December 4, 2007 - 2:49pm
Hi Everyone!
This is my first post, although I have been reading this forum for a couple of years. I am here for some advice and support.
I am currently Rx'd OxyContin 40mgs x 3 per day, plus Dilaudid 4mgs x 4 per day. I have been in so much pain lately and have been bedridden for almost a week now.
I have an appointment with my PCP tomorrow morning, she Rx's all my meds, including pain meds. I want to ask her to increase my OxyContin. From what I read, Oxy only comes in 10, 20, 40, 80 and 160. Can she increase it to 60mgs? I realize that would be a 40mg plus a 20mg. My question is would this be considered 2 meds, 2 co-pays. Or would it be a one co pay for both strengths? Does anyone know?
I see the surgeon again on December 18th, he may have to repair damage from the surgery I had in June.
Thank you all for letting me vent and ask questions.
FLGIRL
PS In the past I have been Rx'd Duragesic 100mcg every 2 days, but after a few years developed a reaction. Weird, I know. Also, I have been on Avinza, Percocet, Lortab and many more I can't remember right now.
December 4, 2007 - 5:44pm
#2
I wish they had that 60mg
I wish they had that 60mg dose too.
If you get a script for 40mg 3x daily plus 20mg 3x daily, you will undoubtably have to pay two co-pays. If 2x a day dosing of oxycontin works for you, you could try 80mg 2x a day. Most people seem to need that 3x a day dosing however. You could also just go to 80mg 3x a day, but if it were me, I would give you less Dilaudid in that case. You could also switch to another medication, or increase the amount of Dilaudid you get. Your insurance company would probably not let you get 40mg 4x a day, which would also be an intermediate dosage.
I have had good results with Opana ER (oxymorphone) for patients needing high doses of narcotics. It is truely twice a day dosing, and comes in a variety of dosages. It also comes in an immediate release form.
I would enjoy knowing what your doctor decides to do.
December 5, 2007 - 11:32am
#3
**UPDATE**
Dear Dr. Lois and gcdylan:
Thank you both so much for the very helpful advice. I just got back from my appointment with my PCP and had a heart to heart talk about the pain impacting my life. And, basically bedridden for over a week now.
She agreed to increase my OxyContin to 60mgs x 3 per day, plus she increased my Dilaudid to 8mgs x 4 per day (as needed). Yay! My doctor is so compassionate, caring and NEVER makes you feel rushed through your appointment. I have been with her for 5 years now and she is a keeper!
As for the copays, my insurance only charged me one copay. So that helps me a lot, since I am no longer able to work.
Dr. Lois, I have one more question for you. I have heard that OxyContin is available in the 160mgs again. Is this true? I am just curious, I don't think I will ever need that much OxyContin.
Also, my insurance doesn't cover Opana, they claim it is too new and they re-formulate their Rx plan in January. So it may be covered at that time.
Thank you so much for all your help!!
FLGIRLINPAIN (hopefully less pain after this increase :)
December 5, 2007 - 11:37am
#4
Oops, one more thing!
My doctor also increased my Neurontin to 300mgs x 3 per day. I think that will help a lot, since I have been on 100mgs x 3 day for about 8 years.
Thanks again,
FLGIRL
December 5, 2007 - 2:50pm
#5
no oxy 160mg
oxycontin is not available in 160mg. and you would'nt want to take it if it was. i don't know what you are suffering from but it must be awfully debilitating for the amount of pain meds you are on. i hope your doc has told you of the effectts of long term use and should you need or be ready to stop them they are very painful to come off of. good luck in your recovery
December 5, 2007 - 3:09pm
#6
You shouldn't comment like
You shouldn't comment like that Keadon before knowing someone's situation...even if intentions were good
PaWl WaLl
December 5, 2007 - 3:51pm
#7
160 mg Oxycontin
The last I knew, the 160 mg Oxycontin was no longer on the market in the United States. It was pulled because of the huge amount of diversion and O.D.'s. I have serious doubts they will ever be brought back.
When I was taking Oxycontin (I'm on Methadone now) I was taking 160 mg TID or 480 mg per day. When I came off it, I was switched to the Fentanyl Duragesic patch and decreased the Oxy until I was off it. In all fairness, I have to say I have never gone from a high dosage of Oxycontin to zero. I was brought off the patch (Fentanyl) quite quickly, and although it was no picnic, it wasn't too bad either.
December 5, 2007 - 4:05pm
#8
Thanks Pawlwall
Hi Pawlwall and keadon!
Pawlwall (love your name by the way) thank you for sticking up for me.
In my post, I was just curious if the 160mgs were back on the market, someone on this forum mentioned that they were. I wasn't planning on taking that dosage.
Keadon, I have been in pain management for 12 years, so I do realize that coming off of these types of meds would not be easy. However, I trust my doctor completely. If the time comes when I no longer need pain meds, I am sure my doctor will taper me and make me comfortable during that transition.
