Anomalies of Pain Management options

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Gingerton
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Date Joined Apr 2012
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   Posted 4/13/2012 1:56 AM (GMT -6)   
After extensive research, I realized that hydrocodone has a longer half life than any other pharmaceutical. Why don't some companies make a higher dosage than Norco? Like maybe 15mg/325mgAPAP? That would be better than oxycodone since it lasts longer. I think for post acute surgical pain for a first time they should give Tylenol 4 or percocet 2.5. Hydrocodone seems much much stronger and longer lasting for pain.

What does anyone else think on this?

Blessedx8
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   Posted 4/13/2012 2:29 AM (GMT -6)   
Gingerton,

I did a quick search of the half life of hydrocodone - and I'm coming up w/ around 3.8 hours... Percocet being around up to 4.5... but there are many things can affect half-life and, to be honest, I haven't looked that greatly into it.... that was just from a 2 minute google search.

But, I do know that I've been on most of the opiod medication... I wouldn't say that hydrocodone is "stronger"... I think all of these drugs affect people differently...

Also, for chronic pain, a tolerance can build towards these shorter acting drugs, like hydrocodone. While they might work well for breakthrough pain and so forth - overtime, it seems that most people have to keep taking more and more - and, then, eventually transition to something else. Again, not in all instance, but this seems the norm w/ long-term pain.
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Screaming Eagle
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   Posted 4/13/2012 6:35 AM (GMT -6)   
 
     ...I happen to see a news article about this...and they are coming out with an ER hydrocodone soon. I could be wrong...but I do think I remember this...and was about a month ago...in one of my news reports that I read.
 
         SE
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Blessedx8
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   Posted 4/13/2012 6:59 AM (GMT -6)   
Michael,

There very well could be... I know many have asked of this... Maybe that's what the poster was referring to. I thought she meant just stronger, short-acting, lol.

:) --Tina
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Screaming Eagle
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   Posted 4/13/2012 7:22 AM (GMT -6)   
 
   ...LOL...I replied on a half-dead brain..and have yet to wake fully. LOL
 
  Sorry if I missed the point here.
 
 SE wink
Moderator Chronic Pain Forum

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tmjpain
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   Posted 4/13/2012 7:46 AM (GMT -6)   
you're luck you have a half-dead brain michael, mine is always completely brain dead, lol

Good morning gingerton, love your name
i wanted to welcome you aboard, great members here and very caring and understanding
what is your cp pain problems

hope you have a good day and welcome

suzane

cogito
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Date Joined Oct 2010
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   Posted 4/13/2012 7:55 AM (GMT -6)   
Site vary regarding half-life. A few of the illicit use sites state that Hydrocodone does last longer, but I'm not going to trust them. Here's a more reputable option:
http://learn.chm.msu.edu/painmanagement/chooseopioid.asp#d

From my experience (as I have scripts for 10mg hydro and 10mg oxy), the half life is about the same. A few years ago, 10mg of hydro of 5mg of oxy would last 6-8hrs. Now, 15mg of hydro, 7.5 or hydro would last around 4. That's not the same as half-life of course, but it does fit with the Michigan dosing recommendations.

As for strength per mg, Oxy is definitely stronger, per my experience and per the many opioid comparison tables out there.

I'm eagerly awaiting a time-release hydro and almost went into a clinical trial (my PM said no). From what I've read, there are 3 or so companies developing hydro ER. One brand name is Zohydro and they're apparently ready to submit their application to the FDA: http://www.globenewswire.com/newsroom/news.html?d=241133

I used to do some sidework in Pharma, and forget the standard timeline, but if the NDA is submitted by mid-year, there will still be up to a year until the FDA has their expert panel submit a recommendation, then many months after that until a formal decision is made. There will also have to be manufacturing tests and decisions about labeling. I used to know the details... ug.
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Current meds: Ultram ER 300mg & 2-3x 10mg Hydrocodone daily. Oxycodone 10mg for BT. .25-.5mg xanax as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

Jim1969
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   Posted 4/13/2012 11:03 AM (GMT -6)   
I would imagine the "half life" or full "life"/duration of any medication is determined under some kind of "all things being equal" basis. Unfortunately as anyone who has dealt much with any kind of medication, be it pain meds to insulin to depression meds and everything in between, will readily agree upon is that things never are equal in the real world. Still there does need to be some sort of "standard" criteria for evaluation and comparison.
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Gingerton
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Date Joined Apr 2012
Total Posts : 8
   Posted 4/13/2012 3:56 PM (GMT -6)   
I dont know what you mean by where I got the information, it is quoted in many places the action, timing, and relative strngths in many articles. Even wikipedia has it: http://en.wikipedia.org/wiki/Opioid_comparison. Go see that link. For the ones I know, hydrocodone seems to last the longest. I don't understand why oxycodone is so popular. Percocet lasts at most maybe 4 hours. They measure everything in relation to morphine, thats why fentanyl is in the microgram. They are using a relative strength of a different drug.

