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Old 04-15-2012, 03:51 PM   #1
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Switching from 100mcg Duragesic patch to MS Contin or ???

Hi, What would be the approx correct equivalency for switching from using 100mcg Duragesic patch to MS Contin pills- what mg dosage should the pills be at to equal the patch?

This is my 1st post- so I'll give a little background. I've suffered severe chronic pain from Interstitial Cystitis for 8 yrs. I've been wearing Duragesic (fentanyl) patches for most of that time w/ addition of various breakthru meds (of course that took about 14 -16 mos of extremely painful experimentation to finally get to the right combo- you name a med and I've tried it). I used to be at 250 dosage (so I wore 2 x 100's and 1x50 - changed every 48 hours) - but was able to gradually reduce down to 100 after I had an Interstim device surgically implanted in 2008. But now the patches aren't working as well for me anymore- and my Dr is reluctant to go over 100 dosage (I moved states during this time- so also had to change pain mgt docs)- so now switching me to long acting medication in oral form: MS Contin (morphine) at 60mgs twice a day dosage.

Well now that the patch has started wearing off (50%@17hrs) I'm very sure that 60mg is NOT the correct equivalency for a 100mcg patch LOL - pain & withdrawal symptoms. Anyone know what the correct approx number is?

Or have any ideas or experiences of switching off of the patch onto something else?

 
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Old 04-15-2012, 08:46 PM   #2
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Re: Switching from 100mcg Duragesic patch to MS Contin or ???

Hi there! When doctors switch you from one med to another they typically play it very safe in dosages as there is only so much cross-tolerance we have...ie. with a switch the patients can typically be stable on a lower equivalent dose of the new med if they haven't been on it previously. They should have told you that there would likely be some titration after this initial switch. How soon is your next visit?

A good doctor will see you every 2 weeks or so when doing a med switch like this, ask you to call if your have issues, etc. If you are having major withdrawal, I'd put a call into your doctor to be seen sooner. You may be able to get an oral ok to take more meds until they can see your early (before you run out), a prescription called in for Clondine to help with withdrawals, etc.

From a calculator I consulted, a 100 mcg/hr patch may be about equal to 400 mg/day of morphine, but these are iffy and of course I'm no doctor/pharmacist. When converting from methadone or fentanyl to another med you need to do even lower than the 50-80% of equivalent dose that is typically done in a conversion, as they attach to a different receptor. But, 120 mg/day may be too low for you to start.

They do this to be safe though...I have often had my doctors say they would rather a patient be in withdrawal and in pain than unconscious or dead. It is quite common for the patient to need to call and have something done before the next appointment as the conversion was way too conservative...sadly they often don't tell you this though! Same with not telling you that they can't switch you over to a dose you'll likely need straight away, but they need to make a safe switch.

Also keep in mind that morphine often needs to be dosed every 8 hours, not every 12 hours (so be sure to mention to your doctor if you notice your relief ending early...my doctor actually started me on 8 hour dosing). Hope you can reach your doctor tomorrow. Also keep in mind that the morphine will take a few days to reach its full level in your system, so it could get better (but the fentanyl withdrawal will get worse too). Do you have breakthrough meds to take? Best wishes.

 
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Old 04-20-2012, 12:20 PM   #3
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Re: Switching from 100mcg Duragesic patch to MS Contin or ???

Are you sure you want to switch from such a highly potent medication to such a relatively weak one, given the dosing needed? I've found Morphine to be a mess of side effects and histamine response even at fairly low doses. A plug for Oxymorphone, it has few side effects and is much more potent.

 
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Old 04-20-2012, 09:51 PM   #4
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Re: Switching from 100mcg Duragesic patch to MS Contin or ???

Personally I think the potency has nothing to do with it...if a med is 10 times stronger than something else, you are likely to need about 1/10th the dose. It doesn't mean its a stronger med, ie. it will work better for you. If dosed correctly for the patient, no med should be a step down from another, you will just need more mg of it. Some folks do need a higher (or lower) than quoted equivalent dose of a med though. Often its good to find which med you need the least amount of which is supposed to be equivalent.

Typically folks have a pain med or few which works better for them than others, whether they need less of it or have less side effects (or more tolerable side effects), etc. Its often almost necessary to switch if you are tolerant to one med and can be on less of another med, rather than increase the dosage.

Sometimes conversion wise it doesn't work out though...that is why they need to be so conservative on dose conversions (what is supposed to be equal may in fact be too strong). Methadone is one in particular which is very tough to convert to & from, especially from. Best wishes.

 
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Old 04-21-2012, 09:53 AM   #5
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Re: Switching from 100mcg Duragesic patch to MS Contin or ???

Potency is actually quite relevant -especially when considering side effects. while there may be no ceiling dose there are optimal dosing ranges; ie, taking enough acetaminophen to equal a high dose of a high potency narcotic is obviously not advised. Many examples abound. Morphine is very dirty, and not particularly potent. If one is requiring close to a Gram of Morphine a day the side effects would be over the top. They are better served with a higher potency alternative.

My suggestion is Levorphanol, 3mg tabs. A very under appreciated Pain medication that is a life saver for those with very high tolerance.

Last edited by Isotope; 04-21-2012 at 10:00 AM.

 
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Old 04-21-2012, 01:42 PM   #6
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Re: Switching from 100mcg Duragesic patch to MS Contin or ???

Well to be quite honest, your doctors have screwed you over. Straight out of the gate they put you on the strongest long term med that PM patients generally use....you developed a tolerance for it and now they're going to try and treat your pain with long acting meds that are way less active, potent whatever you want to call it.

You were on a high dose of Fentanyl, if you can get the MSContin to work you'll probably be on a high dose of it. MScontin works on a 12 hr clock, prescribed twice a day. I've went through all the oxy's, fentanyls, morphines...currently I use an MSContin and Oxycodone mix. 150mg MSContin and up to 60mg Oxycodone per day.

It's hard to convert a Fentanyl patch into a Morphine pill, PM Docs don't work off of a preset conversion chart. They generally put you on the amount that will best work to ease your pain, based on your tolerance, pain levels, etc. And it probably won't be an easy switch as they tend to put you on an amount and have you take it for a month before they increase it.

Kat

 
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