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Old 07-11-2006, 08:40 AM   #1
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Avinza - Is it a 24 hour or 12 hour pain relief?

My PM&R dr. had my blood tested for morphine and demerol. He was surprised to find it was negative for both. I told him it was probably over 24 hours since I had taken the Avinza. When I got home and looked it up, it was not even 24 hours since I took it. I was also surprised. I am real new to opioids and naively thought Ligand was being 100% truthful.

I emailed a contact at Ligand, asking about this and their spirit of cooperation evaperated instantly. When I contacted them about my not being able to swallow after 90mg of Avinza, they said they had never heard of this before and asked me lots of questions over a few weeks. I gladly cooperated, after all, we both have my health to worry about. This word naive keeps popping up.

Now I have heard from others using Avinza that they use it on a 12 hour cycle. That makes sense to me because my Avinza quits working way before the 24 hours. Please don't think I am "bashing" Avinza, it has helped a lot.
But it is not as effective now as it was on day one. We can all say "Of course it is not as effective, your body has adapted to the Avinza." But the 24 hour usefulness, or lack thereof, has always been there. Let me explain that...initially I noticed my pain was worse in the evenings (took avinza at 7am) but I attributed that to my body being...tired after being up 12 -15 hours. I never thought about the meds not lasting 24 hours. Did I mention being naive?

IF that is closer to the truth...the 12 hour concept. I wonder about taking 90mg of avinza at 8am and 8pm? 180mg total, but at any given time, I might only have 120mg in me. And the dr. thinks the 120mg is the max I should take due to respiratory problems (severe asthma).

I was told by Ligand to take all the avinza in the morning. I have also been told NOT to take an opioid within 2 hours of bedtime, due to the swallowing problem. And yes, I still have trouble swallowing when horizontal.

Do any of you take avinza based on a "12 hour" time table? I would like to try this, but will ask the dr. first. I don't think my body would ever have much over 120mg in it, but it would take a blood test to be sure. Opinions?

 
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Old 07-11-2006, 09:39 AM   #2
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Re: Avinza - Is it a 24 hour or 12 hour pain relief?

While the Mfg. deems that Avinza is a 24 hour dosed medication many of us who have taken it, disagree. I found it to be ineffective after the 14-16 hour mark. Many doctors are now prescribing it and Kadian on a 12 hour schedule instead.

I ended up going back to MsContin on an 8 hour schedule because it was more effective as a whole for me.

I'm curious about the swallowing, it isn't a normal side effect. In fact, it's down right scary. Is the doctor simply not concerned about this enough to try you on something different like Methadone to see if the problem is eliminated? I personally would be demanding answers from everyone and anyone who comes in contact with the product (ie Mfg, Doctor and Pharmacy) because it does in fact sound like an allergic reaction.

All the best
Barbie

 
Old 07-11-2006, 02:55 PM   #3
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Re: Avinza - Is it a 24 hour or 12 hour pain relief?

D-
I have to agree with Kissa about not letting this go. You are having problems with swallowing which, if this is an allergic reaction could lead to problems breathing. Allergic reactions can increase/get worse with continuous exposure to the allergin. I'm not saying that you are having an allergic reaction, but if it were me, I would probably be talking to the doctor about changes ASAP.

If I remember correctly though, there are several other meds that you can't take, or am I confusing you with someone else? If so, I'm really sorry.

It's scary to think that Avinza is advertised as a continuous 24 hour medication when a blood test showed that it wasn't in your system. PM doctors will dismiss patients from their practice if the medications they are prescribing are not in your system. How did the doctor react when the test came back negative?

Oh, I do hope you get some answers soon! Keep on researching.

Lezlee

 
Old 07-11-2006, 10:04 PM   #4
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Re: Avinza - Is it a 24 hour or 12 hour pain relief?

I never thought about him dismissing me from his practice. I think he wants to check this out for himself. I do to.

Kadian? Never heard of it, he didn't mention it. Guess I can look that one up.

Swallowing? I did go to Ligand. They said NO ONE has ever, ever, ever had that problem before. My PM&R dr. knows about this problem, said it was no big deal. I need to tell my Pulmonary dr. about it.

Maybe I SHOULD ask for another med, except he said I would have to ..uh...
what is the word...get off morphine...sorry, new to this stuff. He said it might take a couple of months to get of "off Avinza". What do I know? I said ok.
DOES IT TAKE TWO MONTHS to get off Avinza? I do not feel addicted or dependent on it. Of course, if withdrawals started I might change my mind real fast.

Can I go from morphine to another drug easily? I can take all my "capsules"
to him, count the ones I have taken vs the ones prescribed vs what I have left. No one in my entire family has ever taken opioids before. So this is real new to me. Opinions appreciated.

