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Old 03-17-2006, 05:31 AM   #1
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Question Is MScontin 40 ER a high dose?

I love this board... As I will be using narcotics for the next several months, this will be a good support forum for me.

What I was wondering... My doctor gave me my first script for MScontin and it was 40 ER. It has me a little groggy but has almost wiped out the pain unless I'm just having a good day on top of taking the meds. I have only taken it twice so far.

She presribed it every 12 hours and I have vicodin 10/660 for any breatthrough pain.

Is it possible to be give too much pain meds??? lol Because maybe I can use a lower dose now because I have surgery sched in 6 weeks and will definitely need the higher doses then.

Anyone have any suggestions on dosing during this period? I thought perhaps with your experience, someone may know whether to go lower before surgery and jump up afterwards. I don't even know how large a dose 40 ER is..

Thanks for any feedback.

Last edited by theweaver2; 03-17-2006 at 05:31 AM.

 
Old 03-17-2006, 05:33 AM   #2
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Re: Is MScontin 40 ER a high dose?

Oh, I guess I could add that I was using 2 5/500's about twice a day before going to the 40 ER - it just seems like a BIG jump to me....

 
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Old 03-17-2006, 06:13 AM   #3
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Re: Is MScontin 40 ER a high dose?

I am just a bit confused here(nothing strange there)about the post you made on your other thread and this one.on the other post,you said the name of the med was hydrocodone ER 40mg?I know that one can't be right as there is no such med.but Are you sure that the one you are currently taking is indeed MS contin and not oxy contin instead?Just want to know for sure what you are actually on,what does it state exactly on the Rx bottle itself?Glad you have something that is working on your pain,whatever it actually is.Marcia
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Old 03-17-2006, 06:15 AM   #4
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Re: Is MScontin 40 ER a high dose?

Hi weaver, I'm a little confused because there isn't a single 40 mg morphine tablet available in the US. MSC comes in 15,30,60,100 and 200. Are you outside the states.

As far as what a 40 mg tab releases over 12 hours compared to 10 mgs of hydro every 4, that dose of morphine isn't a hge increase. If your takin OxyContin, then he pretty much doubled your serum level which is more than most docs will do because of safety reasons.

Are you talking about OxyContin? Oxy is about 50% stronger than morphine and the way it's released, half the dose is released at about 1 hour and the rest at about the 6th hour. It is a relatively high starting dose and I do hope that your doc explained about physical depndence, 3-4 months of around the clock opiates at that strength and you will become physically dependent, meaning you can't stop abruptly or you will experience some nasty withdrawal.

If he's using oxy the next step down is the 20 mg tabs and then the 10 but each step cuts your dose in half and that's large enough to make you feel pretty wrotten.

Is this a PM doc or your GP playing PM doc. A doc that knows what he's doing is usually going to start at the lowest dose possible that gives you relief, the goal isn't to wipe all your pain out, just make it tolerable. If he had started you at 20mgs twice a day that would be about a 50% increase in strength and I don't understand why a doc would skip that step if it could relieve yur pain.

THe only place you have to go from 40mgs is up, that's why they usually start lower. When you add BT meds to the mix it just raises your tolerance even higher. You might want to describe your situation a little and double check your bottle, long acting morphine isn't available in a 40mg strength in the US in any form whether it's Kadian or Avinza, the 12-24 hour versions of morphine or plain generic MSC. OxyContin comes in 40 which is what I suspect your taking.

Because the increase is significant the pain relief may be very effective initially, but tough to maintain that honeymoon over time without leaving you very groggy and impaired by constantly increasing to maintain that level of relief. You might even want to have you spouse listen to you breath while you sleep to be sure your not struggling to obtain oxygen due to the respirtory supressant effects of all opiates and this being such a large increase and a med your not used to taking.
Good luck, Dave

Last edited by Shoreline; 03-17-2006 at 06:42 AM.

 
Old 03-17-2006, 07:26 AM   #5
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Re: Is MScontin 40 ER a high dose?

Im such an idiot..... Can you tell I'm new to these drugs? lol

I have the bottle in front of me now... It is labeled IC OXYCODONE HCL 40 MG ER... which isnt hydrocodone like I said

Here is my history with pain meds the past 2 years so maybe you can understand whats going on for me. I am thinking the med above is highere than what I should maybe start with.

I have used Vicodin for the past 2 years - mostly taking 5/500's 2-3 times a day. Unless my pain levels were very low the 2 5/500's didnt do much at all.

