Dosage chart for opiates - Pain Management Message Board

smackliet · 12-21-2006, 12:37 AM

Hi all,
I remember reading a dosage chart or this board a while back that showed the doses of differant opiates. I cant seem to find it now though. My Dr.is changing my methadone to oxycontin she said she wants to start low and work up, of coarce i am worried about withdrawls. She claims methadone doesnt cause withdraws.(yeah she has no clue). If you can point me in the right direction i would appreciate it alot.
Thanks in advance.

Shoreline · 12-21-2006, 06:32 AM

The charts you are looking for are called Equianlegesic dosing converters. However these are just guides and I have yet to see one that acounts for the build up of meth in your sytem over the first 5 days. The charts I have seen only seem acurate for single dose conversion. With meth you end up with twice the blood serum level by the end of the week which isn't accounted for when you see conversion ratios of 1:1 or even 2:1 for morphine to meth.

I've switched back and forth betwen meth and morphine several times and after the intial triration, I was able to do a cold switch at 5:1 meaning meth was 5 times stronger than morphine. I've seen some charts that suggest it's anywhere from 3-10 times more potent than morphine and some very dangerous charts that compare it 1:1. If you even close to the ballpark with meth, you won't have a problem converting to methadone or withdrawal. Switching away from meth is a little more difficult, but meth is usally a last line drug due do to it's unpredictable and wide range of response from one patient to another.

Even when I started the converrsion at 10:1 it was still enough meth to prevent withdrawal, you would really have to be in left field for you to experience withdrawal. More than likely wherever you start you will feel more sedated and that just takes time to adjust too. What med and dose are you presently taking. As far as meth maint, The higher the dose of opiates prior to meth, the greater the conversion factor, meaning if you were taking 500mgs of morphine the conversion would be 5:1 where the conversion from 1000 mgs a day would be 10:1 . It's a pretty standartd rule that 40-60 mgs of meth with stop just about all signs of withdrawal when used for detox. It's extremely unlikely you would experience withdrawal switching to meth. You may have to make adjustements to manage your pain, but pain is a much greater concern than withdrawal as meth is very capable of stopping the effects of opiate abstinence syndrome.

Meth does have to be tritrated slower than other opiates because the dose you start today willproduce twice the serum level after taking it for 5 days due to the extremely long half life. ie if you take 50 mgs a day by the 5th day if they tested your serum level , it would appear your taking closer to 100 mgs a day due to the residual half life from each of the previous days. By the 5th day things start to level out and then it's safe to start adjusting this med upwards to obtain better relief. It takes longer for side efefcts like sweating, nodding out, urinary retention, nausea and that whoozey feeling to deminish. Trust your doc. It would be nice to assume a PM doc is qualified to prescribe meth and understands how it works.

The scarry part is when GP's start playing PM doc and have no clue as to the actual strength of meth, If they look at a chart that's used for single dose comparison and use that 1:1 conversion factor for morphine you won't be worrying about a thing. I certainly didn't need an equal amount of meth as I was taking morphine. Lookng back it likely would have killed me by day 3 as my serum levels were rising. I'm glad my doc disn't use some ill conceived chart and used his clinical experience.

Everything is compared to morphine as morphine is the gold standard to which other opiates are compared. Anything from 1/3-1/10th the dose of morphine should prevent withdrawal

Trust your doc, "the Force is with him" LOL

Take care, Dave

smackliet · 12-21-2006, 07:09 AM

Thank for the responce Shoreline

Sorry for the confision I have been on methadone for a couple of years i am switching (to) oxycontin. So going that direction i realize the methadone will stay in my system longer. So she has me starting with 20mg of oxy for the first week then another 20 the second and the titrate up from there. I though i was suppose to take some methadone the first week but she said i dont need to that i can just swich straight to oxy without tapering th methadone down. I dont see how due to the fact that i start feeling sick when i am the least amount late taking my dose. There is no way i could do a cold switch as she said without feeling like crud. She said the meths long half life would keep me from getting sick. But on the other hand she had me taking it every 8 hour because i cant make it 12. She said i matabolize drugs quickly. If she knows that then why would she want me to do a cold switch starting at only 1 20mg er for the first week, 2 the second week and so on from there?
Thanks again

forginon · 12-21-2006, 09:02 AM

smackliet,

May I ask why your doctor is switching you from methadone to Oxycontin? Just curious.

Is your doctor open to new information? I'm very fortunate to have very understanding doctors, both GP and PM. I've taken articles to them and they actually read them during the appointment and we discuss them. Sometimes something changes. It's just a respect thing that's developed over time.

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Cheers!

smackliet · 12-21-2006, 07:30 PM

i am changing because to get the pain relief i need from the methadone i have to take more than i am on and it already makes so drowsy. so she decided this may work better as some find it less sadating.