Another oddity with him is that I called his office on a Monday morning, told them I was in a lot of pain, can I increase my dosage? No one called back.
I called the next day. No one called back. I called Wed. No one called back.
Finally I went in to see him and he told me they were busy. I asked him what we should do if we are in a LOT of pain. He said go to the ER, or come to his office. I would change dr. but I am getting close to leaving him anyway I think. I found another PM&R dr. I like better, but I am not sure about "changing horses" in the middle of the stream.

Has anyone ever been taken off Avinza after 7 months? 120mg a day?
1. What did they put you on?
2. Did it take you 2 months to get off the Avinza?
3. IF you got another Opioid prescribed, did you take it simultaneously with
drug they used to get you off Avinza.


Last question is....what would you think of my taking 90mg at 8am and 90mg at 8pm? I don't think I would exceed the 120mg he prescribed.


Thank you so much for all your help. This is a great site. It is the first one I bring up in the am and when I get home.

 
Old 07-11-2006, 10:17 PM   #5
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Re: Avinza - Is it a 24 hour or 12 hour pain relief?

D-
I can't speak as to taking your medication any other way than exactly as your pm doctor prescribed. That is for him to decide.

However, this doctor is in pain management, and when a patient calls in with a serious issue, and increased pain is a serious issue, I find it inexcusable that for three days straight, there was no return phone call. And if you were to go to the ER, once they find out you are in pain management, they may not want to do anything for your pain without speaking with your pm doctor. If they were to call his office, would he even speak with them, or would you have to sit in the ER for 3 days for him to return a call to them?

I think finding a new pm doctor would be in order at this point. You are paying him to take care of you and manage your pain. Why pay someone who doesn't return a phone call? It's all up to you, but you deserve more courtesy than what you received these past few days.

Let us know what you decide with the pm doctor, and please take care. Don't allow yourself to be ignored.

Lezlee

Last edited by ozzybug; 07-11-2006 at 10:18 PM.

 
Old 07-11-2006, 10:19 PM   #6
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Re: Avinza - Is it a 24 hour or 12 hour pain relief?

I am only allergic to penicillin and doxycycline. That I know of. When it comes to trees, bushes, weeds, etc. I am allergic to a lot...around 20 things as I recall...and I am on...a little under 20 prescriptions. I feel like I am on a tightrope at times.

The PM&R doctors ....are limited in number around here. Some PM&R dr. are not taking any more patients, so finding one who who take me was good. Not sure what I would find if I checked around. It could get complicated politically. If I feel I have to leave his practice, no problem. I have fired several doctors I thought were incompetent. I don't mind telling them why I am leaving. I give the specifics.

This entire concept is new to me. From Robaxin/Naprosyn to morphine is quite a jump.

I think he implied he wants me to take my meds, then get a blood test after 12 hours. Or maybe 12, 16 20 and so on. I don't mind. I am REAL curious.

Thanks again...hope I covered your questions to me.

 
Old 07-11-2006, 10:28 PM   #7
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Re: Avinza - Is it a 24 hour or 12 hour pain relief?

D-
I do hope this can be cleared up. I'd be very interested in the results of the bloodwork too. I hope you and the pm doctor can get this worked out, and I also hope that the not being able to swallow isn't a major thing. Very best of luck with this.

Lezlee

 
Old 07-12-2006, 11:28 AM   #8
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Re: Avinza - Is it a 24 hour or 12 hour pain relief?

Personally I'm not sure how comforatable I'd be in seeing your doctor. If your doctor doesn't respond in 24 hours after a call and a then a follow up perhaps it's time to find a new doctor.

It isn't an issue to move from one narcotic or opiod to the next but it does take some time to get the dosage amounts correct so you may start a little on the low end of pain control until you can find the acceptable level of comfort with the new medication.

Many members have gone from meds like Oxy or Morphine to meds like Methadone without many issues and deems looking into or questioning your doctor about because of your side effects as asthema.

I think it's time you get actual answer from your doctor instead of brush offs or perhaps time to consider finding a more sympathetic PM!

Barb

 
Old 07-12-2006, 10:26 PM   #9
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Re: Avinza - Is it a 24 hour or 12 hour pain relief?

Kissa, I know what you mean. I am trying to get into see the Medtronics doctor right now. My PM&R doctor said he would send my package there for me. He said that before I was gone a month. I called his office today, asking if it had been sent, but never got a call back.

His office is very poor. The staff. I like the ladies, but too many things don't get done unless I call and call. THEN they sound irritated that I have been calling so much.

