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Old 07-19-2006, 06:19 PM   #1
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Equivalence question

Hello all,

Its been a while since I have been here. Im usually very long winded about my questions but this time Im going to be short.

Im looking for the equivalence between Avinza, Methadone and Kadian.

I was on 120mg Avinza q12h then switched to 40mg Methadone q6h/q4h and now have a new script for 120mg Kadian q12h.

Do these make sense? Im most concerned with the Methadone to Kadian conversion. While my circumstances caused the need to switch, each time it was a new P.A. that I saw. They each had their own preferences.

Thanks!

Last edited by Bilbo; 07-19-2006 at 06:24 PM.

 
Old 07-19-2006, 08:48 PM   #2
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Re: Equivalence question

Hey Bilbo, I hope it hasn't been pain keeping you way. Next to $e# this is probably my greatest distraction from the pain.

The conversion really looks fine, if anything the meth is generous but still inthe safe range. I flopped back and forth between 120 mgs of meth, 600 mgs of Kadian,back to 120 of meth then 600 mgs of generic MSC and back to 120 mgs of meth. Meth really shouldn't be the first drug any doc uses because it's so unpredictable as far as patient response.Some folks need a 3:1 conversion and some need a 5:1 converson or even higher.

There is the possibilty that the meth was a little on the high side, but not exteme. Switching back to an equal dose of morphine may not be as effective once exposed to methadone. I actually started with oxyc, went to meth, tried Duragesic, back to meth, then kadian,bac to meth back to MSC and then meth again.This was 4 years of dealing with crazy insurance or none at all.

The biggest jump in my tolerance was after taking meth. My pain was poorly managed with oxyC and then a moderate dose of meth. I changed docs for insurance reasons and he increased my meth dose to one that was effective as could be without intolerable side effects. I was shocked at how much morphine I neede after taking meth because my previous dose of oxy never exceeded 120mgs a day with no BT.After taking meth for a year, it took 600 mgs of morphine to reach the same level of relief.

That was a little scarry, but at the time I no longer cared about numbers. What's the fdiffeence between 400 and 600, you become just as dependent. However 600 mgs of morphine compared to 120 of oxyC is a big step. Then again,I wasn't getting relief from the oxy where both meth and morphine were equally efective. Although they both had a very disticnt feel, for lack of a better word. My head felt clearer and I flelt more motivated on morphine, not to mention the libido and testosterone problems meth seemed to be the culprit of. When on morphine I had to DC the Androgel because my levels would shoot through the roof.

As far as kadian Vs Avinza, 120 mgs of morphine a day is 120 mgs of morphine a day reagradless, I doubt your doc won't see it any different. I'm sure there is a slight variation in the serum levels that both create but I doubt it's more than a 15% differnce which is almost close enough to call it a generic equivelant.

IS that what you are finding? Your tolerance seems to have increased after exposure to methadone. It may be that you simply were takng more meth and hopefully got better relief. But if you didn't, it's not an indicator of anything other than I do better with a different conversion rate, which is no surprise with methadone.

I hope this helps but it's just my experience and I know others would need a completely different conversion rate going to meth and converting away once exposed.

Take care, and stick around if you can.
Good luck, Dave

 
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Old 07-19-2006, 10:09 PM   #3
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Re: Equivalence question

Hey Dave!

I hope I dont have a problem dropping in equivelence with Kadian. I can see now that the P.A. made a mistake. He didnt do an equivelence of the amount of Methadone I am taking now, he did it off the Avinza I was taking before the Methadone. I didnt increase in Methadone during the almost 4 months I was taking it. Maybe the equivelence would have been to high going from Methadone to Kadian. Dont know. I guess we will see.

I havent started the Kadian yet. My PM Dr said the same thing about Morphine. Morphine is Morphine. Because my wife took a better job we were without insurance for 3 months and Avinza was just too much $$$. Now that she has insurance again I can afford to look to something else other than Methadone which I started when the insurance ended. Doctor's leaving the practice also caused me to see a new person almost each time I went. It seemed each one had their own preference for PM...which is natural.

