I'm still on 60 mg of KADIAN bid as my base med with 30 mg Roxicodone for b/t. Honestly, I get 99.99% of my releif from the Roxicodone.
Anyway, my question is this. When I was using MS Contin as my base med, when I took a 100mg tablet, I would be essentially taking 50 mg of Morphine followed by another 50 mg of Morphine abbout 6 hours later.
I know the KADIAN time release mechanism is different than the MS Contin system.
When I take a 60 mg KADIAN, how much Morphine is released immediately, and how much is released as the hours go by?
Kadian does not have an instant release as MSContin or even Avinza. Like you said, MSContin has a an instant release at about .6 hours. Avinza which is marketed as q24 also has a small instant release. However, Kadian does not have an instant release formula.
Kadian is made of tiny pellets that are Polymer coated. Each pellet contains Morphine and is designed to release at different times in the gastro system, hence the 24 hour release.
But even Kadian does not maintain an exact 24 hour straight steady serum level with just one dose. It will however go for 24 hours, but it does start to fall off, but at a much slower rate then MSContin.
Studies show that Kadian pellets spike a little at around 4 hours, but then level off slightly at around 5 hours and maintain that until about the 10th or 12 hour. The serum levels then slowly start to decline, but at a pretty slow rate. This is why a BID dosing of Kadian is best.
Studies show that a pretty steady serum level is achieved after two days. Because you are dosing at every 12 hours, you are catching it right about the time it starts to decline. But like I mentioned earlier, Kadian declines much slower than other forms of Morphine. This is why most people don't notice the decrease.
Kadian actually has a pretty decent release system as far as ups and downs are concerned. But a BT med is usually needed due to no immediate release of Morphine.
The above is not to an exact time, just approximates. You mentioned that you are not getting much pain relief with the Kadian. Have you spoke with your Dr about an increase? If you are still needing the same amount of BT meds, then your base dose is probably not high enough.
Morphine has no ceiling by itself. Some people require high doses of Morphine to get their pain under control. Kadian makes several different strengths so maybe your doc could start to add 30 mg's to your daily dose until you get to the right dose. The only thing that limits that is the side effects. Constipation is usually the biggest side effect with higher Mg's of Morphine along with sedation. But if you are able to control it with diet and supplements, then it may be something to think about. For him, the end result would be that you could reduce the Roxi. Docs are usually more comfortable prescribing LA meds like Kadian as it has not really had much abuse, unlike OxyContin which is easier to abuse.
Sorry to take the long way to answer your question, but hopefully it made a little sense....
Kadian is a continual (called sustained) release throughout a 24 hour period. Doctors lately have been prescribing it twice a day as opposed to once a day because they have found it to be more effective than the general once a day dosing.
Avinza is the same type of medication but I had read here on the board that initially 10% of the medication is released and then the rest is released continuously throughout the 24 hour period.
Personally I've never found them to be effective. Avinza was better for the first few hours, probably because of the inital dose but by the time I'd hit halfway through the day or even sooner it felt as though I was not on any medication at all. I've found the MS Contin to be much more effective for me, but of course, everyone reacts differently to medications.
Last edited by Kissa; 06-11-2006 at 09:40 AM.
Reason: someday I'll learn grammar :)
Hey Allan, Although this isn't an absolute or exact way to do it, You can replace the total daily Kadian dose with short acting morphine divided into 6 short acting doses. So 120 mgs of kadian a day woul be comparable to takeing 20 mgs of IR morphine every 4 hours. 20 mgs of IR morphine every 4 hours is les than half of what 30mgs of oxycodone would provide as far as relief in theory if equiananelgesic tables were dead on. Unfortunately they really aren't, Most conversion would have 30 mgs of Oxy equal to 45 mgs of MSIR, Personally I don't get the relief from 60 mgs of MSIR that 30 mgs of Oxy provides, but that' just how I respond.
20 mgs of MSIR every 4 hours really isn't squat when only half your dose of oral morphine crosses the blood brain barrier. I've swithced from kadina to generic MSIR mg for mg. My doc used TID dosing with kafdian and has no problem with TID dosing as long as the doses are taken evenly apart "8 hours" and at the same time evrey day. When I switched from 200mgs of Kadian TID I replaced it with 200 mgs of MSC 3 times a day and really didn't find much differnce othe than the MSC would flat wear off if you were more than an hour late for the dose. The advantage of taking Kadian TID is that as your first dose of the day is wearing off 24 hours later, you still have 2/3 of your daily dose working. So worst case scenario your serum level is only going to drop by 1/3 it it's lowest point.
IF you had to convert all your opiate intake into morphine/Kadian to maintain what takng one 30 mg Roxi on top of the existing 120 mgs of Kadina every 4 hours you first convet the kadian into 6 IR doses taken every 4 hours. 120 mgs of kadian would equate to 20 mgs of IR every 4 hours. Using a 1:1.5 conversion for morphine to oxy which is extremely conservative IMO. You would replace 30mgs of roxi with 45 mgs of MSIR every 4 hours. Plus the 20 mgs of MSIR every 4 hours the Kadian roughly sustains equals 65mgs MSIR every 4 hours.
