May 16, 2006 - 2:48pm
When deciding which narcotic to continue using my M.D. We had already tried hydrocodone, oxycodone, dilaudid, and I know Darvocet is not really going to do much for me. He offered a fentanyl patch but I prefer to be able to regulate my meds to tailor them to my pain relief needs, rather than having a measured dose 24/7. He suggested tramadol saying it was about equipotent to vicodin. I suggested demerol remebering an IV shot I received in the ER, and it worked very well with minimal side affects. My M.D. said Demerol taken orally is very ineffective compared to IV and needs a substantially larger dose for adequete pain relief. I told him I would rather try that than Tramadol so we agreed on a dmemrol 50mg tabet. The pharmacy then was out of 50mg so they subbed 100mg tabs with doc's permission. Also, is there any narcotic analgesic i did not mention that might work well? (What is tramadol and where does ot compare in pain relief compared to the other I've tried.)
Sorry to ramble off topic but Dermerol is pretty potent stuff, one of the most potent sythetic opioids along with fentanyl and a few others IIRC. Why is it so ineffective orally and how much less effective is it. I know 100mg is an IV dose on the high side and I was told to take 1-3 50mg tabs. So how much more oral demerol do I have to take. Is i 1/2 less potent than IV, 1/3, 1/4? I know this site is not intended for medical advice so I've tried to keep it that way except fot the last few sentences. I you do have any info for me that cannot be shared on on the forum, please send me a private message.
Once again sorry for the long post. Hope for some informative responses. Thanx
PDX
May 17, 2006 - 8:59am
#2
Tramadol
That is the same as ultram. It does work good, and its a non-narcodic
May 17, 2006 - 10:38am
#3
"1mg is equal to about
"1mg is equal to about 7-10mg of morphine i think... so you can ask about that... but i doubt seriously you'll get it... the only other drug i can think of is Nubain... which you can now get in tablet form and is along with methadone, a newer drug used to treat heroin addiction... "
i am not sure where you get your info but;
1) fenyntal is the strongest opiod rx and is considerbly stronger than that
2) methadone has been around for quite a while
3) methadone is sometimes used to treat opiod dependency but is more frequently used for pain management.
May 17, 2006 - 10:38am
#4
"1mg is equal to about
"1mg is equal to about 7-10mg of morphine i think... so you can ask about that... but i doubt seriously you'll get it... the only other drug i can think of is Nubain... which you can now get in tablet form and is along with methadone, a newer drug used to treat heroin addiction... "
i am not sure where you get your info but;
1) fenyntal is the strongest opiod rx and is considerbly stronger than that
2) methadone has been around for quite a while
3) methadone is sometimes used to treat opiod dependency but is more frequently used for pain management.
May 17, 2006 - 12:52pm
#5
Oxymorphone is about 6-8
Oxymorphone is about 6-8 time more potent than morphine.
The duragesic patch or Fentanyl is about 50 times more potent.
Of course everyone is different and what works one some will not work on others
Personally I find oxycodone HCI 30mg along with Oxycontin 40mg to work quite well for my intractable nerve pain.
Maybe it is because it is converted to oxymorphone in the body
Speaking of oxymorphone there is some interesting news about it.
It is a bit outdated so please bear with it
Penwest Pharmaceuticals Co. (Nasdaq: PPCO) today announced that Endo Pharmaceuticals Holdings Inc. has issued a press release reporting that Endo has reached agreement with the U.S. Food and Drug Administration (FDA) on the design of a new clinical trial to provide additional safety and efficacy data for oxymorphone extended-release tablets (oxymorphone ER) to support Endo's New Drug Application (NDA) for this developmental product. Endo, which jointly developed oxymorphone ER with Penwest, said it had submitted the trial protocol to the FDA under the Special Protocol Assessment (SPA) process. Under the terms of the SPA, Endo will initiate a 12-week, multicenter, double-blind, placebo-controlled trial of oxymorphone ER.
