding is that you need to build a blood plasma level, much like methadone when used for pain management. 32 mg of subutex is what is used when dealing with addiction, it is far too high a dose for the use of pain management. When used for pain management, less is more, in fact, the usual dose for pain management is considerably less than what you are taking, the standard not being more than 4 mg for pain management.
I would talk to the doctor again , and see about lowering the dose that you are on.
You might find that the pain relief is much better when you aren't on such a high dose, and the vomiting might subside as well.
Sandi

catahoula
Regular Member


Date Joined Dec 2009
Total Posts : 184
   Posted 12/24/2010 10:35 AM (GMT -6)   
Thanks and yes i agree about the dose. I have also done MUCH research and it is possible to use a breakthrough while using subutex, the dose must just be adjusted. I just feel I am in that bind of being a "good patient" and following doctors orders even though the pain is awful. .sigh
cat

Screaming Eagle
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Date Joined Sep 2009
Total Posts : 5005
   Posted 12/24/2010 12:47 PM (GMT -6)   
Glen, I think your Dr has it right, and that is what my Dr is hoping to do as well. I hope to have access to a few breakthrough meds though, just in case I have a bad day.

Thank you all for your comments, and I hope the information posted here will help someone. It did me! wink


SE wink
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