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Old 01-27-2005, 01:05 PM   #1
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what's the difference?

Can someone explain the difference between oxycodone, oxycontin and MS contin?

I take oxycodone 5 mg 4 times per day for severe TMJ but it doesn't control my pain.

Thanks.

 
Old 01-27-2005, 05:05 PM   #2
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Re: what's the difference?

Oxycodone is the drug in Percocet, Endocet, Other Generic Oxycodone/APAP formulations, and it's also the active drug in Oxycontin.

I assume when you refer to Oxycodone you are referring to either Oxy-IR, or one of the various Oxycodone/APAP formulations (Percocet, Endocet..etc). These drugs deliver a small amount of Oxycodone with a non-modified release mechanism. IE: It hits you all at once, starts in 30-45 minutes, peaks in an hour and 20 minutes, wears off generally in 4 hours or less. Nothing wrong with this if you are taking it every 4 hours, but most people end up with a script for taking them once every 6. Hard to get good pain control this way as the serum levels go up and down all day, and the pain levels go up and down all day.

Oxycontin is simple a modified release form of Oxycodone. It comes in various strengths, 10, 20, 40, 80mg, and it generally written as a 12 (but sometimes 8) hour medicine. It has a time release mechanism that releases a fair amount of the drug at once, and then a few hours later it releases the rest of the drug. It gets a more consistent blood level than just taking Percocet on a regular basis. It also allows for higher dosing that the Oxycodone/APAP formulations because Oxycontin doesn't contain tylenol.

MSContin is very similar to Oxycontin, except that is a modified release form of morphine. You take it on 2-3 times a day dosing, and it releases a very steady level of morphine over an 8 to 12 hour period. It's much more convienant to take an MSContin tablet than to have to take small doses of MSir (Morphine Sulfate Instant Release) every 2 1/2 - 3 1/2 hours. MSContin comes in various strengths, 15, 30, 60, 100, and 200 mg.

It's largely a convienence issue on the Long Acting/Modified Release medicines, but I think you get a little bit better pain control, and it's certainly easier to sleep through the night when you don't have to get up every couple hours to take a pill to keep a continious amount of medicine in your system.

 
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Old 01-28-2005, 08:27 AM   #3
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Re: what's the difference?

Hi Jullie, Just to add to what phos exlained, The way OxyContin or any of the long acting meds work. If you take a 20mg OxyCOntin, It doesn't sustain 20 mgs of oxy in your system, as if you had taken 20 mgs of plain oxycodone every 4 hours. It sustains roughly half it's mg content for the duration of the pill. So if you were taking 10 mgs of Oxycodone or a 10 mg percocet every 4 hours, your would need a 20mg OxyContin every 8 hours to replace 10 mgs of oxy instant release every 4. The mg count on the long acting meds is the total amount of oxy or morphine that's in each pill.
IF you took 2 10 mg percocet every 4 hours, you would need to replace that with the 40 mg OxyContin tabs to sustain roughly the same serum level that 20 mgs of IR oxy creates.

AS far as Oxy Vs Morphine, One is synthetic and one was originally derived from extract of opium. Morphine, heroin and codiene are derivatives of opium, People may be alergic to opium products like morphine or codeine but may do fine on synthetic products like Oxycodone or hydrocdone or even hydro morphone.

However since 1979, all opiates/opioids are synthetically manufactured, the know what the morphine molacule looks like and it's chemical structure and now duplicate it with a syhthetic process. No actual opium is required to make morphine or codein any longer.

Morphine was the first opiate to be derived from opium and gthe first used in a syringe. So morphine is the gold standard to which other opiates are compared in strength, mg:mg. Oxy is actually about 50% stronger than morphine , Morphine is not the big gun people seem to think it is, Most of the synthetic s are stonger when compared
mg:mg. But the idea that morphine was the big gun and oxy isn't was only true when oxy doses were not available in the doses that morphine was available in, or didn't prior to 96 when OxyContin hit the market, and Duragesic patches were aproved for non cancer pain and phylosophies about treating non cancer pain changed.

Most opiates are stronger than morphine but morphine is still used as something to compare other opiates as far as strength and other aspects. The charts they use to compare opiates in strengh are alled equinalgesic charts, they give docs a basic guide as far swithcing a patient from one opiate to the other. Even with the carts, it doesn't gaurentee the same relief taking an equal dose of one med or the other.

Different opiates have different properties, they bind to different opiate receptors and sub groups of receptors and may have different side effects.Some are more efficient when taken orally and cross the blood brain barrier and each person will respond to different opiates differently. OXyC may work great for one person for the same condition that another person gets great relief from morphine with.

It's really just trial and error, as far as finding what works. PM docs usually prefer the LA meds because they don't have the ups and downs and don't have that initial kick when they start working, the onset is smoother and slower so there is less chance of relating the feeling that a SA med may give someone as far as that warm fuzzie feeling when it starts working to actual pain relief.

The warm fuzzies disapear long before the pain relief disapears, but some people associate the feeling a med gives them to pain relief and without that fuzzy feeling they will complain of lack of relief. The only way to maintin the warm fuzzies is to continually increase the dose of a med to one your not used too. However the fuzzies are first thing you get used to, so it can become a viscus cycle of increase after increase trying to maintain a feeling that really has little to do with pain relief.

You can get pain relief and be functional without the "warm fuzzies" and maintain on the same dose for up to several years as long as the problem isn't progressive or changing in severity. LA meds free you from clock watching and trying to cram activity into the time where you recieve the most effective relief from a short acting med. It's usually usaully 2 hours or less after you take time for it to start working and the last hour as the level in your blood deminishes.

The idea behind long acting meds is that it's easier to keep pain in check than to bring a high level of pain down. Once pain spirals out of control it becomes much harder to bring back down to a tolerable level.

Those are some of the PRO's of LA meds. The major negative aspect is that continous use of LA opiates results in physical dependence. Dependence just means you can't stop the med abruptly without experiencing negative effects "abstinence syndrome or withdrawal" without tapering off the med.

That doesn't equate to addiction. Addiction comes with a lot of psychological bagage and use continues even when it's destructive.

Although long acting meds cause physical dependence and so can short acting meds after prolonged use, if they improve quality of life and ability to function, that pretty much contradicts every definition of addiction.

Good luck, Dave

 
Old 06-04-2006, 08:57 PM   #4
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Re: what's the difference?

Very well put and easy to understand. THANK YOU!

 
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