June 11, 2007 - 12:05am
When I saw my dr. last, he gave me the option of sticking with oxycontin 20mg TID up to 40mg BID, or going with a long acting morphine med, with a short acting morphine med for b/tr pain, instead of my usual 15mg oxy IR or 10/325 percs for b/t pain. I have been given morphine IV in the ER before and did not like the way it made me feel. My dr. seemed to think morphine was the superior med and stated that oxycontin has has a lot of "problems." When I inquired what problems, she mentioned generics running short, not lastng 12 hrs. more sied effects, etc. In the end she ledt the decision to me and I stuck with the oxycodone products as I know they work for me and my body tolerates them. I am curious to what you would do if you had to choose between a long acting morphine med and short acting med for b/t pain, or oxycontin and oxy IR for b/t pain? Is morphine in its long actinf form really that much better a drug? MY dr. definitely seemed to think so. All opinions and comments are welcome. I look forard to any and all feedback!
PDX
June 11, 2007 - 12:20pm
#2
I understand what you are
I understand what you are saying. My dr. prefers morphine products but I know from past experience they dont work well for me. My doc did mention methadone as an alternative but that she could not prescribe it and would have to reffer me to someone who could. I wish I was in Canada as I could get hydromorphcontinas hydromorphone works wonders for my pain with minimal side effects. I was taking oxycontin 20mg TID and was having to use a lot of my b/t meds so my dr. wanted to change things around, hence the morphine. She said oxycontin doesnt usually last 12 hrs. and she told me instead of 40mg TID, she will do BID and take b/t meds if it doesnt last long enough. It sucks though, when I filled my OC 20mg last (1 week ago for 1 months supply, 90 pills) the pharmacy had plenty of the watson generic but this time I was suprised to find teva 40mg when I got home and opened the bottle, yuck! I asked about brand, but they were not carrying the purdue brand at this time all they had was teva. So far it works ok, but not as good as the watson brand. One question of mine is why are the teva pills so much larger than the purdue and watson counterparts. I also have had to take 2 15mg roxis for my b/t pain but my doc wants me to do that sparingly to avoid the jump to 30mg for b/t pain with the roxicodone. I still have a 3 weeks supply of 20mg watsons so I could use that if the 40mg teva dont work as well, as she gave me a 2 week supply to try it out and decide what I want my final medication mix to be. My dr. wants to stop switching things around and settle on 3-4 meds that will not change anytime in the near future. So I am going to suggest at my next appt. that we do 40mg oxy TID instead of BID and keep the 15mg roxicodone(1 tab) or 4mg dilaudid (1-2tabs) for b/t pain, along with the 10mg of diazepam I take BID. Has anyone mixed long acting oxycontin with short acting dilaudid for b/t pain and had good results? I am just trying to find the right meds and dose for myself so all comments and responses are much appreciated.
PDX
June 11, 2007 - 12:25pm
#3
Yep!
Teva was the one generic I was referring to as infirior. Watsons are great, Endo's are so-so.
I have no exp. with dilaudid.--MUDEBONE--
June 11, 2007 - 1:33pm
#4
Teva and brand name price rant
The Teva brand of generic OxyContin is notoriously problematic. Pain relief is in no way equal (or "bioequivalent") to the brand. This is just a guess, but perhaps the reason why they're so much larger than Watson, Endo & brand is because of the anti-abuse filler that they add. Adding to the frustration is due to legal issues & agreements between Teva and Purdue (which has been discussed at length here), they are the only generic available once pharmacies/wholesalers run out of the Watson and Endos.
On a somewhat-related note, my fiancee just got her prescription of OC's filled today. I told her to request the brand (she doesn't really know or care to know the differences in generics, etc.) She used a pharmacy that's physically located in the hospital (not a chain) where her neurologist's office is. Total price (no insurance) for #60 OC 20mg? $289.78! When she showed me the receipt I was blown away. I posted a couple weeks ago about this, last time my OC script was filled - also for #60 OC 20mg - the total came to over $230. A $60 leap in price in two weeks time just doesn't sound right. That's almost $5/pill. I realize OC's have always been expensive, but come on! I also understand that there are variations in prices between different pharmacies, but they're usually basically all around the same price. Is Purdue insane? What kind of costs are they trying to recoup with these prices? When the Teva agreement ends they'll have a monopoly once again, so they're already sitting pretty.
June 11, 2007 - 3:04pm
#5
Pharmacy prices are
Pharmacy prices are definitely not all the same. The largest discrepancy I had was $80 mark up on a generic at Kmart. At Costco, it was $10. There does seem to be less discrepancy in very expensive medication.
