scrapper1
09-29-2006, 11:39 PM
I was on 100mg of Kadian but was recently switched to 50mg of Fentanyl. Does this seem correct? I am in extra pain but it has only been 3 days. Let me know your thoughts as I know there are some experts out there :)
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cpapp31
09-29-2006, 11:55 PM
Hey Scrapper!
That does seem like a lower dose. I was on 20mg of Oxy, 3 x Day and was switched to the 50mcg of Duragesic. Now, I am a higher dose. I have never taken Kadian.
Hope this helps a little,
Cpapp31
That does seem like a lower dose. I was on 20mg of Oxy, 3 x Day and was switched to the 50mcg of Duragesic. Now, I am a higher dose. I have never taken Kadian.
Hope this helps a little,
Cpapp31
Shoreline
09-30-2006, 12:39 AM
Hey Scrapper, I have a copy of the Kadian conversion handbook made by the manufacturer, According to it, the 50ugh would be replaced by 150-200 mgs of Kadian. However, equinalgesic tables are just guides to prevent docs from ODing a patient and to get you in the ballpark. The rule is to always side on caution and patient safety. You can also see huge variations from one chart to the next so it really comes down to a matter of individual response. They do suggest going through a couple cycles of the patch and if it’s wearing off before it’s time, you need to report that too. It may take much more fentanyl than morphine or less Oxy mg to mg, or mcg in this case. If you happen to respond to one med better than the other it just means your normal..
Personally, I never found relief with Duragesic even at twice any conversion table suggested, so I did give up and go back to the old med at the same dose This being the starting dose, I would certainly go through the titration process and pretty much expect docs to start on what they believe is the low side every time. Taking in a chart you may have may not be the chart he uses, if he even uses a chart. So how you respond is all he can really go by along with his comfort prescribing and his understanding that what works for one, doesn't always work for another, or it may take significantly more.
You certainly shouldn't be going through withdrawal, which is the best test as far as knowing if you're even on the field or if your got left out in satellite parking and he completely missed the bus. Switching to Duragesic is fairly easy, Switching away can be a little more difficult since Fentanyl has properties other opiates don’t.
Hang in there, It should improve with the next patch or two and then you will have a better idea of where things stand with that med & dose.
Good luck, Dave
Personally, I never found relief with Duragesic even at twice any conversion table suggested, so I did give up and go back to the old med at the same dose This being the starting dose, I would certainly go through the titration process and pretty much expect docs to start on what they believe is the low side every time. Taking in a chart you may have may not be the chart he uses, if he even uses a chart. So how you respond is all he can really go by along with his comfort prescribing and his understanding that what works for one, doesn't always work for another, or it may take significantly more.
You certainly shouldn't be going through withdrawal, which is the best test as far as knowing if you're even on the field or if your got left out in satellite parking and he completely missed the bus. Switching to Duragesic is fairly easy, Switching away can be a little more difficult since Fentanyl has properties other opiates don’t.
Hang in there, It should improve with the next patch or two and then you will have a better idea of where things stand with that med & dose.
Good luck, Dave
scrapper1
09-30-2006, 02:02 PM
Thank you for responding. I feel better today. Maybe because it is day 4. I changed my patch yesterday morning. I would say my pain level today is at a 2 which is wonderful...it hasn't been that low since I first started taking pain meds. I am really glad I am on the Patch except I don't plan on being on it forever...I hope to fix my herniations. Shoreline, you mentioned problems coming off...what are those? I am scared that I may have opened a can of worms that I didn't want.
wolfmarket
10-01-2006, 04:58 AM
I went from 100 mg MS Contin bid to 100 mcg Fentanyl patch to 60 mg Kadian bid, which really seemed low to me. As a result, I ended up back on the 100 mcg Fentanyl Patch using 30 mg Roxicodone qid prn for b/t.
Based on Dave's conversion book, if a 50 mcg patch = 150-200 mg of Kadian, wouldn't a 100 mcg patch translate into 300-400 mg of Kadian?
As Dave has told me a few times, when doing a convesrion, the PM Doc will start you lower than the dose suggested by the convesrion table just in case.
Another thing of interest is that while Kadian does not have an instant release, Avinza does release some morphine instantly. Based on that, Avinza would seem to be a better choice than Kadian, in my humble opinion!
Based on Dave's conversion book, if a 50 mcg patch = 150-200 mg of Kadian, wouldn't a 100 mcg patch translate into 300-400 mg of Kadian?
As Dave has told me a few times, when doing a convesrion, the PM Doc will start you lower than the dose suggested by the convesrion table just in case.
Another thing of interest is that while Kadian does not have an instant release, Avinza does release some morphine instantly. Based on that, Avinza would seem to be a better choice than Kadian, in my humble opinion!
Shoreline
10-01-2006, 06:51 AM
Hi Alan, your correct about 100ugh being equiv to 300-400 of morphine acording to sevreal guides, that's why your kadian dose never made sense, and never worked. Even your MSC dose was low compared to the 100 ugh patch. For whetever reason your doc is comfortable with higher levels of Duragesic than he is with the equivelent levels of morphine.
I know you tried to get your doc to adjust the morphine, for whetever reason he's more comfy with the patch. Maybe it the false sense that duragesic is less prone to abuse, but that really a silly assumption. It's more dangerous to abuse because someone that does abuse the patches are consuming 3 days worth of fent in one pop. As crazy as it sounds people do open up the patches and consume the alcohol based fent in the resevoirs, I guess it's no crazier than injecting oral meds and thinking it's safe. Unfortunately we pay the consequence of our docs bad experiences with patients abusing specific meds. Good luck, Dave
I know you tried to get your doc to adjust the morphine, for whetever reason he's more comfy with the patch. Maybe it the false sense that duragesic is less prone to abuse, but that really a silly assumption. It's more dangerous to abuse because someone that does abuse the patches are consuming 3 days worth of fent in one pop. As crazy as it sounds people do open up the patches and consume the alcohol based fent in the resevoirs, I guess it's no crazier than injecting oral meds and thinking it's safe. Unfortunately we pay the consequence of our docs bad experiences with patients abusing specific meds. Good luck, Dave
wolfmarket
10-02-2006, 03:37 AM
Based on some comments made by my Doc, I'm of the mindset that I've hit his limit. Too bad as the pain is getting worse and as soon as the Roxi wears off, I'm a 12 on a 1-10 scale.
Thanks for your comments as usual. Hope you are doing well!
Thanks for your comments as usual. Hope you are doing well!
slipperyslope
10-02-2006, 06:05 PM
Hi wolf, how come you don't switch pain Dr's. you have had such a time with your pain and your Dr really isn't doing you any justice by keeping you on the patch that barely helps you. I think oxycontin works so well for pain, its really helped me and I take 2 40mg tabs a day plus I am allowed 4 percocets 5mgs a day but I only need them on the weekends when I am doing yard work and my pain gets bad. I might have asked you this before but have you thought about switching dr's to manage your pain better? what about your GP would they give you oxycontin? you could tell your Dr that is what you want to take and if he can't help you with it than your going to find a Dr that will. You know it works for you since you take the 30mgs of roxy so why don't you just ask him, point blank....that if he won't give it to you, your leaving? I hate to see you suffering so much, I feel very badly for you but I don't understand why you keep seeing a DR that isn't managing your pain properly. I don't understand this concept, they are supposed to be helping you and this Dr isn't giving you enough pain control.