What are everyone's thoughts re: dosages - Pain Management Message Board

klh121560 · 01-20-2005, 06:53 AM

I still don't get it. I will use Dilaudid/Palladone as my example.

If someone is Rx'd dilaudid 8mg every 6hr, that means 32mg daily total. Now we switch to palladone 32mg once a day.
Let us say for argument sake that the 8mg every 6 hrs was working fine for the patient. Now comes palladone, Rx'd at 32mg once a day, the total amount used on the dilaudid. (Isn't that how you told me docs figure the amount from short to long).
Well the 32mg of palladone is over a 24hr period or really 1.3mg/hr. So the patient is getting 1.3mg hr which is really very little.
I never get this. It is just like percocet and oxycontin. Two 10mg/325 percocets do not equal one 20mg oxycontin in pain relief. At least in my humble opinion.
It should be rather, that if a 10/325 percocet helped a patient get relief, then we would want to have that 10/325 percocet working all day long at that level, not a small division of that level all day.
Does this question make sense? I hope so. This is why I think many docs get scared at higher RX dosages. They see the number, but don't realize it is spread often over a 12/24 hour period.
The LA meds don't have the stregth as the SA ones, but supposedly the steady serum blood level argument is used to suffice. Meanwhile patients only get a fraction of real pain relief.
Are my calculations and conclusions wrong? What are your thoughts? and anyone else who cares to answer ?

Peace,
Ken

mommy2scl · 01-20-2005, 07:03 AM

Now mind you I am no expert at this by any means, but 8mg of dilaudid every six hours is not actually having 8 mg in your system at a steady level for 6 hours either. It is 1.333 per hour. If you divide 32mg by 24 hours you come up with the same amount 1.333 in your system. So what is the difference?? I don't see what the issue is?? Should a doctor be dosing you to keep 8mg times 24 hours - 192mg???? Every knows that 8 mgs of dilaudid every 6 hours does not keep a serum level of 8 mgs the whole 6 hours. You would actually be better off with the long acting one especially with dilaudid which has a rather short half life and never lasts 6 hours. Now if you were to push 8 mg of dilaudid in an IV it would probably kill you as it would deliver the entire 8 mg at once. Even a short acting med does not dump it all in your system at once - at least I don't think it does, like I said I am no expert at this. But with your example, I don't understand your confusion.

8mg every 6 hours equals 1.3333 per hour

32mg every 24 hours equals 1.333 per hour

mommy

klh121560 · 01-20-2005, 04:56 PM

Yes this is what I thought. I try to explain this to docs, but they just don't seem to get it or they do and just don't want to Rx what is really needed which is a higher dosage.
Just making sure I ain't crazy! (yet!)

- Ken

wirry1422 · 01-20-2005, 11:29 PM

Ken, the problem is you don't understand the release mechanics of the la meds. They do not evenly split the total dose over each hour, but rather deliver a "bolus" of medication immediatly, and another bolus in several hours. For example, oxycontin 20 mg (12 hour dosing) delivers 10 mg within the first 90 minutes, much like percocet 10/325, and then it releases another 10 mg at the six hour mark, much like taking a second percocet 10/325. The oxycontin 20 mg does not release 1&2/3 mg's every hour as you have eroneously indicated. Rather it releases the meds in the same increment as taking 1 percocet 10/325 every six hours. The 24 hour meds (avinza, palladone) release their meds in a very similar fashion as the 12 hour meds, only over a 24 hour period. And no, the serum level created by an oxycontin is not level, but simply more level than the serum level created by an ir med. However, if you read the full prescribing info for oxycontin, you will notice a serum chart showing two distinct peaks in the serum level, only the dips are less then on the chart for the equivalent ir meds, thus showing the superiority of oxycontin in achieving higher average serum levels than ir meds. That is why la meds are a better choice than ir meds, for chronic pain patients and anyone on high doses of opiates/opioids, not to mention the conveniece of la dosing, ken.

klh121560 · 01-21-2005, 06:58 AM

Thank you for the clear up. I always believed in LA meds. I actually should be going to methadone soon and staying with it. I will use oxycodone as a BT med. Thanks for everyones input !

Ken