You may remember me from my thread from last month where I was having terrible side effects from oxycontin ER (unrelenting nausea and vomiting among other side effects). Well, when I went to see my PM doc last month, he took me completely off the oxycontin and switched me to Opana. I was taking 40 mg of the oxy 3x a day....I am now on 40 mg of Opana twice daily. Supposedly the Opana is about 1 1/2 times stronger than the oxycontin, thus the apparent dose decrease.
Well, here I am 3 weeks into treatment with Opana and I am doing no better...worse in some ways. I still have recurring nausea, chills and sweats along with a constant overall feeling of malaise. The most debilitating thing I am now experiencing since starting the Opana is panic / anxiety attacks...which I have not had previous problems with. I am finding it near impossible to make it through a full day at work....I get an attack and end up going home. I cannot continue like this. My life since going on these long acting narcotics 5 months ago has been pure hell. Yeah, the pain levels are manageable, but I feel SO BAD ALL THE TIME~!!
I find myself crying a couple times a day because I feel so desperate.
I ended up calling the pain management doctor again this month to schedule another early appointment to get off this medication. I know that I have read on this forum that it's not a "good thing" to keep scheduling "emergency" doctor visits, but I am at the end of my rope.
I have an appointment scheduled for 8am tomorrow. I am going to tell the doctor that I need to get off ALL the long acting narcotics... that I feel the meds are just too strong for my body. I want to suggest going down a couple notches in pain meds.. dropping form the Schedule II drugs I have been taking to hydrocodone or something similar. (I think approaching my problem in this manner might help minimize the doctor thinking that I am insome way scheming to get more drugs).
Does anyonw have any suggestions as to whether this is a good idea on how I handle my doctor visit tomorrow?? Also, is there anyone out there who has had personal experience with Opana. Has anyone had any of this "emotional" disturbance that I have been experiencing?
From what I've read about Opana, I think the rotten feeling you're experiencing is withdrawals from Oxy.
And, I think very possibly that your dose of Opana is too low. Only 10% of this drug makes it into your central nervous system. So, even though it's stronger than Oxy or morphine, at only 10% bioavailability, what you are getting is next to nothing. I think this drug is gonna fail miserably in the market if docs don't figure this out.
I really don't know if going off of all LA meds, and going to hydro or something else so low on the potency list is the right idea. I highly recommend trying morphine, like MS Contin or Kadian. These are two forms of LA morphine. Please don't assume it won't work or you'll react badly unless you have already tried it and know for sure.
My husband is on Opana ER, but his dosage is 20 mg twice a day. Prior to the Opana, he was on the Fentanyl patches for about 3 years. He had been up to 100mcg, but had been titrating down due to the side effects. The 20mg is working fairly well for him along with 10 mg hydrocodones up to 3 times a day for breakthrough. Since you have just been on the long acting meds for 5 months, it could be that your base dosage is just too strong.
You may want to talk to your doctor about lowering your dosage and having a short acting med available (if you don't already) for when you need the extra relief.
It sounds like your body is rejecting the la meds all together, I agree you should try mscontin since it is a natural not man made...It might help just thinking out loud.I had the same problem with methadone so they switched me to mscontin. They took me off because they said I was too young:mad...This was after my first back surgery...After my second surgery(fusion) I was reffered to a pain clinic were they put me on oxycontin with percocet for breackthrough. I also take zanaflex and mobic along with klonopin. This combonation is working great for me! Remember, everyone is different!Let us know how everything works out!
I have been on Opana for only about a month now, but it seems to be working pretty well for me. At first I was on 10mg 2x a day but now I'm on 20mg instead. It certainly lasts longer than OC. Steve, what exactly do you mean about only 10% getting into your system? That may be why I need a stronger dose, or stronger BT med. I wasn't aware that Opana was stronger than OC, I know that its oxymorphone as opposed to oxycodone...I'm just a little confused now...
On the ladder of potency, milligram for milligram, oxymorphone is pretty potent. Look at it this way, starting with codeine, you go to hydrocodone (vicodin), then to morphine (MS Contin, Kadian, Avinza), then oxycodone (OxyContin, Percocet), then hydromorphone (dilaudid), then oxymorphone (Opana), then fentanyl (Duragesic, Actiq). Opana is pretty high up that list. I don't mention methadone because it's a beast unto itself - good material for another time. Ultram falls somewhere between codeine and morphine, and it really depends on the person.