So...2 reasons for not changing now. (1) Is the Medtronics doctor referral. If they have not sent that I will probably change. (2) I am permanently disabled.
I was told to file for Social Security Disability. I meet all their criteria, but if I switch doctors, the new one won't know anything about me, so he couldn't really tell social security whether I am disabled or not. Or maybe he could, I don't know how that works either. I had a 3rd reason, but have had a morphine moment since then...can't remember it. Darn it.

Ozzybug, thank you for your kindness. I will let all of you know what we find in the blood work. My regular family doctor is gone for 2 weeks. Hmmm.

I called earlier today, to speak to my PM&R doctor. He was busy. I decided to try the 3 avinza every 12 hours for one day. The wife is watching me closely and I logged it in. I took 2 avinza at 8:45am today and 3 at 9:19pm
tonight. I won't be asleep until about 11:30, so that should allow my body to give its first reaction, if any. Remember, I took 180mg once. Threw up.
90 and 90...twelve hours apart shouldn't be as bad, and I have been on the Avinza several months now.

Thanks again...

 
Old 07-13-2006, 01:09 AM   #10
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Re: Avinza - Is it a 24 hour or 12 hour pain relief?

Hi Dllfo,
I'm sorry to hear you are having so many issues with your docs - not what you need on top of trying to manage your pain!

I just thought I would share my experience with Avinza...I was on it for several months, and then switched to Oxycontin.

I started out at 120mg every 24 hours, but found it only worked for 12 hours. So my dr switched me to 120mg every 12 hours. I found I got good pain relief, but felt pretty groggy on it. This did get better, but eventually I decided I needed to try something that was not morphine to see if I could reduce the side effects I was experiencing. I switched to Oxycontin and am now taking 60mg 3xday and getting the same pain relief. My doc said the equivalent was 80mg 3xday but I wanted to start a bit lower to see if that would work. I also find I am more alert and my mood has improved.

I didn't find the transition hard...I just stopped Avinza and started the Oxy. I guess if the dosage conversion wasn't right you might have withdrawal problems, but I didn't have those. Btw...I did find that in my case the Avinza took about 3 days to get to it's full effect.

Best of luck with sorting through your issues. I hope you can get to a solution with doctors and your pain soon!
Take care,
Vickie

 
Old 07-13-2006, 06:01 PM   #11
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Re: Avinza - Is it a 24 hour or 12 hour pain relief?

I've been reading a lot about people only getting 8-12 hours of relief from Avinza, but I guess I'm the exception here becuase I take 120mg daily and feel it work past the 24 hour mark. Sometimes it seems to last up until the 30th hour. I've been on it since mid 2003, starting at 30, then 60, then 90 up until this past March and 120mg from then on. My doctor wanted me to try the Avinza because of it's 24 hour dosing - she didn't want to add more pills to my dozen or so others. I have a hard enough time remembering to take my Accolate twice a day, so having to worry about taking two MS Contin was a concern. Morphine was also reccomended because of my severe asthma and it's 'ability' to help people breathe easier (my grandmother used it to help her breathe during the final stages of cancer with Oxycontin as her primary painkiller).

I'm right about to switch from taking 2 60mg's to a single 120. I take both at the same time daily, but have finally gotten my pharmacy to give in and order the 120mg tabs (apparentloy I'm the only person they've got on it ).

 
Old 07-13-2006, 10:22 PM   #12
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Re: Avinza - Is it a 24 hour or 12 hour pain relief?

Fibbles,
If I understood you correctly, you have been on Avinza since mid 2003?

And you had NO trouble quitting it? I hope I can do that.

Please understand, I believe you, but my PM&R was talking about it taking me a couple of months to wean myself off Avinza. Below, I quoted you saying you have asthma (Me too) and Avinza was recommended because of it ability to you breathe easier????????? Please...I am NOT arguing, but I was told just the opposite. My PM&R dr. told me he would limit me to 120mg of avinza per day due to my asthma. God help me find the truth...I just don't know which doctor to believe. Mine or yours. I hope and pray it is yours.

"Morphine was also reccomended because of my severe asthma and it's 'ability' to help people breathe easier ....."

Mainecoon66..(hope I got that right).....I hope and pray I can do that too.
Just switch meds. I really don't understand my current doctor. I did ask another PM&R office today if they were taking patients. I hope to hear back tomorrow...that they are.

Being in pain IS tough enough for all of us, without feeling like we are fighting for our meds, fighting to get our doctor to just call us back...or listen to us.

Thanks so much for your help. After my PM&R doctor did not call me after I called the office for 3 straight days, telling them I am in pain..when I asked him about it he shrugged and said he was busy.

