Re: Oxycontin vs MScontin
Hey Mo, That's great your doing so well on a lesser dose of Morphine. That's why I hate to pass along the equienalgesic charts because people can get it in their head that if they are not getting an equal dose acording to some chart which is simply meant to be used as a guide thay are not getting therelief they deserve.
The standard conversion from Oxy to MS is 1:1.5 meaning Oxy is about 50% stronger. But because MS is usually more sedating initially an equal dose may seem to be be too sedating and folks give up. 180 mgs of morphnine a day is not a rediculously high dose. It just depends on what you have been exposed to in the past. Your condition, the progression of your condition and a few other variables.
What's inoperable today may have other solutions a few years from now. PM is a fast growing field. There may not seem to be be many opiate options but there are more than your thinking and there are adjunctive meds that can help deal with your condition.
My advice is that if you just made the change, It's important to get your dose correct from the get go. You don't want improper titration to come back 3 months down the road and be called rapid tolerance.
Personaly I have seen people develop huge tolerance to Oxy very rapidly. Then again some can stay on the same dose for years. Everyone metabolizes meds differently. Some of the generic versions of MSContin are certainly as effective and much cheaper.
The newer long acting morphine products are lasting longer. Kadian is a true 12-24 hour med and Avinza is the newest which people seem to call the truest 24 hour med. However not all docs have the experience with the new meds and I seee too many folks giving up on The longer acting morphine prepes because docs are not comfortably properly titrating the dose.
100mgs spread over 24 hours creates a much lower serum level than 100mgs of MSContin released over 8 hours. 100mgs of Kadina twice a day may give you smoother coverage and about the same serum level and costs less than brand MSContin.
There is Duragesic, the actice ingredient is Fentanyl, a generic will hit the market this year.
methadone is an opton, and costs about 1/20 of what LA morphine costs and is generally more effective on Neuropathic pain due to it's ability to block the NMDA receptor.
There are plenty of new meds in clinical trials that have NMDA blocking agents combined with morphine and Fentanyl.Like Morphidex.
There is a Sufentanyl patch in trials, an Oxy patch in trials. Cone snail juice, CN-111 is in stage 111 clinical trials for intrathecal use and doesn't cause physical dependnece and is 1000X more potent than morphine. THe intrathecal pump may be an option down the road.
Things have changed so much in the last 10 years from when there was no such thing as OxyC and Duragesic was used solely for cancer. There is Levodromoran, similar to methadone with NMDA blocking ability which is believed to increase your threshold to pain and decrease tolerance to opiates. Roatating opiates helps, Rotating BT meds and usng a different BT med than your base hits a broader range of receptors.
There really is a lot going on more than just morphine which is 300 years old an Oxy which is 50.
Try not to worry about what's gong to happen in 10 or 20 years The latest trends in clinical trials are meds that have less potential for dependence and are much stronger than morphine. And many non opiate methods that can enhance or help your management of pain. It won't hurt to learn some of the non med methods like Yoga, relaxation techniques, bio feedback, etc.
It's important to stay as active as posible, Muscle wasting and loss of strength and decreasing good cholesterol all happenms when you are sedentary.
There are many thing you can do or try to slow progression of problems and keep your strength and spirits up. Become a master of the internet and educate yourself as far as what treatment options are available for your condition. This forum is a great place for sharing info and what's new and going on in PM.
If you do a search for the FDA site Centerwatch, it lists all the drugs and products in clinical trials, For some reasons links haven't been working. I can list them but you will have to cut and paste them into your search engine.
Here is a list of drug manufacturers and once you learn who the big PM companies are you can watch what's new.
Purdue, Endo, Watson, Ligand, Jansen, Roxanne all have great sites that will keep you updated as far as what's new and in the works.
Here is a decent free PDR but I prefer to go to the manufacturer and read the full prescribing info if I'm looking for something.
There is just tons of info out there and no reason to think your only other option is meth. If you respond well to Morphine there is no reason they can't keep up with any tolerance you may develop. There is virtually no ceiling on most pure opiates. What was once believed to be a toxic levels of Opiates have found not to apply to a the CP patient that has developed tolerance to the CNS effects over time. There are folks that take several thousand mgs of morphine per day very safely with minimal side effects.
Welcome and good luck. If you have a question we have many folks capable of answering and leading you in the right direction. Just start creating databases of useful info. Manufacturers, How to find free med programs, laws and regualtions etc. It's all out there.
Take care, Dave.
Last edited by Shoreline; 05-04-2004 at 11:48 AM.