After potency, you have to consider what's called bioavailability. Once you take a med, it goes into your stomach and then the intestines. During this process the medicine is absorbed and goes to the liver where it's metabolized. It's here that the absorbed med is broken down and sent out for use by the brain, spinal column and peripheral tissues. Getting into the brain and spine is where it gets into the central nervous system (CNS), attaches to the opioid receptors and relieves the pain. Which drug it is, how the drug is metabolized and how much gets to the central nervous system is called bioavailability. With morphine only about 30-40% gets into the CNS. Oxycodone ranges from 70-80%. Opana is about 10%. Keep in mind this is when the med is taken orally. All drugs have much higher bioavailability when given IV, as they have no first pass through the GI tract. So, taken orally, very little of the oxymorphone in Opana actually gets used to relieve the pain you have. Granted, milligram for milligram oxymorphone is very potent, so even a little goes a long way. But at 10% that very little that's left doesn't go all that far for someone who's tolerant of opioids. This is why I believe Opana is given in doses too low, and why the majority of users don't get the relief hoped for. And, I think this drug is gonna fail in the market if they don't wise up and figure out how to appropriately dose this med.
I hope this helps to answer your question. Please post again if you have more questions. I'm no doc or pharmacist, this is just from my reading.
THANK YOU!! That makes a lot of sense, and now I understand much more! However, now I am concerned that since I do have such a high tolerance if that is enough for me. Maybe that is why I feel I need a better BT med. You say that it is b/c of taken orally, it goes through the gi...etc...My brothers friend (who takes for recreational purposes unfortunately) does not take it orally and does what you SHOULD NEVER do with them (crush) and I think that is why he believes it is so strong and why he wonders why it doesnt work well for me when I take them like you are supposed to. So, I think your clarification really helps. I wonder then if I should have the Opana changed to 40 and keep my BT the same, except for the fact I dont like the additional apap. I just dont think I need additional tylenol.
Last edited by manders061904; 05-15-2008 at 05:58 PM.
Well, I went to my pm doc this morning and am not all that happy with the result. This doctor is a firm believer in strictly prescribing LA narcotics for chronic pain control. So, he was not at all receptive to my suggestion to drop off the LA meds and go down to something like hydrocodone. He said that taking a dose of hydrocodone every 4-6 hours to chase the pain is the fastest way to become an addict.
SO, he has decided that I am going to stay on the Opana for now...but slowly decrease the doseage. I am to take my normal 40 mg tablet in the am, followed by a 20 mg tablet at night. This is a daily drop of 20 mgs. The doc feels that possibly my body cannot tolerate the high doseage that I am currently on.
To the poster that claims that such a low amount of the drug is metabolized from Opana....I don't quite agree with the logic that I am getting much less active narcotic in my system to work on the pain. The 40 mg tablet is the highest dose that Opana comes in, and I could feel that I was getting a very hefty dose. The whole idea of LA meds is that the patient is not supposed to feel the med "kick in" as you would in an IR form. Well, I defintely feel a massive "kick"....nothing euphoric at all...just a dizzying overwhelming sensation that makes me severely nauseated ans experiencing a sort of "out-of-body" sensation. Not at all pleasant. These symptoms definitely feel to me that I am getting too high a dose of the drug.
Anyway, I was hoping to be taken off the Opana by now and started on something else. It looks as if I have a couple more months of slowly titrating down the Opana. The doc is mentioning a couple other LA meds he would like to try once I get down off such a high Opana dose..ie...Kadian and other Morphine derivitives. I have no knowledge of these drugs, and I hope I will not be jumping out of the frying pan into the proverbial fire.
The doc did give me a script for some klonopin to ease me throught the severe anxiety and panic attacks that have developed since I started the Opana. He is also hopeful that, at a lower dose, these symptoms will also begin to dissipate.
One can only hope...Say a prayer for me gans...Thanks for all the replies so far. I value each and every one's insight and personal experience. It helps me a great deal
Well, I defintely feel a massive "kick"....nothing euphoric at all...just a dizzying overwhelming sensation that makes me severely nauseated ans experiencing a sort of "out-of-body" sensation. Not at all pleasant. These symptoms definitely feel to me that I am getting too high a dose of the drug.