As announced on October 20, 2003, the FDA issued an approvable letter for Endo's oxymorphone ER NDA, but had requested that Endo address certain questions and provide additional clarification and information, including some form of additional clinical trial to further confirm the safety and efficacy of this product. Also as previously announced, the FDA, following a meeting with Endo in early May, 2004, indicated its concern that the statistical analysis of two of the three Phase III efficacy trials submitted in the NDA that met its predefined primary end-points may have been favorably biased by the statistical handling of data from patients who did not complete the trials. In its press release today, Endo reported that the design of the additional clinical trial is intended to address this issue.
In today's press release, Endo also noted that this trial will complement the Phase III clinical trial, which it believes the FDA has accepted as demonstrating efficacy in the intended patient population. Endo also reported that based on the duration of the trial and the number of patients to be enrolled, and assuming the data is favorable, it will be in a position to finish the study and submit the complete response to the FDA in the late third quarter or early fourth quarter of 2005. Penwest expects that Endo will receive a further action letter from the FDA within six months of Endo's complete response letter.
Tod R. Hamachek, Chairman and Chief Executive Officer of Penwest, said, "We are pleased with this important step forward in the approval process, and look forward to Endo completing the clinical trial and moving oxymorphone ER closer to its launch in the marketplace."
Oxymorphone ER is an oral extended-release opioid analgesic for the treatment of moderate-to-severe pain in patients requiring continuous, around- the-clock opioid therapy for an extended period of time.
May 17, 2006 - 2:41pm
#6
that is very interesting. i
that is very interesting. i wonder how old it is and if it still bears truth.
May 17, 2006 - 5:10pm
#7
Decisions, Decisions
I see my M.D. tomorrow and thats when I will be refilling my meds so I am curious what anyone who reads/replies might think
Here are my options
Fentanyl Patch (Duragesic), or lozenge- Actiq
Dilaudid (hydromorphone) 2,4, or 8mg
Percocet 10/325mg
Oxycodone Hcl 5,15, or 30mg
(Not sure about oxycontin, havnt asked)
Demerol 50, 100mg
Tramadol (Ultram) 50mg
Darvocet, Davron
I can't take hydrocodone so that is not an option and I havnt ever heard of oxymorphone but Iwill discuss it with my doc
Also, what about Butorphano (Stadol) and Nubain, what is the difference between an opiate agonist, opiate antagonist or a mix?
Any personal experiences and thoughts would be much appreciated
May 18, 2006 - 12:15pm
#8
Fentanyl
Phisher is right; the Fentanyl Duragesic patch is the strongest rx opiod available, and it will virtually eliminate your pain. BE SURE YOU FOLLOW THE INSTRUCTIONS concerning 'things not to do' while wearing the patch, as it can release too quickly into your body causing overdose. Two very close friends of mine use Fentanyl patches to control severe chronic back and leg pain, and they swear by it. Ordinarilly they would not even be able to function without it. They are very expensive, but with insurance they are affordable. If not, Duragesic (the brand name company that manufactures the patch) offers an coverage to qualifying patients that pays 100%!!! (which can be around $250-$600/month).
Dilaudid is also a very potent pain medicine (I know from research and second-hand expericenes) but I've not had any first-hand experience with hydromorphone myself. BEST OF LUCK! GOD BLESS!
May 18, 2006 - 8:55pm
#9
Demerol
hydromorphone (dilaudid) 4mg was quite ineffective and caused lots of stomach upset. I decided on oral demerol but seem to get less pain relief with very little side affects. At first he had me taking 50-150 demerol oral but even 150mg was barely taking the edge off. Today he prescribed 100mg tablets meperidine (demerol) and said to take 1-3 every 8 hours. Anyone know how much less potent demerol is when taken orally? I took a 300mg oral dose and got great pain relief for 3-4 hrs but that seems like kind of a high dose when IV it is given 50-100mg usually. Anyone know why demerol is less effective orally. I have heard 40-60 percent less effective orally. I've also heard that below fentanyl is it one of the three strongest narcotics used in the US.
