Saw my PM today...

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cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 932
   Posted 4/7/2011 1:15 PM (GMT -6)   
I've posted over the past few months about needing something stronger than Ultram ER for my time-release med.. Though it was very helpful at first, I've been in increasing pain this winter and decided to finally switch to something else.

I found out about a time-release hydrocodone study and was scheduled for an appointment in two weeks. But I saw my PM today and he didn't want me to enter the study. His reasoning was (a) 50/50 whether I get the placebo and if so, I'd either need more BT meds or have to drop out; (b) if I get the hydrocodone and like it, that's great for 12 weeks (maybe 24 if I enter the open label phase), but then I'd have to find something different for the next 2-4 years until (and if) it is approved and marketed. Also, based upon my opioid contract, he would cease prescribing for me as long as I am in the trial. So, that would be a problem if I run out of BT meds, etc..

His argument was reasonable. If time-release hydrocodone is approved, I can try it then. So, we then moved on to my alternatives. Immediate release hydromorphone didn't work for me. Immediate release Opana's effects were too varied. He didn't see methadone or fentanyl as suitable. That left oxycontin and morphine. He's a strong supporter of morphine and ever since I started seeing him, he has encouraged me to switch. He pointed out that the 2x daily oxycontin really ends up being 3x -- the mechanism just doesn't last longer than 8 hours. he said the same about the 2x daily generic morphine. So, his preference is for me to use the 1x daily kadian.

I'm quite nervous about it, but I decided to go with his recommendation. He told me to take it before bed, so that the peak serum level is during the day... so I'll start Friday night in order that I have the weekend to deal with potential side effects.

He prescribed 30mg -- and I wonder if that is too high for me. For BT pain, I'll take 10-15mg of hydrocodone or 5-7.5mg of oxycodone.

I didn't look up the relative potentcies until I got home and 30mg of Kadian is like 50mg of hydrocodone. Now looking at it, it seems as if he's prescribing an amount that is about double the BT I would take on my worst of days. Or, given the time-release system, should I not compare the Kadian to BT meds in this way?

Can other members, especially other who take Kadian, give me some feedback. I wonder if I should call and ask for a lower dose to start?

Thanks.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

Blessedx8
Veteran Member


Date Joined Aug 2008
Total Posts : 3193
   Posted 4/7/2011 2:32 PM (GMT -6)   
Cogito....
 
Over the last 8+ years, I've been on all of the time-released and immediate released meds - and I always come back to using morphine as my main time-released med.  Right now, I'm on MS Contin...but I have used Kadian before for more than a year.
 
It's really hard to compare a long-lasting med to a break-through medication.  It's even hard to compare opiate to opiate.  For example, I take both Dilaudid (hydromorphone) and Actiq (oral Fentanyl) for breakthrough.... they are both very strong opiods and should, in theory, work the same, right?  Nope.  For me, they completely hit different pain paths in my body (hence, why I'm on both, as needed).
 
30mg of Kadian - in my opinion - is a good starting point.  You can always increase/decrease it.  I think you'll see a difference in having a constant amount of pain meds in your body - instead of all the peaks and valleys.
 
I always like to start new meds on the weekend, too.... just in case of possible side effects.  I think that's a good idea.  I didn't really have any side effects w/ the Kadian.... maybe a bit of tiredness in the beginning...maybe a little dry mouth... but all of that diminshed quickly.
 
I'd say give it a try tomorrow and see how it goes.  If you are having any major side effects - you can call your doctor on Monday to discuss.  But I really think 30mgs is a relatively low and appropriate starting dose.
 
Let us know how you are doing!  I sure hope it helps your pain. --Tina
Main Health Issues: Dysautonomia/POTS; CFS/Fibro; Chronic Pain (back issues, migraines, carpal tunnel, among other things); Chronic Hypertension; Hypothyroidism and Hypoadrenalism; Mixed Sleep Apnea (on BiPap); Depression/Anxiety; Vitamin D Deficiency.

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 932
   Posted 4/7/2011 6:47 PM (GMT -6)   
Thanks Mom28kids.

My wife is out of town at a conference, so I'm particularly nervous about starting the 30mg dose -- I can imagine it being so strong it causing respiratory depression and I stop breathing.

But I don't want to put it off till next weekend. So, I know this sounds a bid odd given typical time-release systems, but Kadian is a gelatin capsule filled with tiny balls. The 30mg capsule has about 78. "about" because I opened three and two capsules had 78 and one had 79. Then I divided them into two capsules so I can start at 15mg for the first few days. The doctor said I didn't have to worry about titrating out of Ultram and into the Kadian, but I'd rather step into it with a bit of caution.

I checked to make sure that opening the capsule is safe and doesn't effect the mechanism (just gelatin, after all). On the Kadian web site, they even suggest opening it up and pouring the contents onto apple sauce for patients who have trouble with pills.

Who knows, maybe I'll find that 15mg is actually all I need.

Blessedx8
Veteran Member


Date Joined Aug 2008
Total Posts : 3193
   Posted 4/7/2011 8:04 PM (GMT -6)   
Cogito....
 