June 11, 2007 - 3:42pm
#6
Oxycodones
I was told by more than one pharmacist and doctor that all the generic oxycodone's have to pass the rigerous FDA tests regarding that medicine. I agree that Endo's and Teva's must have more fillers compared to the brand name and Watson's. I currently got a script of Teva's for the 1st time along with 30 mg. oxycodone IR's for breakthrough and I cannot tell the difference at all. I really beleive that many who think that there is a difference expect one. I am no doctor or pharmacist so it is obviously only my opinion.
June 12, 2007 - 6:28am
#7
morphine vs oxycontin
I'm new here, but, I've had the extended release morphine, 60 mg 3 times a day, and it worked pretty well for me. Better than oxycontin, but, still not enough for breakthrough. I think whatever works for you, stick with it
June 12, 2007 - 11:29am
#8
The generic drugs must be
The generic drugs must be bio-equivalent to the brand name in order to get FDA approval. The size of the pill is probably irrelevent. I think the two big concerns your doctor has with oxycontin are frequency of diversion and the fact that the release of medication is biphasic. There is an initial release of a little oxycodone, and then release of more of the oxycodone after a few hours. Many doctors in my area have stoped prescribing oxycontin altogether in favor of Kadian and Avinza. While I really like using fentanyl transdermal patches, recent negative publicity about patient deaths on Fentanyl has made some doctors leary of using it. Some doctors are leary about using methadone for chronic pain for the same reason.
June 12, 2007 - 11:38am
#9
methadone vs oxy vs morphine
Have you ever tried methadose for your pain? In my experience the pain killing properties last much longer and better than both oxycodone and morphine. For me Morphine has a sleepier effect on the body than oxycodone which can perc you up in some instances. I know methadose has a bad stigma to many people but price comparison wise and painkilling wise it really is a great medicine. You might actually want to take your docs advice and see the other doctor. I don"t think that any oxycodone ER meds last for a full 12 hours, however the right dose of methadose does and a monthly script won"t cost much more than 30 bucks. If you stick with the oxycodone definately go with purdue or watson and stay away from teva. I was told that Watson was going to be the only generic available soon but there seems to be some other opinions about that. Does anyone know-phisher or incognito maybe?
*None of this should be construed as medical advice. You should always speak with a licensed MD. or medical professional for professional medical advice. These opinions are my own and should not be taken as professional medical advice*
June 12, 2007 - 11:59am
#10
Have you tried the ER
Have you tried the ER morphine yet? I know you had the IV once, but the IV and pill form are going to have different effects on you all together. If she gave you the 40mg's to try, maybe she could also allow you the morphine ER to try? I think it really is worth looking into it, especially with everything going on right now with the oxycontin. as someone else posted, #60 cost them b/w almost $250-$300. and with purdue taking over, you never know how much it could go up. just remember to shop around pharmacies b/c you never know how much different the prices may be. my #330 norco at CVS cost $260, whereas at Kroger it was $130, 1/2 as much! also, I have heard morphine ER is ALOT cheaper on the wallet 
If you do plan to stick w/ the oxy's, I would suggest the 40mg 2/day. I say this for this reason: think of how many hours you are up during the day- if you get up at 8am, then go to bed at around 11pm, that is what-15 hours? So as everyone says, the oxy's only last around 8hrs, if you take one in the morning, then another 8hrs later at 4pm, you should still be good by bedtime. usually while sleeping, most people do not take those kinds of ER meds, so if at night you have problems you could take whatever b/t meds you choose. I don't think the b/t meds are really what is a problem here, it's the maintenance meds that are, correct?
I'm a social worker, not a medical professional. All comments and thoughts are simply my opinion and experience.
June 12, 2007 - 12:26pm
#11
not to disagree but
Extended release medications are commonly used while sleeping, unless the patient doesnt like sleeping or likes to sleep in pain. While your suggestions are good this person would probably need to take one pill again at around 11 at night, because once dependent on these types of meds the body will go into withdrawal symptoms which are very unpleasant.
*None of this should be construed as medical advice. You should always speak with a licensed MD. or medical professional for professional medical advice. These opinions are my own and should not be taken as professional medical advice*
June 12, 2007 - 12:33pm
#12
Thanks thatswhatsup, I
Thanks thatswhatsup, I really don't have alot of experience taking the extended release meds- I thought that most people did not take them at night. I am on immediate release meds that I take regularly during the day, but I do not take them at night, so I just thought other people did not. usually at night some people do not feel the pain as bad since they are asleep, or may need just a short acting med to get to sleep, then they are okay until they wake up. I guess it just depends on the person
I've never seen anyone go through withdraw though by just going a few hours without, or just b/c the med is not in the body. I'm not saying it can't happen, I just haven't seen it. I guess ER meds have different effects than IR. I can go half a day without meds and not have w/drawl--like I said, I guess everyone's different!
I'm a social worker, not a medical professional. All comments and thoughts are simply my opinion and experience.