Take care,
FLGIRL
December 5, 2007 - 4:52pm
#9
Wow! I am really surprised
Wow! I am really surprised your insurance company didn't make you pay two copays! I think the Opana ER is new this year and it IS very pricey. I don't know about the 160mg. I have pretty much stopped using oxycontin because of problems with diversion and addiction. Oxycodone and codiene also show a lot of genetic variation in how quickly they are metabolized to the active byproduct because some people have an inactive gene for P-450 CYP 2D6 and don't get any pain relief at all and some people have multiple copies of the active gene and so they metabolize it ultrafast!
December 5, 2007 - 5:02pm
#10
The recommended Neurontin
The recommended Neurontin dosage for neuropathic pain is 1800-2400mg a day. A lot of people cannot tolerate doses that high because of sedation.
December 6, 2007 - 10:38pm
#11
Hurray for another
Hurray for another compassionate and caring pain mngmt Dr! Saw my pain dr yesterday. He took me off the perc 10/650's, (which don't help at all in my case), and changed me to dilaudid 8mg, 4xday. So far I've noticed the difference in my pain relief. On a bad note, I need a new pain pump, which means another surgery. Not looking forward to that, but it would explain while I was NOT getting the relief I should have been getting. (per "Pain Pump and Other Meds" posting).
December 7, 2007 - 4:28pm
#12
I'm surprised too
I'm surprised too about the insurance company only charging you one copay. It has been my experience that when you walk in with 2 different rx's, even though they are the same medications only in different strengths, that they will charge you 2 copays. (And that's only after they question the fact of why you are getting 2 rx's for the same type of Class II drug). I know when I had to get that a few years back, the dr had to write it on the same rx, (as item 1: Oxy 40mg - then - item 2: Oxy 20mg). I see a lot of posts on here about people on oxycontin XXmg x 3/day. I know when my dr wrote an rx like that for me awhile back, the pharmacist said that they could Not fill it as written, because it was a 12 hour medication AND a Class II drug. So I had to go back to the Dr and he had to write the rx as "Take 1 OR 2 every 12 hours - NOT to exceed 3 per day, Qty 90, (for 30day supply).
December 7, 2007 - 5:16pm
#13
Pre-approval
Hi Always in Pain!
I was surprised as well. I called my insurance company and explained that OxyContin does not come in a 60mgs dosage and what was the protocol in this situation. I was advised by the insurance company to have my doctor write the Rx for 60mgs total, not 40mgs and 20mgs and they would pre-approve it for that dosage.
Even my pharmacist was surprised that I only had to pay one co pay. He said he has NEVER had an insurance company charge one co pay for 2 different mgs.
Thanks and take care,
FLGIRL
December 7, 2007 - 6:21pm
#14
Ahaaa! Another way around
Ahaaa! I just KNEW that there had to be a way people were getting them filled like that. As you read in my answer, I had a heck of a time getting that one filled. Cuz even though I did manage to get it filled, I still had the 2 copays. bty ---> FL here also ;-)
December 7, 2007 - 7:41pm
#15
I should have been
I should have been a little more clear and not have put 2 stmts in my earlier response. Maybe Dr Lois or Director could help? My question is that I see some people, (including Director) were prescribed Ocycontin TID - when I had problems because the pharmacist said they could NOT fill it as written - it is a BID only Rx? This was a few years ago, so maybe the laws have changed? Just curious, thx.
December 7, 2007 - 9:47pm
#16
Methadone dosing
Methadone is normally dosed every 4-6 hours when prescribed for pain. It is normally dosed once a day when it's used for maintaining someone who has been using and needs to detox or be on a long term program. It is definitely not restricted to BID dosing.
My doc writes my scripts 60 mg TID, but he knows I take it throughout the day 10-20 mg, as needed. Usually every two hours or so, but I can take up to 180 mg per day.
December 7, 2007 - 10:30pm
#17
?
this may be a little off subject,my doc. has also stopped writing oc.he changed me to opana(3 months ago)and i am having a lot of anxiety and other side effects.(even though i take 1mg klonipin x3 a day)he said he may change me to patches next visit.is this a good med. as compared to oc?i know everyone experiences med.s differently but any help would be appreciated. side note,avenza has similar side effects.
December 7, 2007 - 11:09pm
#18
I was meaning
Hi Director. What I was asking about was the Oxycontin, (when you were on it previously), being a BID dosing, as to you mentioning you were taking it, (Oxycontin), as TID. I've noticed other people also say there were Rx'd oxycontin as TID. thx
December 7, 2007 - 11:17pm
#19
Duragesic Patch
Hi TednRobyn!
My experience with the Duragesic Patches was quite well. I was Rx'd them for about 3 years, 100mcg every 48hrs. with Dilaudid for breakthrough pain.
