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Old 09-21-2004, 07:37 AM   #1
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Question Breakthrough Meds

Hi all I decided to switch back from the Duragesic patch to Oxycontin, (the patch just ended up being to much of a hassle and wasn't working all that well for me, difficulty getting it to stick, more side effects, not any more effective) I had been using Oxy 60mgs 2X a day and although I want my doctor to up it 20mgs so far he hasn't, but i have decided so far it has worked best w/ the least amount of side effects. One problem i had been running into w/ the Oxys is most of the time it would only work a good 8 hours not the 12 hours it is prescribed for. For "breakthrough pain" my doc rxs me hydrocodone 5/500 and i go through about 5 a day. At this point I don't think that they even make much of a difference anymore and am considering talking to my doctor about switching me to a more effective breakthrough med. Does anyone have any ideas for me? Thanks all

 
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Old 09-21-2004, 09:55 AM   #2
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Re: Breakthrough Meds

Hi Bob!

I've been on various doses of Oxy for 4 years. I think most patients find out pretty quick that Oxy's don't last 12 hours even though the manufacturer says it does.

Fortunately for me my dr. rx's the Oxy 3 times per day (tid) which works well. Rarely have I needed anything for breakthru with this schedule; however, it seems there's alot of docs that won't go against the manu's prescribing info and will stick with the twice per day dose. I find Oxy barely lasts 7-8 hours so taking it three times per day makes it much more effective.

If your doc could get the longacting oxy dose right, then you may not have a need for breakthru meds. But he may not be willing to bend with the prescribing info. It wouldn't hurt to talk with him about it if you feel comfortable doing so. I know how frustrating it can be because initially I was rx'd bid too. Thank goodness my doc listened to me and over-rode the manu's schedule with tid dosing. Good luck, Linda

 
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Old 09-21-2004, 12:11 PM   #3
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Re: Breakthrough Meds

Hello Bob,

It's my experience that none of the pain meds last as long as the mfg states. I'm fairly certain that the mfg. says Oxycontin lasts "up to 12hours". If you were to switch to TID, you might find that you could get by 40Mg x3.

Good luck on your DR being receptive to the 3x dosing.
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Old 09-21-2004, 12:52 PM   #4
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Re: Breakthrough Meds

Hey Bob, I just explained the twelve hour thing and why it's like that to bilbo, it's in Italics, but linda is absolutely right, when an even level is maintained with an opiate, Break through meds can truly be used for breakthrough pain or the additional pain from an actual incedent or a time of the day where you actually hurt more, ie. morning or evening. Not to bridge the 4 hour gaps in OxyContin.

BT meds should be proportinate to your base dose if not, is like taking atic tac. Purdue recomends 20-30 of the BID dose, so although hemanufacturer is really imiting your use to BID, they do recomend 20-30% of the BID dose in instant form ie Oxyfast or OxyIR as BT. Notice how they reccomand their own product. That;'s part of a law suit about it not lasting 12 hours to encourage the sales of their SA line.

Kadian does lst at least 12 hours so if dosed BID t is a very smooth med. Methadone is very forgiving because of the long half life. I haven't tried Avinza but have doubts about 24 hours and the patch says up to 72 hours. Purdue stands strong on OxyContin lasting 12 hours.

"The only problem with 3 times a day dosing is that Purdue, the manufacturer sent out letters to every PM doc they can find and everyone getting free meds through their patient asistance program and to as many pharmacies as possible, telling docs not to write OxyC more frequently than BID and telling pharmacist they should outright not fill TID scripts for OxyC. People in the PAP had to have their scripts written BID or no free meds from Purdue.

There are also many tracking systems set up specifically for OxyC due to all the over reporting of 500 Oxy related deaths in as many years. Forget the 17k a year that die from OTC NSAIDS and Apap. So a surgeon can be hinky about long term use, and from 40mgs TID you would defintely need to taper and surgeons are not axactly the best at tapering you comfortably off the meds. Even PM docs are getting away from oxycontin due to the press and tracking systems in place. Big bro's watching. My state was the first state and Purdue paid for it as their way to solve the abuse problem. It just scares docs from writing it. VA didn't have a huge abuse problem.

It was all part of their patent litigation to keep generics off the market, and by docs following the manufacturer's guidelines they lower their risk of liability should someone abuse and OD on TID dosing, Or get cought selling the 3rd dose Purdue says we don't need. The best defense in any position is, I followed the FDA aproved prescribing instructions and didn't exceed twice a day dosing."


If you check OxyC's full presribing instruction it's very specific, it's not up to, It's 12 hours throughout the entire pamphlet. I know it doesn't last that long. But Purdue had to fight for their patent and first fought that the others did not last 12 hours so it was not a generic equivelent, their second fot was that These meds were to close to Oxycontin method of action, strength, etc and infringed on their patent rights. They wanted it both ways and eventually lost, but they did take Endo's OxySR off the market 4 years ago when it slipped on. It's and the patents overturned now.