Anyway, I am just saying that if oxycodone has such a bad rap, why don't they make higher dosage hydrocodone? Oxycodone is not so great.

Screaming Eagle
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Date Joined Sep 2009
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   Posted 4/13/2012 5:40 PM (GMT -6)   
I understand the question now…LOL…and really!…it is a good one! …maybe one of our members can come up with a good answer…I just don't have it for you.

…what I will say is that generally Percocet may last 4hrs in a patient who is not a CP patient…but I beg to differ in many CP patients if we are talking about effectiveness.
What my Dr has said before is that the med is still in your system for 4 to 6 hours effective or not. I have heard many nurses and Dr's say Oxycodone is stronger than Hydrocodone. All I know is that it takes a different neuro pathway for effectiveness…..and of course every patient is different. Hydrcodone…does absolutely nothing for me. I could take two #10's…and nothing!

…again,….I think I saw a medical news article…saying they were going to come up with a ER hydrocodone med soon.



SE wink
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Weekly Quote!

"Getting over a painful experience is much like crossing monkey bars. You have to let go at some point in order to move forward."

Post Edited (Screaming Eagle) : 4/13/2012 5:51:14 PM (GMT-6)


Snowbunny21
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Date Joined Jan 2010
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   Posted 4/13/2012 6:12 PM (GMT -6)   
Yep...milligram to milligram....Hydrocodone is lesser than Oxycodone...

It's also why Vicodin/Lortab is still a Schedule 3 and not Schedule 2 medication...(In the U.S.)

The list from least to greatest is:
Codeine
Morphine
Oxycodone
Hydromorphone
Fentanyl


But....as we all know....everyone is different and some people, which sounds like Gingerton, have better pain control with Hydrocodone over Oxycodone...

So...it's really all relative and what works for me is not going to necessarily work for you (collective you)...I have always noticed that Percocet has worked better for my pain than Vicodin..

Same goes for half life....

All the short acting medications from Vicodin, Tramadol, Percocet...etc....have a peak around the 45 minute mark....and then tapers down over the next 4-6 hours...

Long acting medication like Oxycontin or MSContin release their medications near the 45 minute mark and then again at the 6 hour mark...

But same thing about strength....these are all just medical figures.....and each person can metabolize medicine differently based on other factors of the individual...

So....all of this boils down to finding what works for you Gingerton...And until the new version of a long acting Hydrocodone comes into the market....It sounds like speaking with your Dr. would be good about finding another long acting medication that may work for you..

Another example of how everyone is different...I was on Oxycontin for years....and then the patent ran out so the generic disappeared with the new formula....

So I got switched to MSContin....again...mg to mg...I am actually on less mgs than before for now....because switching opiates allowed my body to have less tolerance to this medication.

The key is also finding other modalities to treat your pain besides a narcotic..

I use exercise, PT, yoga/stretching, massage, acupuncture, TENS unit, injections, muscle relaxer, sleep medication, counseling, eating Organic and avoiding inflammatory foods....etc...

So...each thing that I add to my "toolbox"....allows my pain to stay at a 5-7 range...

Gingerton...it's great that you are getting such good pain control with Hydrocodone.....can you share more about what type of pain you have and what all you have done to help it...We would like to get to know you better...
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Blessedx8
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Date Joined Aug 2008
Total Posts : 3193
   Posted 4/14/2012 2:02 AM (GMT -6)   
Gingerton,

We were trying to throw out ideas to try to answer your question. :)

While looking through google, I did see that hydrocodone "can" be compounded at a compounding pharmacy in higher strengths than the 10mg. That being said, in many years here on the board - and a vast amount of experience in the chronic pain world, I've not personally seen someone have a doctor prescribe that.

I went to the link you referenced...there are many of these opiod comparison/conversion charts out there. Hydrocodone is lesser "strength" than Oxycodone. If you look on there - it would take 17mg of hydrocodone to equal 10mg of morphine; whereas it would take only 5.0 to 6.7mg of oxycodone.

But as Snowbunny said, we are all different... and if this works for you, that is great. That's literally half the battle. Do you have a doctor that might be willing to write you a script for a compounding pharmacy at a higher dose? And, as others said, it looks like they are working on an extended release hydrocodone.

Take care... --Tina
Moderator - Chronic Pain Forum

My faith and family sustain me even on my worst days... as well as my wonderful friends here at HW.

Health/Pain Issues - too many to list; feel free to ask
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