At first Methadone worked really well and my side effects were mild. It wasnt till I was into the 3rd month when the side effects became soooo bad. I found that strange. You would think that they would come on within a few weeks. I started experiencing 6-8 MAJOR sweats a day. I mean sweating so much for 10-20 minutes that I have to change clothes. I starten just not wearing them around the house. I always had a small towel with me when I left the house. I have to constantly drink water. This became pretty bad the few times a month we met with friends for dinner or such. The fact that we have had record breaking temps here hasnt helped at all. We have had more days above 100* then I can ever remember. The day we hit 117* I almost went mad. Our A/C just couldnt keep up. Ugh.

Also, I found that I was going to bed at 10pm and waking up at 9am....only to fall back asleep until 3pm EVERYDAY. If I was horizontal I was sleeping. After a few weeks this can make one go crazy. Too much sleep is not a good thing. I tried just poping out of bed in the morning a keeping busy but I was always tired. I was even falling asleep in my lazy boy.

The last straw is when my bowel movements started becoming fewer and farther apart. I used to be almost like a clock with my BM's. Every day at 10am. Naturally, as soon as I had to start taking opiates this all changed. With Hydro, OxyC, Duragesic and Avinza I was irregular but I would never go more than 2 or 3 days with no movement. With Methadone I was constantly 3+ days and even reached 5 days which was not cool. This is using all the normal stuff like Colace, Senacote and Ducolax.

I think you are right that the dose was too high. That makes me wonder if I would have had the same pain relief with a lower dose and maybe escaped the extreme side effects??? I hope that I dont have problem going to Kadian.

You thing I should try Kadian for a while and if I dont good pain relief then I should go back to Methadone at a lower dose?

I dont know what I am going to do now that I am going to be on Kadian. The 40mg Methadone tabs were so big I didnt need to eat. Just kidding....but they are huge. I tried disolving them in everything and just found it easier to break them in 4's and swallow them 1/4 at a time.

Oh, does Methadone cause a drop in testosterone like Morphine does? I used to use Androgel too but stopped a while back. Cant remember why. I wish there was an easier, equally effective way of getting testosterone into the body. I guess I am being a bit whiney now

Thanks for your insight(s) Dave! As always, you are a wealth of info. I should hang out here more often but I tend to want to post too much and with a neck and shoulder problem I end up hurting myself. I on 6 or 7 forums and all but this one are hobby stuff. Now and then I just click and browse. I can do that from bed with my mouse close to me. That doesnt make my pain levels rocket.

 
Old 07-20-2006, 12:00 AM   #4
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Re: Equivalence question

I had a somehat similar problem. I went from 200 mg a day of MS Contin to 100mcg Fentanyl Patch to 60 mg a day of Kadian, titrated up to 120 mg of Kadian, now back to 100 mcg patch.

Still relying on the 30 mg Roxicodone for bt

Alan

 
Old 07-20-2006, 09:37 AM   #5
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Re: Equivalence question

Hey Bibo, It really sounds likee you wewre on too much meth, the sleeping is the biggest problem. You can't realy have a life spent horizontal. The sweating was the same thing I exeperienced, IT tok an hour to stop even after a cold shower. I would change clothes 2- 3 times a day and having sweat drip from your nose isn't exactlyhard to hide. Like yourself, I had lost insurance so meth was really the only choice. 600 for morphine or 50 for meth wasn't a tough decsion. But tehe side effects and lack of insurance and options, I choose to have the pump implanted.

I actuallyhad lowr testosterone levels on meth. When I switched back to morphine I had a follow up with my endocrinologist who preescribed the meth. My numbers trippled once off meth and I discontinued it completely.

I'm having the same problem again with Intrathecal dilaudid, but it's somewhat expected with IT meds so I'm back on androgel. Thank god for medicares prescription plan. I choose one without the donut so I'm well covered and have lower copays than my wifes insurance. If I was on LA meds, things wouldn't be quuite so easy because of dose quantity restrictions. Like 30 avinza a month, 30 Kadian, 60 OxyC. Fortunately I don't have to fight with my insurance evry month on that.