Today...about 2 months after they said they wanted me to go see the dr. who does the medtronics pain relief surgery..TODAY..they faxed my file over there. I know he told me several times I needed to go see these people. If I had not called his office twice in two days, my files STILL would not be there.
So I trying to find a dr. I had once. If he will have me I will move.

Oh well, I hope and pray you all get relief from your pain. There are times I wish I could reach out and hug your necks. And I could use a hug too. My wife is great for that. With all my medical problems I am still lucky.

Take care...


I was on 120mg and I hurt. I upped it to 90mg twice a day. I still hurt.
I can stand it, but it really "talks" to me. I wish I knew who I could call to find out about morphine. Does it help us breathe or suppress our respiratory system.

Pharmacies are a pain. I guess they are inspected a lot. I went out of town for an extend vacation and you should have seen their faces when I carried
a 3 month supply of Avinza out the door.

Thanks for your inputs

 
Old 07-14-2006, 01:39 PM   #13
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Re: Avinza - Is it a 24 hour or 12 hour pain relief?

I didn't say I quit taking it, I'm still on it and will have been for 3 years (and 1 month) since June of 2003. It's unlikely that I'll ever live w/out pain meds according to my doctor, because my primary problem is a bone and joint disease for which there's really nothing that can be done, except for bracing, medications and appropriate surgery when needed (I've had over 2 dozen surgeries so far and I wear various back and neck braces). I have smaller lungs due to a chest deformity since birth and that's what caused my chronic asthma and assorted breathing problems. I get hospitalized every few years with severe pneumonia or RSV (in 2004 I had my last bout and was in the hospital on 5 litres of Oxygen for 2 weeks). My normal O2 sat is something like 80% to 88%. On 3-5 litres of O2 in the hospital I was hitting 96%!

All opiods can cause respitory despression, but Morphine can be used to help people that are dying or under severe stress/anxiety (and some other circumstances) to breathe easier. Once I got used to my dose (and because I went up to 120mg slowly - over the course of 3 years), it's not really so much that I'm going to go into respitory depression just because I'm on Morphine or just because Morphine can cause respitory depression does not mean that I'm going to stop breating or have problems with it. My doctor has also told me that going into respitory depression is dose dependent. If I'm taking the dose I am prescribed, I should be fine, but if I were to, say, double it or take more than I'm supposed to, I can go into respitory depression because I'll be overdosing on the medicine.

When I was first given a narcotic (a 30mcg Fentanyl patch), I was given a pulmonary assesment to make sure I would be fine and it did not affect my breathing at all, so she has not been stressing my asthma too much. In the beggining, whenever I would get high, it felt like I could take a deep breathe and that I could breathe easier, but those are my personal thoughts. You could do a search for breathing and Morphine and see if anyone else has any personal do's or don'ts. Even when I was in the hospital for my last bout of Pneumonia, I was given my same dose of Morphine (60 or 90mg, I can't recall) in MS Contin, because they didn't carry Avinza. If they felt I was in danger of respitory depression, I doubt they would have given me a narcotic and a sleeping pill when I couldn't sleep.

 
Old 07-14-2006, 04:46 PM   #14
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Re: Avinza - Is it a 24 hour or 12 hour pain relief?

Fibbles, I am sorry. You are right. and HBMod07, if I posted something twice,
it was a bad day all the way around yesterday. Sorry if I double posted it.

My mental functions are poor. I attribute that to the morphine and my dosage.
BUT...darn it...IF I am taking sooooo much morphine it effects my cognitive processes, why do I hurt so much? In the last 36 hours I seem to just sit here.
It hurts so bad it is nauseating me, bringing tears to my eyes, yet I seem to be messing up simple processes.

Sorry folks, I don't mean to have a pity party, just frustrated. You have been very nice, I should just read for a day or two, until I can figure out what is wrong with my brain. Increasing my dosage of morphine did not cut the pain.
I just don't understand it.

 
Old 07-15-2006, 05:21 AM   #15
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Re: Avinza - Is it a 24 hour or 12 hour pain relief?

dl-
There is no need for you to apologize about a pity party. You are in pain, and pain really wears a person down. You needed to vent and all of us here can understand that. We have all needed to vent from time to time. It's healthy to get it out of your system instead of bottling it all up inside.

I know the increase in your morphine dose has made you feel out of it, but hopefully it will even out in a short while. Now, if it isn't managing your pain, then your pm doctor needs to be made aware of it after sufficient time has been allowed for it to "get into your system". Isn't there something they can possibly give you for the breakthrough pain until the morphine has had time to build up in your system? I just don't know what the answer would be because I'm still new to the pm scene.

I really do hope that you can get some relief from your pain. All of us know how long term pain can affect us. Try and hang in there dl. My fingers are crossed for you, and I hope something can be done soon.

Lezlee

 
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