So now you at 65 mgs of MSIR every 4 hours or 390 mgs of morphine per day. Now you simply convert the IR morphine back into LA morphine mg for mg.
65mgs of MSIR X 6 doses per day equals 390 mgs of sa morphine, which could then be replaced by 400 mgs of Kadian per day or dosed 200 mgs BID.
Kadian's full prescribing info recomends you do all the conversions to come up with your total daily opiate intake, convert it to morphine and start at half for safety reasons. That's really for an opiate naive patient.So the starting dose would be 100mg BID. Someone that can take 30 mgs of Roxi on top of 120 mgs of morphine a day is not opiate naive. IF that's what it requires to manage your pain, I really don't see the logic in relyng so heavily on your BT meds. Have you told him that the kadian only provides 5% of the relief you get from the combined opiates you take, and what does he say to justiify continuing this plan?
From the docs standpoint is taking 180 mgs of oxy plus 120 mgs or morphine a day really that much different than taking 400 mgs of kadian a day and having a limited number of BT meds available to truly use as BT medication. I don' know if your doc provides you 6 doses of roxi a day but if you can handle even one dose a day on top of the kadian, you know how that makes you feel for the 4 hours it lasts and you know it's safe because you have been doing it so frequently, for so long.
Increasing your level to be constanly in that range really is no more dangerous and I would think 4 capsules/doses of kadian a day would bring less attn to his prescribing than 6 roxi a day plus 2 doses of Kadian.
He could reduce the number of pills he needs to prescribe by half and keep you in a range you already know is safe because you do have that high of a serum level every time you take a roxi. If it's safe for those 4 hours the roxi is working, it's safe to do around the clock.
Basicaly when you take a roxi now it more than tripples you opiate serum level that the kadian creates. When it wears off you take a huge nose dive and will have a hard time recovering unles he is giving you 5 or 6 doses of roxi a day. It really doesn't make sense to rely so heavily on the roxi. IF you were actually at 400 mgs of kadian a day the 15 mg roxi would probably be fine for BT and you wouldn't requre it around the clock.
We used the same logic to titrate my pump. I had a day time setting and at night it would increase by 15%. After 2 weeks I have a good idea of how the higher night time setting effected me and how much relief it provided. IF I still wasn't getng relief we would turn my night time dose into my day time dose and increase the night rate another 10-15%. We just kept going based on how the higher rate effected me untill we reached a level I could function in the day time on and one that managed the increased night pain and allowed me to truly use BT meds for BT pain.
Your higher rate is when you take BT meds, if you can function during that 4 hour period and don't feel impaired, there is no reason not to use your BT level as your target for your base level. This way you can limit your BT use and actually use it for BT pain rather than trying to sustain what the kadian could be doing at the right dose.
Every peron I have met that isn't happy with Kadian is usally in the same position as yourself. The dose is simply too low. I started at 200 mgs a day, that didn't touch my pain and there are docs that would have given up on morphine right then. Fortunately over the next 8 weeks we increased to 300 , then 400 and then 600 where I stayed for a year although I did have to switch to the same number of mgs of generic MSC when my insurance changed. If my insurance hadn't coveed the generic MSC we would have converted to the same number of mgs of MSIR per day devided into 6 doses.
Obviously evryone doesn't need to be at that high of a dose, but based on your BT med use, you can obviously handle tripplng your long acting dose safely. If it was done all at once the constpation or UA retention may hit you so hard you couldn't handle the side effects but he could continue to titrate the Kadian untill it's providing 80-90% of your pain control and then BT meds could be used for their intended purpose. It follows no principles of pain management or standards of practice to force a patient to rely on continual use of BT meds when your long acting dose is so proportionally low compared to where you are after taking 30 mgs of roxi on top of your present dose of LA med.
What's the goal here, Is he expecting something else your doing to slowly improve your condition so that you can decrease your BT meds use? Whether you take 400 mgs of Kadian a day or 180 mgs of roxi plus 120 mgs of Kadian, your tolerance level is still the same. If he is presently providing 6 doses of roxi a day, I would ask to trade the roxi for more LA med so you don't have to continue to watch the clock and live your life in 4 hour increments. The whole purpose of LA meds is to prevent the ups and downs and free you from clock watching.
Great post Dave. Great. Yes, you make so much sense. Actually, they allow me 1 Oxy every 6-8 hours although I'm rx'ed 90 per month. And I know how you count that! However, I do get refills from the insurance based on taking 4 per day.
Sure, I'd rather take 400 mgs of Kadian than taking the bt. I should have my Doc read your post. But remember, this is theh same Doc who told me that there is no long acting Oxycodone med!