According to my pharmacist, Opana's claim to fame in the pain med market is that it doesn't target the pain receptors that cause euphoria. Thus, it's marketed as less abuse potential. However, it hasn't caught on because it's very expensive and doesn't work for many people. Conversely, OC works for many, assuming one gets the doses per day correct.
Sorry you are having such a hard time. I have never taken Opana, because Morphine makes me sick as a dog. I have had very good results with Oxycontin. I've been taking it for about 6 years now and have only had 2 changes. The first was from 10mg to 20mg. The next was a change from 2x/day to 3x/day. This is where it gets sticky. The manufacturer (Perdue) insists that it is a 12 hour med. It is not. My PM doc has heard from several of his patients that it has never lasted 12, including me, and he agrees. He did have to get special authorization from my insurance to dose 3x/day, and has to renew the request every six months.
There are docs who feel that a long acting med should cover a patients pain, entirely. The studant who came in with my doc at my last appointment had this mindset. (My doc works and teaches at a teaching hospital) He thought there should be no need for BT meds. My doctor, however, understands that some BT meds are needed, because even pain patients like to move around and do things that might cause their pain levels to elevate, so I take hydro for BT as well.
I hope you can get this straightened out and find something that works for you across the board. Best of luck and let us know how it's going. CMP/MM
Could you add Compazine 10mg twice a day to the regime... it controls nausea, boosts the pain releiving efrect of opoids, and reduces anxiety.
Depending on your leval of pain, tylenol with codeine or tramadol might help (tramadol slow release, 200mg twice a day) is great
I'd be really careful with the compazine. This drug "potentiates" opioids, causing them to be even stronger than they otherwise would be. If the OP is feeling overwhelmed already, compazine might just push him over the edge.
Well, I went to my pm doc this morning and am not all that happy with the result. This doctor is a firm believer in strictly prescribing LA narcotics for chronic pain control. So, he was not at all receptive to my suggestion to drop off the LA meds and go down to something like hydrocodone. He said that taking a dose of hydrocodone every 4-6 hours to chase the pain is the fastest way to become an addict...
The doc is pretty much on target here. ALthough I would substitute the word dependent for addiction. Exclusively using SA meds for chronic pain will cause one's tolerance to skyrocket and make it very difficult to find helpful meds as the condition and tolerance progress.
Originally Posted by Lou1
...To the poster that claims that such a low amount of the drug is metabolized from Opana....I don't quite agree with the logic that I am getting much less active narcotic in my system to work on the pain. The 40 mg tablet is the highest dose that Opana comes in, and I could feel that I was getting a very hefty dose. The whole idea of LA meds is that the patient is not supposed to feel the med "kick in" as you would in an IR form. Well, I defintely feel a massive "kick"....nothing euphoric at all...just a dizzying overwhelming sensation that makes me severely nauseated ans experiencing a sort of "out-of-body" sensation. Not at all pleasant. These symptoms definitely feel to me that I am getting too high a dose of the drug...
What you feel and the facts about bioavailability may not seem to make sense. But the fact is that only 10% of the oxymorphone in Opana remains after first pass metabolism in the gut and liver. The rest is unavailable for pain relief and is excreted by the body. I react to hydromorphone (dilaudid) the same way you seem to react to Opana. It's just plain too much for me at any dose. When it kicks in I feel rotten, just like you describe. It could be that Opana may just not be right for you. We all react to opioids differently. For some hydrocodone (Vicodin) is way too strong, while oxycodone (OxyContin) does nothing for them. And this totally defies logic, but is true nevertheless for that person.
I really appreciate you posting about your experience with Opana. I want to learn as much as possible about this med, because it may be useful for me down the road.
And I really hope you and your doc find the best strategy to relieve your pain.
I thought oxycodone was metabolised to oxymorphone in the body?
You are correct, but it's not the only element metabolized from oxycodone, nor is there much produced.
Here's what I've read - Oxycodone hydrochloride is extensively metabolized to noroxycodone, oxymorphone, noroxymorphone, etc. The metabolite of highest concentration is noroxycodone, which is a much weaker pain reliever than oxycodone. The portion of oxycodone metabolized to the oxymorphone metabolite is present in the plasma only in low concentrations and has little overall effect in relieving pain. Very little is known about the noroxymorphone metabolite.