I would be curious to read the Endo, and Teva full prescribing info.

BRB, Dave.

Well, Endo ihasn't updated there site and couldn't find it at teva, I downloaded the Hebrew text version for windows and will look at their main site for the FPR.

I did see a new sufentanyl patch is coming out by Endo and so is Oxymorphone SR and oxymorphone short acting tablets probably n the next year if not sooner.

But at the Teva site they are calling it an AB rated generic of Oxycontin so it should follow the same 12 hour prescribing instructions, otherwise it wouldn't have gotten a generic equivelency and been an entirely new product, different release like with MSContin and Kadain or Avinza.

Last edited by Shoreline; 09-21-2004 at 01:22 PM.

 
Old 09-21-2004, 01:48 PM   #5
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Re: Breakthrough Meds

here is the full prescribing info from Purdue They beat the 12 hour thing like a dead horse..

PHARMACOKINETICS AND METABOLISM
The activity of OxyContin Tablets is primarily due to the parent drug oxycodone.
OxyContin Tablets are designed to provide controlled delivery of oxycodone over 12 hours.
Breaking, chewing or crushing OxyContin Tablets eliminates the controlled delivery
mechanism and results in the rapid release and absorption of a potentially fatal dose of
oxycodone.

Absorption
About 60% to 87% of an oral dose of oxycodone reaches the central compartment in
comparison to a parenteral dose. This high oral bioavailability is due to low pre-systemic
and/or first-pass metabolism. In normal volunteers, the t½ of absorption is 0.4 hours for
immediate-release oral oxycodone. In contrast, OxyContin Tablets exhibit a biphasic
absorption pattern with two apparent absorption half-lives of 0.6 and 6.9 hours, which
describes the initial release of oxycodone from the tablet followed by a prolonged release.

Absorption
About 60% to 87% of an oral dose of oxycodone reaches the central compartment in
comparison to a parenteral dose. This high oral bioavailability is due to low pre-systemic
and/or first-pass metabolism. In normal volunteers, the t½ of absorption is 0.4 hours for
immediate-release oral oxycodone. In contrast, OxyContin Tablets exhibit a biphasic
absorption pattern with two apparent absorption half-lives of 0.6 and 6.9 hours, which
describes the initial release of oxycodone from the tablet followed by a prolonged release.

Given the short half-life of elimination of
oxycodone from OxyContin ® , steady-state plasma concentrations of oxycodone are achieved
within 24-36 hours of initiation of dosing with OxyContin Tablets. In a study comparing
10 mg of OxyContin every 12 hours to 5 mg of immediate-release oxycodone every 6 hours,
the two treatments were found to be equivalent for AUC and Cmax, and similar for Cmin
(trough) concentrations. There was less fluctuation in plasma concentrations for the
OxyContin Tablets than for the immediate-release formulation.

OxyContin Tablets are a controlled-release oral formulation of oxycodone hydrochloride
indicated for the management of moderate to severe pain when a continuous, around-the-clock
analgesic is needed for an extended period of time. The controlled-release nature of
the formulation allows OxyContin to be effectively administered every 12 hours
(see CLINICAL PHARMACOLOGY; PHARMACOKINETICS AND
METABOLISM). While symmetric (same dose AM and PM), around-the-clock, q12h
dosing is appropriate for the majority of patients, some patients may benefit from asymmetric
(different dose given in AM than in PM) dosing, tailored to their pain pattern.

 
Old 09-21-2004, 01:57 PM   #6
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Re: Breakthrough Meds

Hello Dave,

My pm dr has me Oxycontin 20Mg x3. Been on it like that for several months and have had no problems getting the scripts filled either.
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Old 09-21-2004, 06:28 PM   #7
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Re: Breakthrough Meds

Hey Gang,

I have been on 160 mg three times a day for a while and since few pharmacies (none) here stock the 160 mg, I have to take two 80mg three times per day. No break throughs. Also the DEA is backing off of pain patients so what are you talking about? I haven't had any trouble except with one idiot pharmacist getting my meds.

Am I missing something. Besides all of the lawsuits have been thrown out of court.,

Its about time the OC BS stops. We have lives to live and I can live mine as a leader at my company because of my meds.

By the way its great to see Shoreline back in rare form. I hope you are doing great.

