Question on B/T meds?

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Trudy2
Regular Member


Date Joined Dec 2010
Total Posts : 213
   Posted 12/7/2011 12:58 PM (GMT -6)   
For the past about 8 or 9 months my medication regime has been the same - I am on a lot of them. As far as my narcotics go - my PM doc does not want to increase them at this time - so I am thinking maybe asking him about a change in the B/T med I am on. For narcotics - I take 80 mg oxycontin twice a day and then for B/T I take 30mg oxycodone twice a day. The oxycontin doesn't really last a full 12 hours - 8 to 10 maybe and that is pushing it for me. He will not increase the oxycontin to 3 times a day even with decreasing the mg. I suggested this - I just want more complete round the clock control. Since the oxycontin isn't working the full 12 hours - I end up taking the B/T meds on a schedule to cover when the oxycontin isn't working. He knows this and understands this and doesn't want to increase the amount of B/T meds I get either. I have had this same pain doc since 2007 and he helped me get my disability. He really does care about his patients and I like him a lot and I do not want to change doctors over this - it really isn't an option for me just because I do not want to.

I am looking for a B/T med to suggest to him that would not increase my total daily mg amount but that maybe the B/T med would last longer or cover better. I cannot take morphine as it makes me sick. I was thinking maybe dilaudid? I have used this before - but it has been years. If I remember correctly - it lasts up to six hours for B/T pain. Any input?

This medicine regime has been the one to best control my pain since back in 2007 which is why I am sure that he doesn't want to mess with it. I also have a very good and trusting relationship with him and I only have to see him every 6 months now. This has just been going on for about the past year.

Thanks for any input!
DX pyoderma gangrenosum, Acute Myelogenous Leukemia, Bone Marrow Transplant, Chronic Pain syndrome, Chronic Kidney Disease Stage 3, Major Depressive Disorder, Radiculopathy, Bilateral Hip Pain, Insomnia,Left Groin Hernia, Bulging Disk in Lumbar Spine, Tear in Lumbar Spine, Tendonitis and Bursitis in both hips, hypoxia due to sleep apnea and new problems with my lungs. Have had 2 abnormal CT scans.

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16776
   Posted 12/7/2011 2:35 PM (GMT -6)   
The problem most find with Dilaudid is it only lasts about 2 hours and for bad BT pain that really is not very good coverage. I am on Dilaudid for BT pain and I also have a pump. This has been a complaint I have seen here at the forum about Dilaudid. I sure wish I could tell you something better.

Take care.
Moderator Chronic Pain Forum

rjbeck
Regular Member


Date Joined Feb 2008
Total Posts : 255
   Posted 12/9/2011 5:33 AM (GMT -6)   
I was taking the same med's that you were taking for several yr's and had the same problem. My PM doc changed my med's to 90mg's of methadone for my long term dose then 15-Mg's of oxycodone 4xdaily and the BIG difference was adding Nucynta 100mg's 3x daily. The oxy's and nucynta are ordered for break thru pain but I take them on a regular schedule and so far I am finally getting the 24hr relief for now. And the future plan is to rotate  about every 3-4 month's between the methadone 90-Mg's and the oxycontin 80-Mg's for the best relief..The office I have been going to has been rotating the opiates for the last year and have had very good result's.
 
The Nucynta is a C2 narcotic in the opiate family but works on different receptor's in the brain, unlike adding dilaudid or morphine or just increasing the dosage of oxycodone. The nucynta worked as if I had not built up a tolerance to opiates.. My tolerance to oxy's or dilaudud has become so high that increasing the mg's just doesn't work for me but the nucynta does. Take Care Randy

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 932
   Posted 12/9/2011 2:43 PM (GMT -6)   
My understanding is that Oxycontin generally does not last the 12hrs its marketing claims. My father needed it 3x daily and my PM says that he does not like to prescribe it for this reason.

If you want to find a longer-acting BT med, then look into their respective half-lives.
Here's one site:
http://www.globalrph.com/narcoticonv.htm

Hydrocodone looks a bit long, but you'll have to take more MG to match the oxycodone.

Perhaps a better option would be to switch from oxycontin to a different time-release. You noted that morphine makes you sick, but maybe the right formulation would make a difference. One problem is that too much gets released int he stomach vs. intestines. So, if you haven't tried it yet, perhaps something like Kadian which is supposed to control the release until it passes through the stomach.

Other options would include Opana ER and fentanyl patch.
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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