Change of meds again - Pain Management Message Board

catnap · 12-31-2005, 05:24 PM

I decided to see another pm doctor. I just could not go to see the last one again because of his bad attitude and abusive manner. I was warned about him but tired of driving to Dallas. Remember, I changed because my pm doc closed his practice.

Anyway, this one I called and scheduled an appointment and told them I had enough meds to last to the visit. When I got there I could only see the assistant and he could not write schedule II. Great! He didn't know what to tell me. Thankfully, this was not a problem because I had enough methadone left over from a previous script. I had to come back in 3 days to see the doctor. This doctor comes in and says "you have really been through it haven't you." Then he tells me he would be uncomfortable writing such a large dose to me. I was taking 100 mcq Duragesic q 48 hrs. with 6 - 7.5/500 lortabs for bt. He wanted to start me on Avinza since he though I was receiving such a "large" dose and my pain level was still at 5. I agreed to the change and left the office with the script for 120 mg. Avinza "1 daily." I did ask him before I left if he thought I would have any problems with the change. He said no. What do yall think happened to me? After quite a few years of taking 405 mgs. of opiates per day down to 120 mgs. surely did put me into withdrawal. Thankfully I had enough methadone to take to keep the monsters away. I went back in in one week and handed the assistance a conversion chart and another article on dose changing between opiates. Even though I was out of the withdrawal stage I was in some very bad pain. I was taking only enough of the methadone to stay out of the withdrawal stage. I understand the potency of meth, long half life, the stacking of doses and how dangerous the drug can be. I told him I needed to discuss the amount of the Avinza prescribed to me and handed him the conversion chart. After briefly looking at it he got up and said he would call the doctor to find out what to do. He also said he didn't understand why I was in withdrawal because its an opiate. I told him it was the AMOUNT that changed that put me in withdrawal. How dense can someone be. He came back after discussing it with the doctor and told me he was doubling the dose. That puts me at 240 mgs. Still under the amount I was previously taking just the past week.

I am in some bad pain. After cutting back so much I reallize how "good" I was feeling before. I have to go back in to see the doctor next Tuesday and what might happen will be anybodies guess at this point. I have been in pm for 10 years and started at a dose of ms contin at 90 mgs per day. I feel as if I am starting all over again.

If done properly the doc should have given the new drug at 1/2 and decreased the old drug by 1/2 and slowly tapered off with old drug and increasing the new drug until I got some relief or to the point of sedation like all of the literature I read. It seems like I know more about it than he does and I certainly don't feel like I am being taken very good care of.

Whipper · 01-01-2006, 07:01 AM

I had been on Duragesic patch for almost four years when pharmacy changed it to Mylan Fentanyl (100mg) patch in Feb 05 while we were in AZ. Change made due to patient running out and quite a cost savings at that time. I didn't notice any physical change until around late June 05 while at our home in NY. I started to feel really lousy and more pain and couldn't figure out why. Made an appt to see pm doctor and when we got to appt had to see his nurse pract. He assesed the problem as being that I had developed a tolerance for the patch and put me on a drug called Palladone which was a morphine pill with a 24 hour release mechanism. Went home and took the pill. The first and second morning after taking the pill I ended up in bed all day and all night. On the third day I was up at around 4:00am and out in the backyard with very bad things in my mind. I walked in the yard for about three hours as I didn't want to wake my wife up. She awoke about seven when I started to kind of pace in the house. Immediately she recogonized the problem. She was really scared and couldn't wait to get the Dr on the phone. She was able to give me a adovane to calm me down. In the meantime I gave her the bullets to my gun. When getting to the Dr's, while she was sitting in the reception area and I was out pacing she overheard an employee of the Dr. say that they had just received notice that Palladone was taken off the shelves. Saw Dr and he put me back on Duragesic patch. Went to local pharmacy to get script filled, co pay was up from $105 for three months to $1300. Couldn't afford that so I went on Sandoz Fentanyl patch. Worked terrific. Moral of the story is that the time release on the Mylan patch did not work correctly as the Sandoxz brand brought me back to where I was with Duragesic patch. Sorry for making this a book but I thought it would give some good info. Good luck, Carol and thanks for your info to me.

Dick

catnap · 01-01-2006, 08:05 AM

Hey Whipper:

I understand what you went through. I once came down with a virus causing vomitting and a fever of 102. I was taking oral methadone at the time and could not keep it down. I ran across the yard to my parent's house in my nightgown, no housecoat, barefooted in 25 deg. weather. It will make you crazy. I would do most anything to keep from going into withdrawal. Horrible feeling, you just cannot describe. My dad was using the duragesic patch at the time and I was able to get at least 2 of his patches to use until my doctor got in the office. Didn't figure going to the emergency room would help. I don't think I could have laid on a stretcher for even a minute in an ambulance.

catnap · 01-01-2006, 08:08 AM

If this new doc had just kept me on the same base med of Duragesic it would have only cost me $68 instead of the $117 for 14 avinza. Plus the cost of each weekly office visit. My old doc had me coming in every three months at $20 for the visit. Other than very frustrating it has been much more expensive.

Josie115 · 01-01-2006, 09:08 AM

I am trying to learn more about the Mylan vs. the Sandoz patch and the whole delivery system. I started on Mylan the past summer. Been on a variety of meds and seem to have a huge tolerance to opiates. Tried Avinza, that just made me to sick to my stomach all the time. Had tried other things..percocets, percodans, oxycodone, hydrocodone (which was the only thing that really worked). Anyway..was started on 75 mcg.mylan. upped to 150 mcg. the next month and switched from 72 to 48 hrs. It worked better..but I think I was hoping it would work since the remaining options were running out. I felt lousy and tolerated pain that just was making me feel like giving up. I would have to leave work several times a week mid afternoon cause it was just getting too awful. I need to work and like to work and it's just a office job.. no lifting or any other heavy work..sitting and standing etc.. but I need to work.

Finally told her it (mylan) just wasn't working. She upped it to 200. At the ame time thoug I had just started my monthly supply which happened to be sandoz..picked it up at the pharmacy and was surprised to see the change..IT WORKED and was nothing like the mylan. Nothing like it. I immediately returned the script for 200 and told her we could stay at 150 as long as it was Sandoz. Please, someone tell me how these meds could be so very different? Even looking at it is amazing. One has the gel like reservoir..shaped larger, just completely different from the Mylan that is square, flat and no visible medicine. How can this work?? I want to report this to the manufacturer or to the government or something. I actually felt like I was getting too high of a dose and was worried that it was too high. Oh well.. it works.

You mentioned that the delivery system didn't work the same...or at different rates.??? I have not been using anything for breakthrough. I have vicodans but haven't touched them...?? any info?? any reason for this?? I may want to try to reduce the amount down..but then, occassionally will feel the pain and then I chicken out of reducing the amt. What to do???