GL

 
Old 09-21-2004, 09:06 PM   #8
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Re: Breakthrough Meds

Hi everyone,

Dave, great post about Purdue's instructions. They say the same thing discouraging TID dosing in their insert, which is just ridiculous considering that apparently the only people who reported 12 hour relief during trials were people without pain issues! For me, OC only lasts 4-5 hours before the pain is back with a venegance. So many people have this problem with Contin formulations running out after 4-8 hours; you'd think Purdue would want to encourage more frequent dosing to boost sales, but I guess not. Luckily I have a compassionate doctor who listens and wants to help--he prescribes me 10 mg five times per day and it works wonders. It's a really low dose overall but the coverage is so much more even that I'm using much less BT meds than when I took it 3x per day. Bob, if you're using 5 bt meds per day that's almost definitely a sign that your LA med is not sufficient. It's probably not that the hydro isn't working so much that once your pain returns full force, it's a lot more difficult to get it under control that it would be if you stay ahead of it. I remember this well from when I was taking it every 8 hours. I do find that Oxy IR works well for me though some people have better results and develop tolerance more slowly with BT pills that are a different med than their LA med. Fortunately, I haven't had to up my dosage of the OC or Oxy IR at all after many months so that hasn't been a problem for me.

I'd bet anything that many of those Oxy related deaths occured in people without legitimate pain who were taking the drug to get high (same thing with a vast majority of the Oxy abuse/overdose reports). But of course, addicts can still get OC easily while CPers suffer because of the bad press and have their privacy invaded. It all makes me really frustrated, but at least my doctor isn't afraid to believe me regarding how long the OC lasts. So many doctors have been scared by the DEA into refusing to deviate from Purdue's dosing guidelines, and as a result many people are in pain for the last 6 of each 12 hour dose . Maybe if you keep a diary of your pain levels throughout the day your doctor will allow you to try taking OC TID--you could probably get by with the same total daily MG but have much better relief with more frequent dosing.

Good luck and take care,
Stacy

 
Old 09-22-2004, 07:15 AM   #9
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Re: Breakthrough Meds

Thanks all that really helps. You don't know how many times I complained to my doctor that the oxys last only 7-8 hours I didn't realize what a common problem that was. Shoreline, you mentioned Kadian would definetly last 12 hours and has a longer half life then oxys, is that basically a generic version of MS-Contin? I wonder if it might be worth asking my doctor about as it would be great to have something that would last and it seems w/ Oxy I build up a tolerance very quickly. A problem I run into is my "PM" doctor is actually a Rhuematology and Internall medicine specialist and i remember he made a comment after having me try the duragesic patches that "if this doesn't work we have tried just about everything we could" and he has made several comments to me in the past that he is not experienced in dealing w/ opiod medications. He had tried to get me in w/ a real PM specialist but there are none in my area that are willing to treat High level Fibro pain, they don't "believe" in it.

 
Old 09-22-2004, 10:30 AM   #10
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Re: Breakthrough Meds

Hey guys, THere are definitely docs that are confident enough to prescribe it the way it works based on patient reporting, although the patent suits are over, It doesn't mean docs and pharmacies and the patients in purdue's patient assistant programs don't have trouble obtaining and filling TID scripts and we still see people suffering through twice a a dosing after this product has been on the market for 8 years and the patent expired.

Some docs will prescribe TID, no doubt, just like some docs use BT meds.

However some docs are obviously still stuck on BID and some docs don't use OxyC at all or any opiates.

If your pharmacy will order the name brand 160's they can be obtained.
Purdue began marketing their 160mg tablet after volantarilly suspending distribution, It's back in their package insert.
1. PACKAGE INSERT
OXYCONTIN ®
(OXYCODONE HCL CONTROLLED-RELEASE) TABLETS CII
10 mg 20 mg 40 mg 80 mg* 160 mg*
* 80 mg and 160 mg for use in opioid-tolerant patients only
PATIENT INFORMATION
OXYCONTIN
®
CII
(Oxycodone HCl Controlled-Release) Tablets
OxyContin
®
Tablets, 160 mg
OxyContin ® (oxycodone hydrochloride controlled-release) Tablets 160 mg are caplet-shaped,
unscored, blue-colored, convex tablets imprinted with OC on one side and 160 on the other.
They are supplied as follows: 160mg
NDC 59011-109-10: child-resistant closure, opaque plastic bottles of 100
NDC 59011-109-25: unit dose packaging with 25 individually numbered tablets per card;
one card per glue end carton
There is the package info on the 160's with he NDC # for a pharmacist to order, one that says they don't make it is either too lazy to look or doesn't want to carry them in their store, likely because "they feel" the dose is too high.