I live in Florida and the summers are quite hot and humid and I started having a problem with the patches staying adhered to my skin. My doctor switched me to OxyContin for the summer and when we tried to go back to the patch, when the weather is cooler, I had a weird reaction. Needless to say, we went back to the Oxy. I just had an increase in my dosage and I am now feeling a lot better.
The great thing about the patches is not having to take so many pills every day, you just put one on and change it every 2 or 3 days (depends on the person). When the generics came out, I had BIG TIME problems with them, so I always bought the Name brand. But, just like you said, everyone is different.
Take care,
FLGIRL
December 8, 2007 - 10:52am
#20
thanks
thank you for the reply,help is very much appreciated.
December 8, 2007 - 11:35am
#21
It is probably your
It is probably your insurance company that will not pay for tid dosing of oxycontin. Laws stricter than the federal regulations may be imposed by the state, but I don't know that any state has restricted oxycontin to twice a day. The pharmacist may also have had a concern about the off label dosing or a scheduled drug, and decided not to fill it based on his own clinical discretion.
December 8, 2007 - 12:23pm
#22
I think you're right
I think you're right about it being more the pharmacist who was using his own clinical discretion. But, if that's how my dr prescribed it, why would the pharmacist second guess my Dr? It was never even 'run through' to see if my insurance would pay for it. He took one look at the rx and said that he could not fill it the way it was written. If you don't mind sharing, Dr Lois, have you ever had a pharmacist second guess any Rx you have written? I don't take this med anymore, so it's not a big deal to me now. But maybe some others might be interested? thanks AIP
December 8, 2007 - 12:52pm
#23
Occasionally it happens.
Occasionally it happens. Sometimes the pharmacist knows that the patient is getting other scripts from other doctors. Sometimes the pharmacist just has a bad feeling about a certain patient or certain scripts from certain doctors. Perhaps this pharmacist just had a personal policy of not filling any off label oxycontin scripts because they can be so problematic. The pharmacists are independantly responsible to their state board and to law enforcement. They can't claim "well that's what the doctor wrote for". Just like a patient can't go to a doctor and demand a certain type of treatment, a doctor can't demand that a pharmacist fill a certain prescription. You can complain to the state board of pharmacy about the pharmacist's behavior and it will be investigated. In this case, it would be likely that no unethical or illegal or incompetant behavior was involved.
This was a real problem for a while when some pharmacists were not dispensing precriptions for "the morning after pill" Plan B, on religious grounds.
Sometimes people with legit scripts for legit problems are given a hard time, but there is a lot of abuse of prescription narcotics, and all you can do is use your BEST JUDGEMENT as a physician or a pharmacist.
Hints for avoiding problems with filling narcotic scripts:
Go to a pharmacy in your neigborhood, or near your doctor's office.
Always go to the same pharmacy.
Ask your pharmacist questions about your medications.
Do not wait until you are out of medication to bring in your script for a refill.
Don't get into an arguement with the pharmacist. Just say 'OK, I'll call my doctor about it.' Let your doctor and the phamacist duke it out.
Ask your doctor if he or she recommends a particular pharmacy.
If you can, avoid going to a pharmacy in an area with high crime or high drug use.
December 9, 2007 - 12:41am
#24
Oxy dosing
I was on TID dosing with Oxycontin, in fact I got up to 160 mg, TID. It is legal for your doctor to write it for that, even though Purdue Pharma claims it's a 12 hour (BID) med. Almost all people have trouble getting by with two times a day dosing. Unless your insurance will not pay for TID dosing, and force you to accept the BID because of cost, you're much better off and more comfortable with TID.
Sorry about the mix up earlier about the medication. I mistakenly thought you were asking about my Methadone. I hope this answers your questions, but please let me know if it hasn't and there's something else I can help with.
December 10, 2007 - 4:44pm
#25
Scripts from other doctors
Dr Lois, The one thing I do NOT do is go to any other doctors or pharmacies. That is one of the things that throw up a 'red flag'. Honestly, a few years ago, I was doing just that - shopping. And on another subject, since I only see my pm doctor every 6-8 weeks, that means on my Sch II drugs, (which can NOT be refilled), my doctor writes me a seperate Rx that is post-dated for 30 days later, (which saves me a 200 mile round trip). It's great to have a good compassionate doctor who puts his patients interest above all other things. Most doctors, (or should I say billing dept's), expect payment at the time of service. My doctor is more concerned about his patients getting pain relief than he is about collecting money. I don't even have to make a copayment on my visits - they will bill me after my Medicare pays it's part, and then I can make arrangments over time. How many doctors will do that for their patients? AIP
I also am on 40mgX3 but for breakthrough I take 30mgx3 oxy IR. They discontinued the 160mg in the states as far as I know I am no doctor and have no idea of your tolerance or pain but there are many type avenues you can go.You might consider asking for stronger strenth breakthrough's, maybe 2 80mg Oxycontins, I had to experiment with different strenth's and different med's until I got it correct where we both were satisfied Of course it all depends on your doctor. Just my 2 cents worth