June 15, 2007 - 12:04pm
#13
I was surprised to have a
I was surprised to have a patient who was on only short acting meds for a while and was waking up every morning having withdrawl symptoms.
June 15, 2007 - 6:05pm
#14
Wow, so how hard was it to
Wow, so how hard was it to wean them off, or did you have to?
I'm a social worker, not a medical professional. All comments and thoughts are simply my opinion and experience.
June 16, 2007 - 10:55am
#15
When he could get his script
When he could get his script filled again he went back on fentanyl patches or an extended release (I can't remember which) and was fine. He couldn't get the long acting because of an insurance problem.
June 20, 2007 - 10:55pm
#16
Oxy vs. Morphine vs. Fentanyl
I used to wake up every morning in wd symptoms until I started using the patches. They were fabulous for pain control! They could be a nuisance on your skin (I used the big 100's) but I never woke up feeling horrible again while I was prescribed them.
I don't know of a good way to titrate off of them other than dropping to next level down and filling in with more instant breakthru meds. That's what my doc's plan was going to be for me before I switched to the Buprenorphine doctor last month.
I would setttle for less oxycodone than double the equivalent in morphine anyday! (The ratio is 2:1 Oxy to Morphine) but I've always felt that pain relief with Morphine was inadequate and yet it had the gaul or (seemed to) increase tolerance and cause physical dependence faster without giving anything positive in return - (for me)! I hate it! (but not as much as this Suboxone because of the blocker, Naloxone in it).
at least that's what I'm thinkin' . . .
Bink
June 22, 2007 - 9:27am
#17
thatswhatsup
I wish I was more knowledgable about prescribing methadone for pain. You and Director(?) are certainly strong advocates, and you can't beat the price.
June 22, 2007 - 12:40pm
#18
Methadone as a painkiller
I don't think you can beat Methadone as a painkiller and you don't seem to be a "clock watcher" while taking it either. You aren't constantly looking to see if it's close enough to the time you can take your next dose. I had good luck with Oxycontin too, but my tolerance to the med went up very quickly. I think in about 14 months I went from 20 mg TID to 160 TID. Fentanyl, Duragesic patches were good too, but I had to have 48 hour dosing.
As far as price, you can't beat Methadone. I'm going down to my pharmacy in awhile to fill my monthly script for #540, 10 mg Methadone. It will cost me $15, co-pay. I asked the pharmacist not long ago what they would cost without insurance, and it was $102 for the 540 tabs. Pretty cheap. It's the best game in town, especially if you don't have insurance.
Director
June 27, 2007 - 10:13am
#19
BINK.....
You are so correct on the morphine!! My first MD was a hardcore prescriber of morphine products. I had my choice of pain medicine....as long as the active ingrediant was morphine. Well, it didn't work well for me at all, my pain was not controlled but he kept upping the dosage until I got to 200mgs a day. I was tired, constipated, and falling asleep driving home from work. I gave up and went to another MD.
June 27, 2007 - 11:46am
#20
The ratio is actually 3 to
The ratio is actually 3 to 2
*None of this should be construed as medical advice. You should always speak with a licensed MD. or medical professional for professional medical advice. These opinions are my own and should not be taken as professional medical advice*
June 27, 2007 - 11:49am
#21
It is interesting that
It is interesting that morphine didn't work for your pain but other pain meds do. Nearly all of these medicines are metabolized into morphine by the liver. I do agree morphine makes you very sleepy and is not that effective on pain.
*None of this should be construed as medical advice. You should always speak with a licensed MD. or medical professional for professional medical advice. These opinions are my own and should not be taken as professional medical advice*
June 27, 2007 - 5:14pm
#22
It's not that it "didn't work for my pain"
the issue was "it didn't work well..." not that it didn't work at all. There is a difference.
Hi there, I used to be on Kadian and I have tried several other meds like Opana, Methadone and I have settled on Oxycontin w/ Roxicodone for rescue or as you folks call it breakthrough. If I were to make the choice given you I would take the 20mg 3x rather than 40mg2x because I only get 8hrs relief. I have a little side affect of feeling a bit loopy for about an hour then it goes away and have pretty good pain control for about 8 hrs. I take 80mg 3x and seldom use my rescue of roxi15mg. However when I do need rescue the 15 mg does not cut it so my dr tells me to just take 2 at a time because I never use the full 60 he gives me per month anyways. If I did he would probably put me on the 30mg's. I am very fortunate that I have found a pharmacy that has run out of generics because I now get Purdue brand and am very happy w/ pain control. I could not say that when I was on a certain generic brand that is made in Isreal. What I'm saying is certain generics are infirior to the Purdue brand and instead of raising your dose it might just be that you are getting the lousy brand of generic and not getting relief when you may get relief on the name brand. I hope that makes some kind of sense to you. Good luck. --MUDEBONE--