I have a feeling the meth may have effected your tolerance because the conversion to meth was rather generous . You can't really undue what's been done so if you find you need to titrrate the kadian, all you can do is ask.

Something to consider is that not everyone can do a cld switch away from meth, It has properties that morphine doesn't so you may experience some differential withdrawal. It will happen at any dose of adian so don't try to fight meth withdrawal by ncreasing the morphine. If you allow it to pass, in a few weeks you may find the present dose wasn't the cause of the withdrawal and may work fine. If you increase to combat the withdrawal , you have to remeber part of withdrawal is increased pain sensetivity. All you may end up doing is increasing your dose and tolerance of morphine beyond what you would need if you can just ride it out. Your doc will either agree or disagree with differential withdrawal just like docs don't agree that medication holidays have any lasting efect. He's going to believe what he believes. However withdrawal has symptoms, if you adress it face to face, it wll show in your vitals, and your apeareance and he can treat it with something like clonodine or librax. I would really try to get through the first two weeks before considering the need for an increease. Your body may be screaming for more pain meds, but morphine won't really satisfy it because it isn't meth.

It just depends on how long you took it and how long itttakes ach person to become dependent enough to have a problem witching meds. If you only took it a month, I doubt it would be an issue. 3 months is on that line where I wouldn't be convnced you will have a problem, but will warn you so you know what's going on. Hoeopefully it wasn't long enough to create a problem and the switch will be smooth. Personally I hated the way meth made me feel. aside from labnido, it seemed to rob my ambition and spending the day watching TV acceptable. IT kind of made anything exceptable but controlled the pain.

Now that my head is much clearer with the pump, I can't stand being stuck in the house or limited by pain. I had high hopes for the pump, probably higher than was realistic... I hoped it woudld smomehow help me get my life back. I am excercising bnut the pain I have to deal with the rest of the day is tough. But can't sit on the couch or lay down anymore of my life.

IF you do have a problem switching, you might want to switch back to a slightly lower dose of meth. You don't want to drop it in half because that's too big a step but consider tapering down 5mgs at a time once your used to 3/4s. I can't imagine the 40 mg dickettes being much cheaper than the 10 mg tabs. Start back at 3/4 of your old dose and if you can decrease and manage the pain with decreased side effects, it's worth a try.

You still have options, so as long as you have a good relationship with your doc, hopefully he can accomadate your needs. Whether it's manageing some withdrawal, Titratng the kadian or decreasing the meth.

iIf you have enough meth to taper down a bit, the less meth your taking when you switch, the smoother things will go and more likely th e old dose will still be effective. Do some fancy breaking of those tabs and try decreasiing by 5mgs every 5 days. You proabaly won't notice the initial decrease but at some point you will hit the wall.
Good luck, Dave

 
Old 07-20-2006, 12:00 PM   #6
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Re: Equivalence question

Dave,

How are ya? Today is a better day for me. Only slept until 11:30am. I am avoiding all horizontal locales because I have an appt with my GP today at 3pm.

I do have about #42 of the 40mg Meth left but the P.A. wants them back when I see him again. He sent them home with me after counting them out just in case it takes me a while to get the Kadian filled. He thought with the new insurance that there maybe a delay. There wont be a delay other then the usual slowness that my pharmacy makes people endure because they loose paperwork.

I could get by with a few days, maybe up to 5 days of Meth. Is that long enough to drop some?

Oh, since you mentioned it, can we dicuss Medicare and perscription plans here? I just got Medicare and I have my Wife's regular insurance too. Her insurance is pretty good but Im not sure how its going to pay on some of these meds. I can say that a recent script of a med that I usually pay $10-$15 with insurance cost me $2 with our new insurance. However, if there is a good percription plan out there that matches up well with what I will be taking I would gladly switch. I have a feeling that while some meds are extremely cheap with this new pharm coverage, others maybe crazy expensive.

If you are allowed to mention your plan and you dont mind, please do so. Do they pay upfront or do you have to submit claims yourself?

