Shoreline

Hey Scrapper, I have a copy of the Kadian conversion handbook made by the manufacturer, According to it, the 50ugh would be replaced by 150-200 mgs of Kadian. However, equinalgesic tables are just guides to prevent docs from ODing a patient and to get you in the ballpark. The rule is to always side on caution and patient safety. You can also see huge variations from one chart to the next so it really comes down to a matter of individual response. They do suggest going through a couple cycles of the patch and if it’s wearing off before it’s time, you need to report that too. It may take much more fentanyl than morphine or less Oxy mg to mg, or mcg in this case. If you happen to respond to one med better than the other it just means your normal..

Personally, I never found relief with Duragesic even at twice any conversion table suggested, so I did give up and go back to the old med at the same dose This being the starting dose, I would certainly go through the titration process and pretty much expect docs to start on what they believe is the low side every time. Taking in a chart you may have may not be the chart he uses, if he even uses a chart. So how you respond is all he can really go by along with his comfort prescribing and his understanding that what works for one, doesn't always work for another, or it may take significantly more.

You certainly shouldn't be going through withdrawal, which is the best test as far as knowing if you're even on the field or if your got left out in satellite parking and he completely missed the bus. Switching to Duragesic is fairly easy, Switching away can be a little more difficult since Fentanyl has properties other opiates don’t.

Hang in there, It should improve with the next patch or two and then you will have a better idea of where things stand with that med & dose.

Good luck, Dave