Here is walgreens price on the 160's
OXYCONTIN 160MG TABLETS
100 each
OXYCONTIN 160MG TABLETS $1,545.09

They are out there but stores may not be stocking them.
Good luck, Dave

 
Old 09-22-2004, 10:10 PM   #11
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Re: Breakthrough Meds

Hi all,while were on the subject of needing more frequent dosing or BT meds if i were offered twice a day dosing ony oxyc and it didnt last atleast 10 hrs id want off.im currently taking 15mg roxi

ive recently had a rought time due to a fall and broke some ribs and did something bad to my back as well.over a couple of weeks following that fall my back pain was getting worse by the day.by the 5th day i was bedridden.constnt pain,unable to rest with meds and ice packs.

all this while on vacation with the entire family ,they got to see first hand how bad it can be and maybe understand why i dont always make a trip out to see them often.

anyway upon returning home and going to my reg appt w/pain doc i told him whats been going on,how when really bad all i can do is lay down.he asked me if i wanted a dose increase and i said no but id just like to be able to manage the pain at night,which is not possible with 4 pills SA med a day.

he added 10 pills and wrote the rx for up to 5 a day.so with seeing him every 28 days i just about have enough to squeeze out a few whole doses at night or many 1/2 doses.

that night was the first night i slept through the night in months.didnt feel 1/2 as awful in the morning either.just much more stiff from the extra sleep.even a 1/2 dose has got me sleeping through the night,deep dreamy sleep.been a very long time.

that was 2 weeks ago and im feeling pretty good.i think when sleep is restored its much easier to cope with the pain.just by adding a single dose a day my family and friends have even said how much better i look.

the pain doesnt get so bad during the night and my first dose of the day seems to be offering more relief than before.

a good doc should be more concerned with what their patients are going through due to pain then trying to fly below the radar at the paitents expense.

ive been asking for months for an additinal dose as it is very difficult to get by on only 4.it took a bad pain spike that had lasted weeks and an offer to increase my current dose which i thought is still not going to get me through a 24 hr day any easier.i just said,give me a pill for the nights and he agreed.im sure he would have been willing to bump me up to 20mg 4 x a day which would last any longer then the 15 mg i was taking.

my point is,sometimes a little change can make all the difference to someone in pain.after reading what most experience on oxyc after the first 8 hrs i dont think id want to try it.shame,becuse it would probably work very well for me as ive always resonded well to oxycodone.

i would think dr's would be a little reluctant to rx breakthrough meds
based on the "IT DOES LAST 12 HRS,WRITE BID ONLY" and pharmacists who back that statement............................JMO scotty

 
Old 09-23-2004, 10:43 AM   #12
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Re: Breakthrough Meds

Quote:
Originally Posted by FibroBob
Hi all I decided to switch back from the Duragesic patch to Oxycontin, (the patch just ended up being to much of a hassle and wasn't working all that well for me, difficulty getting it to stick, more side effects, not any more effective) I had been using Oxy 60mgs 2X a day and although I want my doctor to up it 20mgs so far he hasn't, but i have decided so far it has worked best w/ the least amount of side effects. One problem i had been running into w/ the Oxys is most of the time it would only work a good 8 hours not the 12 hours it is prescribed for. For "breakthrough pain" my doc rxs me hydrocodone 5/500 and i go through about 5 a day. At this point I don't think that they even make much of a difference anymore and am considering talking to my doctor about switching me to a more effective breakthrough med. Does anyone have any ideas for me? Thanks all
My advice didn't work on keeping skin very clean with alcohol swabs??? On the patches? see if he can put you on like morphine sulphate IR 15 mg?? I don't just a thought. fibro friend Dana

 
Old 09-23-2004, 10:51 AM   #13
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Re: Breakthrough Meds

i dont know it just became to much of a hassle to always make sure the patch was not coming off, i thought it was uncomfortable, my wife said i was itching at it in my sleep, i had more side effects and it didnt give me any better pain relief then the oxys were do i decided id rather just take a pill a few times a day rather then have to bother with the patch.

Last edited by FibroBob; 09-23-2004 at 10:52 AM.

 
Old 09-23-2004, 12:23 PM   #14
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Re: Breakthrough Meds

Quote:
Originally Posted by FibroBob
i dont know it just became to much of a hassle to always make sure the patch was not coming off, i thought it was uncomfortable, my wife said i was itching at it in my sleep, i had more side effects and it didnt give me any better pain relief then the oxys were do i decided id rather just take a pill a few times a day rather then have to bother with the patch.
I understand. Did u try different areas of the body? and yeah they make yu itch but not all the time. But if oxy's work better go for it.

 
Old 09-23-2004, 01:33 PM   #15
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Re: Breakthrough Meds

yes i did try different area of my body i couldnt find anywhere that didn't stretch or flex at some point to make the darn things come loose! Ive never been good w/ patches i use ENDO's Lidoderm patches and w/ them i am constantly adjusting and pressing back on, nice thing w/ them is it doesnt matter if they come off a little bit w/ the patches different story...

 
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