I have been offered the Duragesic fentanyl patch as well but prefer to take more or less meds depending on the pain level. If the fentanyl patch really really eliminates pain, maybe ist worth it for my doc to give me 1-2 to try before paying for a whole Rx. Also how expensive is the Duragesic patch and what strengths do they come in?
Lets have a pain free life! Live every day like its the next Take care
PDX
May 19, 2006 - 6:33am
#10
The fentanyl patch comes in
The fentanyl patch comes in 25 mcg, 50 mcg, 75 mcg and 100 mcg. Naturally, your doc will want to start you on the 25 first, which should run (for the Sandoz brand) about $250 for 10 patches (30-day supply). That price may vary depending on where in the U.S. you are. That's a good idea though, if your doc could give you some sort of sample to try, but as with any narcotic you build a dependency for it soon, so I would say 1-2 patches is plenty if you're just going to experiment (although they are only sold in boxes of 5 to the best of my knowledge). Hope this advice is helpful, and I hope you find the solution you're looking for. Best of luck.
i have chronic intractable pain like i assume you do and have been givent he gamut of NSAID's (i'm allergic to them and they induce my asthma!), SSRI (atypical painkillers with bad side effects), muscle relaxants (Soma, Skelaxin,etc...) and of course the 1st line treatment Opiods... i have been given the following in this order of opiod's: Darvon, Darvocet, Codeine, morphine(oral), demerol (injection), Dilaudid (injection, oral), oxycodone (percocet and Oxycontin), Duragesic (patch), and finally Hydrocodone (5-15mg with various amounts of tylenol/apap in them)... i find that Dilaudid works the best at killing the pain completely and fastest... the longest lasting is Oxycontin, but doctor's are wary of giving it for more than a year non-stop because of hysteria a few drug addicts/the media has caused! ack!... so to answer your question... the ONLY drug i could recommend that you havent tried is Oxymorphone... its stronger than Dilaudid and even Heroin... the only problem... its RARELY prescribed and is ONLY available in injection/rectal routes... and is one of, if not THE strongest opiod available... 1mg is equal to about 7-10mg of morphine i think... so you can ask about that... but i doubt seriously you'll get it... the only other drug i can think of is Nubain... which you can now get in tablet form and is along with methadone, a newer drug used to treat heroin addiction... although its not a FULL agonist like all the other opiods mixed, so you can't switch right off as it will cause slight-moderate withdrawal... ick!... so i would recommend sticking to Hydrocodone 10mg 4-6 times a day... i take only about 30mg of hydro a day but my pain level is "moderate" although non-stopchronic... its about 4-7 on the 1-10 pain scale WITHOUT meds... but with 30mg of hydrocodone plus Skelaxin and Cymbalta my pain level is 0-1 most of the time! so try maybe a two or three tier combo like i'm on before going to hardcore stuff like oxymorphone or methadone, etc... hope this helps! i've been receiving chronic pain treatment for 9yrs so i know a bit about what works and what doesnt since i've been given just about everything except Heroin... which isnt legal in the U.S. where i live but IS legal in the UK in case u live there?! its called Diamorphine or Diacetylmorphine... but causes damage to the heart lining so i would highly recommend against chronic use of it... i DID receive it once unknowingly in Mexico while on vacation... it was the BEST painkiller i've ever recieved adn i slept for 6hrs in the hospital...BUT i was completely incapacitated... so now i know the appeal of it to drug addicts to opiods its the ELITE of narcotic painkillers but extremely addictive... i felt addicted after that one injection and i've NEVER felt the least compulsion to misuse/abuse any of myopiod meds ever, so that says alot about the addiction potention of heroin/diamorphine.... have a great pain free day! <3
Christian