You are braver than me :)  Yes, I've read that you can put the "balls" in applesauce or whatever.... but trying to half the balls makes me really, really nervous for some reason.  I think - I could be wrong - but I thought Kadian gave you some level of "immediate release" meds within the capsule.  I'd have to look it up - and I'm out of time right now.  Regardless....even if I'm wrong on that fact - how do we know that each ball acts the "same" way???  What is one releases quicker/slower than the other???
 
I'm on some strong, strong meds.... and even I wouldn't do that (half the capsule).  Maybe I'm just being neurotic and overly-cautious....but that's just me.
 
Honestly, 30mgs is not a big dose of morphine.  Or rather - I don't believe it's going to cause some major reaction over taking 15mgs.  Again, I'm not a doctor.... but your doctor was the one who prescribed the 30mgs.  Also, even though Kadian is "supposed" to be a 24 hour drug.... it doesn't last that long for many patients, and many have to take it 2x per day. 
 
If you are that nervous....I'd recommend waiting until Monday and then letting your PM know.  I don't think Kadian comes in a 15mg capsule...just in the 10mg and then 30mg (from what I remember).  But using 1/2 the capsule makes me really nervous... but, again, that might just be me!! 
 
Whatever you do - be safe and let us know how you are doing!!
--Tina
Main Health Issues: Dysautonomia/POTS; CFS/Fibro; Chronic Pain (back issues, migraines, carpal tunnel, among other things); Chronic Hypertension; Hypothyroidism and Hypoadrenalism; Mixed Sleep Apnea (on BiPap); Depression/Anxiety; Vitamin D Deficiency.

Blessedx8
Veteran Member


Date Joined Aug 2008
Total Posts : 3193
   Posted 4/7/2011 8:10 PM (GMT -6)   
Ok... I did just read that Kadian does not have an instant release component as does Avinza and MS Contin.... I still hold to what I wrote before, but wanted to clarify this point.

--Tina
Main Health Issues: Dysautonomia/POTS; CFS/Fibro; Chronic Pain (back issues, migraines, carpal tunnel, among other things); Chronic Hypertension; Hypothyroidism and Hypoadrenalism; Mixed Sleep Apnea (on BiPap); Depression/Anxiety; Vitamin D Deficiency.

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 932
   Posted 4/7/2011 10:16 PM (GMT -6)   
Thanks for checking for me! I didn't see anything mentioned that the balls were any different, but I recognized that they could be. However, by splitting the capsule contents, worst case scenario would be one capsule would have all the immediate release and the other one, all the late release. That would skew its normal release curve, but by never combining contents of more than one capsule, I wouldn't ever get more immediate release than what would have been in the standard dose if I never opened it up.

My doctor warned me that it may not provide 24hrs and I may have to take two in a day. But he thought I should try it as a once-a-day to start. I also think I'm going to take it Saturday morning rather than Friday night -- so I'm awake just in case I find it too sedating rather than being asleep while my respiration slows to a dangerous level.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

Blessedx8
Veteran Member


Date Joined Aug 2008
Total Posts : 3193
   Posted 4/7/2011 11:57 PM (GMT -6)   
Yep....maybe starting Saturday morning is a good idea.  You know, for me - morphine actually causes insomnia for me.  Not sure if that happens to anyone else.  When I was pregnant and came off the morphine....I slept better than ever (well, as good as you can while carrying two babies).  Now that I'm back to increasing my dose again, the insomnia has hit hard again.
 
If you get a chance....check in on Saturday and let us know how you are doing.  I'll be praying that it will help with your pain with NO side effects.  Good luck to you!!
 
--Tina
Main Health Issues: Dysautonomia/POTS; CFS/Fibro; Chronic Pain (back issues, migraines, carpal tunnel, among other things); Chronic Hypertension; Hypothyroidism and Hypoadrenalism; Mixed Sleep Apnea (on BiPap); Depression/Anxiety; Vitamin D Deficiency.

fish29
Regular Member


Date Joined Apr 2011
Total Posts : 70
   Posted 4/8/2011 9:36 AM (GMT -6)   
Hi, I think morphine is a great drug. I have been on it off and on, and now on permanently. I haven't had any side effects besides constipation, and you really want to watch that.

Otherwise I have been able to increase my dose with no issues. I take Extended Release 30mg x3, and immediate 15mg x3 a day.

The first time I took it it made me a bit light headed, but that's about it. (I switched from Norco)

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 932
   Posted 4/9/2011 12:07 PM (GMT -6)   
I took my first dose (15mg) this morning around 8:30 (3 1/2 hours ago) and am starting to get sleepy. I had a good night's sleep last night and my standard morning coffee. Normally, I don't get tired at this point in the day. As for pain, I've been at my desk writing through the morning and usually after about 2 hours, I need to lie down to take the stress of my back or take a hydrocodone. So far, the pain isn't better. I have about 4 more hours until the time-release gets to its peak serum level. I'll probably post again on how the Kadian is affecting me later today.

I'm also not going to take any BT meds today so I can assess the overall pain relief of the Kadian at this dose.

Post Edited (cogito) : 4/9/2011 11:18:35 AM (GMT-6)


cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 932
   Posted 4/9/2011 4:05 PM (GMT -6)   
I fell asleep for a few hours and am now at about the peak level of the Kadian. Still sleepy -- I couldn't work like this :(
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray
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