What she did first was prescribe Vicodin 10/660 every 6-8 hours or up to 4 a day which I told her is basically the same dose I was using for my pain which didnt hack it.... only thing dif was I could take it 2 more times... but it wasn't doing the job the first time... so I could take it 4 times, but each time I wouldn't cut through the pain which usually runs from a 6-10 each day for me.

Then she gave me the above script. I know nothing about levels, but since it is working so good I wondered if I could get by with less? I know I will prob face some kind of withdrawal - hopefully, this surgery will help my pain levels.

I hope I cleared up some of the confusion. I also assume this drug is MScontin and not morphine. Is that correct?

I'd rather use something lower perhaps so after surgery I can bump it up. I mean its great feeling like I have nothing wrong lol but I know deep down there is a problem.

But, wouldn't it be something if the reason for my continued high levels of pain is just as simple as it hasn't been addressed properly and my body is just overly reacting to a learned pain response? Does that make sense and can that happen?

 
Old 03-17-2006, 07:34 AM   #6
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Re: Is MScontin 40 ER a high dose?

Quote:
Originally Posted by Shoreline
Hi weaver, I'm a little confused because there isn't a single 40 mg morphine tablet available in the US. MSC comes in 15,30,60,100 and 200. Are you outside the states.

As far as what a 40 mg tab releases over 12 hours compared to 10 mgs of hydro every 4, that dose of morphine isn't a hge increase. If your takin OxyContin, then he pretty much doubled your serum level which is more than most docs will do because of safety reasons.

Are you talking about OxyContin? Oxy is about 50% stronger than morphine and the way it's released, half the dose is released at about 1 hour and the rest at about the 6th hour. It is a relatively high starting dose and I do hope that your doc explained about physical depndence, 3-4 months of around the clock opiates at that strength and you will become physically dependent, meaning you can't stop abruptly or you will experience some nasty withdrawal.

If he's using oxy the next step down is the 20 mg tabs and then the 10 but each step cuts your dose in half and that's large enough to make you feel pretty wrotten.

Is this a PM doc or your GP playing PM doc. A doc that knows what he's doing is usually going to start at the lowest dose possible that gives you relief, the goal isn't to wipe all your pain out, just make it tolerable. If he had started you at 20mgs twice a day that would be about a 50% increase in strength and I don't understand why a doc would skip that step if it could relieve yur pain.

THe only place you have to go from 40mgs is up, that's why they usually start lower. When you add BT meds to the mix it just raises your tolerance even higher. You might want to describe your situation a little and double check your bottle, long acting morphine isn't available in a 40mg strength in the US in any form whether it's Kadian or Avinza, the 12-24 hour versions of morphine or plain generic MSC. OxyContin comes in 40 which is what I suspect your taking.

Because the increase is significant the pain relief may be very effective initially, but tough to maintain that honeymoon over time without leaving you very groggy and impaired by constantly increasing to maintain that level of relief. You might even want to have you spouse listen to you breath while you sleep to be sure your not struggling to obtain oxygen due to the respirtory supressant effects of all opiates and this being such a large increase and a med your not used to taking.
Good luck, Dave
Dave, OK now I'm rather concerned. If there are doses of 10 and 20 before the 40 why would she jump that high? It's not like I want to feel like I have no pain at all, just get the levels below 5 for part of the day so I can function. I still feel like percs taken as needed would ahve been better for me now - then use the 12 hour relase aftger surgery... but didn't want to **** off the PM doc (its not my GP).

I see her for follow up on March 27 - by that time I will have figured out how this works for me. I do get irregular heart beats and I have since my 20's (Im 55). It happens usualy with stress and other things. I don't worry about it too much anymore, but wonder if this drug will be stessful for me if Im jumping 2 levels.

Right now, I guess I should enjoy the painless hours - even though I want to sleep half the day. Maybe a 2 week "rest" will be good for me after 2 years of high pain.

I'm just confused right now. I am usually proactive about my treatments. But kinda feel like this PM doctor is a bit of a control freak and I don't want to **** her off by telling her what I think I need...

Think I need a nap right now.... lol

 
Old 03-17-2006, 10:47 AM   #7
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Re: Is MScontin 40 ER a high dose?

Hey Weaver,

I along with the rest was a little confused about your post. You said you read the bottle and it said Oxycodone 40 MG ER? If thats the case, that is generic OxyContin 40mg. (Time realeased Oxycodone)

I totally agree with shoreline here that its a jump from your hydrocodone that you were taking. With that said, we say that Mg's don't matter when you have chronic pain, however, when you first start the med they should titrate you from the lowest dose possible. This way you can move up as needed. This benefits you in the long run and the Dr's usually like you to be at the lowest possible dose that works. But like shore pointed out, you can only go up from there (40mg).