Let me know what I should do Methadone wize. I know I can peel some off without harm as its happened accidently in the past. I just dont know if 5 days will be long enough. If I call the P.A. to discuss this he will only see me as questioning his conversion skills. He is one of those types who gets a little irritated when shown to be wrong or questioned. I have a good relationship with him and dont really want to test it. Ya, I know. Some would say a good relationship would mean you can question these types of things. Not with these folks (clinic).

Thanks Dave!

 
Old 07-21-2006, 05:05 AM   #7
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Re: Equivalence question

Hey Bibo, If you have enough for 5 days you canmake one small drop which would probably be beneficial when it comes time to switch andmay gvce you an idea of less stil provides pain relief and decreases side effects.

Diffeent plans are available in different areas. The way medicare works is fif your wifes compay has more than 100 employees, her insurance is your primary and medicare becomes your secondary. Script coverage is different though. I doubt your going to get the same low copays and if you don't have caps or limits on that script plan, it wouldn't make sense to sign up for a medicare eplan unless it's expensive to keep you on your wifes.

I have Optimas complete plan, no 250 dedcutable, in fact the first scripts untill you reach 250 have no copay so my first two scripts this year were free. Pharmacies have direct billing, not a reimbursement program and instead of the 12 and 15 dolar script plans that have the donut from 2250 to 3600 which is very misleading I opted for a $55 plan with no donut, and no deductable. Generics are 15 and preferred brand is 30 and non prefered brand is 25% of the cost.But you would have to fight for pre authorization if you required more than 30 120mg avinza, 60 80 mg oxyC a month or 15 patches a month. Fortunately I don't have to deal with limits on LA meds because I don't use them with a pump. MY medicare part B covers the pump and meds.It costs me about 50 bucks total for office vists, supplies and meds every 70 days to refill the pump.

I really don't know of a benefit to having two drug plans. You would use one
or the other. Unless you want off your wifes insurance, It's not something I would even consider. To add me to my wifes plan would cost an extra 500 a month and I would have higher office copays and higher script copays.

There are also medicare advantage plans,which is a privately managed version of medicare. Instead of billing through medicare claims center everything is billed through your advantage plan. Optima, cigna, all the biggies have contracted to take on medicare patients so that your plans coverage limits are based on the individual plan you purchase rather than the 80/20 that medicare negotiates for medical service.

If you decide to choose a private medicare carrier or advantage plan those provide both the medcal and script coverage at a greater cost than medicares flat rate but have greater coverage if you shop smart. I would certainly check out Optima, they were the only one in my area that offeed a plan without the donut.

Basically folks are led to believe the script plan pays the first 2250, then you have a lapse in coverage from 2250 to 3600 before coverage kicks back in. But here is the catch, They count the cost of the meds the insurance company pays when reaching 2250 and then it reverts to your out of pocket. You can easily max out 2250 in one month with 3 or 4 meds that have 15 dollar copays. Once the insurance company has paid 2250, coverage stops and then it turns into your out of pocket expense. Because you have only used 4 drugs at 15 bucks a piece in copays you have only spent 60 bucks out of pocket when the laspe or donut begins. In this scenario the gap is from from the $60 you have already paid in copays untill you reach 3600 before covergae begins again. So the donut whole is not a mere 1200 bucks, In this sceanrio, your gap is from the 60 in copays you paid out of pocket untill you have paid 3600 out of pocket.That 1200 gap is now a 3540 gap. Yes everythng after that is covered at the catastrophic rate, but that's darn big gap and will put a hurtin on most savings trying to reach 3600 out of pocket before insurance kicks back in. Plans with gaps cost 10- 15 bucks, my plan without a gap and the first 250 free costs $55 a month in adition to the medicare premiums taken out of my SS check. All in all, I have medical and drug coverage for about 120 a month, which is less than a one month supply of Roxicodone and less then adding me to my wifes policy.

Does that make sense?
Good luck, Dave

Last edited by Shoreline; 07-21-2006 at 05:21 AM.

 
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