Since you're pretty new to these meds (and there is nothing wrong with that), I want to give you a little info. First, Oxycodone is about 50% stronger than Morphine and Hydrocodone. So 40 Mg twice daily (80mg) from someone that was taking 4-5 10 mg Hydrocodone is going to be a jump.

Second, do not try and cut your dose of the Oxycontin. This is a time released med, meaning that it is released over an 8-12 hour period. If you think its too much and cut it, you will release all 40 mg at one time.

I'm surprised your Dr went from 10 mg a couple times a day of Hydrocodone to 40 Mg of Oxycontin BID . They make a 10 mg pill and can go up from there. Oxycodone seems to be one of these drugs that you build tolerance to rather quickly. So if you're taking 40 mg twice daily, you will build up a tolerance and need increases that will only have to go up.

You asked the question, if MSContin is the same and the answer is no. Ms Contin is time released Morphine. About 50 % weaker than Oxycodone. MSContin works like OxyContin it is just Morphine instead of Oxycodone.

I don't want to scare you and you are probably getting pain relief, but its best to start low and work up (titrate). You will probably find that it will be short lived. You will eventually need an increase to cover you pain.

With all that said, Dr's don't like to be second guessed, so I am not sure how to approach your Dr. Maybe Shore has some suggestions. I guess we just don't want to see you have to be taking 160 mg of Oxy to cover you pain and being tolerant. If you are getting good relief where you are at, its possible the 20's or even the 10's with a BT med would have covered your pain fine until surgery. They can actually dose OxyContin 3 times a day for better coverage. (Maybe 10mg 3 times daily)

Anyway to sum it up; it sounds like you have Oxycontin 40 mg with Hydrocodone 10 mg for BT pain. Like shore said, I would be careful as its a pretty decent jump in meds.

Anyway, I hope I didn't confuse you more. If you are taking the 40 mg Oxy now, and it covering you pain wise, I would steer clear of the BT meds to help control your tolerance if you don't need them.

Take Care

Last edited by ARANGER; 03-17-2006 at 10:50 AM.

 
Old 03-17-2006, 10:58 AM   #8
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Re: Is MScontin 40 ER a high dose?

Hi Weaver, I hope your enjoying your nap. I can't even remeber being pain free. You do become used "accomadated" to the sedative effects of all opiates long before you you become tolerant to the pain reliving effects. Oher side ffects like itching and nausea often deminish. The nes tha can be problems that don' go away are constipation and urinary retention. You definitely have to start a maint plan for constipation while taking LA opiates. They shut the muscles down in your bowels and stop the contractions that move things along. THere are lots of products and secret recipes if you find you need help.

What your experiencing is a honeymoon that i experenced when they finaly used pain meds after 7 years of non narcotic pain managment and limited meds after 3 surgeries. IT soundfs like you goals are reasonable, your geting great relief right now but things willl change over the next few weeks. If your still feeeling sedated you might want to try decreasing your dose if you get tird of the naping.

Oxy can cause tachacardia in some people but it's rare. It's a pro opiate which means it's actually more stimulating than morphine or methadone, but with the boost in pain meds enjoy the relief. The level of relief and side effects you have now are fine for post op but it's not a good way to live. I'm not sure if you just had surgery or have it scheduled. If you are still this sedated you may want to talk about using the 20's 2-3 times a day.

As fas as the increase, if your doc is very open minded, and you're a health man, You shouldn't have to worry about respirtory supression, you would feel very funky and have cold sweats if you were having problems. You can also smoothly taper of meds if the doc knows what he is doing. It just takes alittle longer he higher your dose and longer you have taken them.

OxyC is contreversial in the length it last, some say 8 some say 12. The manufacturer is very big on using it every 12 hours because that's it's novelty that earned them a patent. They do recognize the need for BT painmeds but remeber if you have BT meds, only use them for BT pain, It doesn't sound like you need them now

If your allowed 2 or 4 doses of BT meds a day and you use the max every day, it just becomes incorporated into your daily pain med intake, so when you do have a bad day, they are no more effective than they were the previous 30 or 60 days you tok the max amount prescribed. So try to save it for when you need them. I look at BT meds as a tool the doc gave me so that I don't call him in the middle of the night and say I'm in horiable pain or have to go to the ER.

Can you tell us about your problem, are you a spiney? Something else? Anyway, I agree u deserve a break from the pain and that sleepiness should wear off. Many people on much higher doses are highly functinal and you would never know they take meds.

Take care, Dave

 
Old 03-17-2006, 01:59 PM   #9
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Re: Is MScontin 40 ER a high dose?

Dave and everyone else...

My story isn't as clear cut as someone's injury or disease process. My shoulder began "pinching" about 3 years ago when I started exercising.

I'm not going to bore you with all the doctors I went to and MRI's and EMG's I had. Now during this whole time my pain increased and increased, into my arm, scapula and neck, while my pain meds did not get increased.

Finally about 2 years into it I asked my ortho for a scope. He didn't know what to look for and referred me to another surgeon. A large bone spur and supraspinatus tear was found and fixed. The pain in the front of my shoulder and down my arm and scapula got worse. Was something overlooked? I'll never know. But my pain was horrendous. My surgeon even wanted me to stop taking the 10mg percs he prescribed 2 weeks after surgery !! And, my pain was worse than it ever had been. I did use the percs (ineffectively I might add except when I mistakenly took 2 within one hour time frame and then it worked) for about 2 months and finally went back to the vicodin because the percs werent working anyhow and I kept having to travel to my docs office every 5 days to get a new script. At one point two weeks after surgery he had the nerve to suggest I was addicted to pain meds. That made me so mad. It was the PAIN that was causing my need.

Talk about discouraged... About 6 months after that surgery I went for another opinion. Now, remember, except for the first 2 months after surgery all I had was hydrocodone 5/550 about twice a day. It didnt TOUCH the pain and many days I wanted to literally die and I was scared I would accommodate myself. I kept telling my doctors about the pain but all they gave me were tests and excuses for pain. Had the nerve to say I was depressed - no chit ...

My next ortho worked with me for about 5 months, then finally referred me to Ohio State University - a clinic. The doctor there zeroed right into my shoulder pain. Gave me 2 definite tests (a cort shot in the coracoid process and ANOTHER EMG which showed some mild entrapment in my brachial plexus. He suggested this next surgery which will mimic that pain relief. HA - I had 4 EMGS and none of them tested what this doctor asked to be tested. now THATs another story also...

That's the condensed version. I can't believe I spent almost 3 years and ten doctors (neuros, orthos, and GPs) trying to get some kind of diagnosis. I know this might not be THE answer, but its a direction before they cut. The first surgeon had no direction and I sincerely believe he fixed the first thing he saw and didnt pay much attention to the fact I had so much pain in front also.

OK - to present day. Along with referring me to OSU, my last ortho also referred me to a PM (I think thats what you call them). She seemed to understand my situation during my first appt but was asking me whether I wanted oxycontin ER or morphin ER... if I got those names right and i told her I didn't know because quite literally - isnt that her responsibility to know how to prescribe?

The rest is that she went to 10/660 every 6-8 hours to this oxycodrone ER 40mg every 12 hours. I thought it might be a BIG jump as it completely knocked the pain out. lol THAT in itself is a scary feeling. Pain has been my constant companion for over 2 years.

I do wish she had started me at 20mg. I guess she has her reasons but like you mentioned, after surgery I don't have much room to play with. Hopefully, when I see her on the 27th she will adjust appropriately and the 2 week interim won't have caused me to become accustomed to this level.

Here is sit 10 hours out from my 7am dose and feel the faintest of pain begining. Perhaps thats the goal of the 12 hour release. LOL I'm just so not used to having any pain med I've taken work and this is a shocker to feel like I havent felt for 2 years.

Maybe it just a honeymoon.... but I'm praying the surgery will offer some pain rellief. I'm just worried about getting away from the narcotics.

Thanks for being patient about my pain med savy (of which I currently have none). I am going to try and voice my concerns to her next visit w/o offending her hopefully....

In the meantime, guess I'll be sleeping a lot. I had forgotten what if felt like to actualy sleep and not awaken in pain.

 
Old 03-17-2006, 10:18 PM   #10
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Re: Is MScontin 40 ER a high dose?

Jeez, this is exactly what I've been upset about. My Doc gives me the 30 mg Roxicodone for bt, but won't rx OxyContin even though they are the exact same med and here is someone who is only on hydro and he gets OxyContin.

Meanwhile, the patch does nothing.

Alan

 
Old 03-18-2006, 05:32 AM   #11
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Re: Is MScontin 40 ER a high dose?

wanna trade??? lol

I don't want high doses. I'm willing to tough out some of the pain until I figure out what is wrong here...

I guess some docs are more cautious than others. Maybe my tears and telling my doctor this pain has ruined my life helped????

I took my last one at 8 pm last night. It's 8:30 and Im still feeling pretty good and could even live with this level and treat it once in awhile.

Plus, the meds really make me want to sleep all the time, naseous, and gives me a permanent migraine behind my eyes. I still like chit with such a high dose.

I am hoping when I call her office on Monday she will say its ok to take this once a day. I kinda think once around 9am should get me through the day and when I rest the pain is always lower.

How long have you been to this doctor? I know its hard to get into pain docs. Heck, half way through this past 3 years I went to another PM and he told me everything was being done tht could be done and that studies show aeoribic exercises one hour everyday has proven to help people like me. Do you believe that one???

Maybe whoever referred you to this doc will refer you to be evaluated by another. You might just need a "fresh" approach.

Good luck and keep in touch Dave.

 
Old 03-19-2006, 11:05 AM   #12
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Re: Is MScontin 40 ER a high dose?

I remember what it felt like, that head ache and nausea. That was nothing to write home about! If you take JUST A LITTLE LESS I'll bet you don't have that. That's what happens when you give a relatively "opiate naive" patient (even though you'd been taking oxycodone--that's low level pain relief), a sudden "fat" dose of pure opiate!

On the other hand I remember the feeling just beneath that--the pain being GONE! Feeling the headache, and nausea hover at the back of my head--but never breakthrough, amd I would sit back, close my eyes and think "Oh, thank you GOD!" I haven't had THAT feeling in a long time.

Since I've been on Methadone, I don't have sharp pain--but neither do I have the wonderful relief that is common to opiates. I have more of a blah, "Oh yeah. It's not bugging me today." But I guess that's one of the things we get whem we start fooling arounf with drugs. We get the urge to have the Pink CLoud.
Mya

 
Old 03-19-2006, 12:31 PM   #13
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Re: Is MScontin 40 ER a high dose?

Quote:
Originally Posted by dangovt
I remember what it felt like, that head ache and nausea. That was nothing to write home about! If you take JUST A LITTLE LESS I'll bet you don't have that. That's what happens when you give a relatively "opiate naive" patient (even though you'd been taking oxycodone--that's low level pain relief), a sudden "fat" dose of pure opiate!

On the other hand I remember the feeling just beneath that--the pain being GONE! Feeling the headache, and nausea hover at the back of my head--but never breakthrough, amd I would sit back, close my eyes and think "Oh, thank you GOD!" I haven't had THAT feeling in a long time.

Since I've been on Methadone, I don't have sharp pain--but neither do I have the wonderful relief that is common to opiates. I have more of a blah, "Oh yeah. It's not bugging me today." But I guess that's one of the things we get whem we start fooling arounf with drugs. We get the urge to have the Pink CLoud.
Mya
Dang,

I can tell you have "been there"... My pain relief after the first dose was OMG I'd forgotten what no pain felt like. lol there was probably some pain still lingering, but as comparison I was in heaven. Then after the second dose 12 hours later (its longacting oxycondone), the nausea, fatigue and headache got worse. I hesitantly went ahead and tried the 3rd dose and seriously thought I was gonna overdose and my nauses, sleepiness and headache were past the "just a little" stages. I stopped taking them and my pain relief actually almost lasted 24 hours.

Pain started getting annoying last night around 11 pm, more than 24 hours after my last pill at 7 pm Friday night. I tried going back and using the hydrocodone 10/660 a couple times, once at 11 pm and then again this morning at 8am with no luck. However, the nausea and headache and fatigue are much better so that is a good indication the oxycodone 40 ER was causing it.

They hydrocodone was even touching this pain, in fact my pain was getting WORSE and that was my complaint before I went to her, the vicodin just wasnt cutting it. Just to give it another chance I took the oxycodone around 11am. It's 3:30 pm and pain is better though not the OMG feeling it was before. I'm sick to my stomach and groggy. I could never drive after taking drug. My headache is beginning to creep in and since I'm a migraine sufferer also, it doesnt take much headache to trigger a big migraine.

Actually, until I can have my next surgery to hopefully correct what my first surgeon overlooked, I could deal with just lowering my pain levels to a livable" level. Save the BIG guns til after surgery.

crap, I think I need to go take someting for this nausea -xcuse the typos - ive been doing computer stuff for waaay to long and need to prob lay down a while.

Maybe I just need to get use to this high dose?

 
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