I wanted to ask you all this really quick...
I am on 12 fent. patch every 2 days, or 3 if I want.
15 mg hydro LA 4-6 times daily
10 mg hydro short acting 4 times a day
I have had times when I have run out or had to wait on my hydro, and within 16 hours I am in withdrawls starting full on. WHILE I AM ON THE PATCH!
Can you all tell me why that would happen when I have stopped the patch for a good 2 weeks and nada, nothing from it, but if Im on any type of hydro, I get the full on w/d. Anyone??
At first I thought maybe my patch dose was lower than all of the hydro...but even when I was on the 75's and 50's I noticed it too. I even tried to go a few days w/o my hydro because I knew I may be short, and thats when I REALLY noticed it. Thats why if my hydro gets delayed? I know for a FACT, Ill be suffering really soon.
Ive gone to the conversion charts, ect. everything about the dosages, but my main question is, again: how can i have worse w/d from the hydro?
Hydro isnt as strong, so Im confused. I have cold turkey stopped the patch and had not a single problem, but if I stop my hydro or am forced into w/d it is terrible. You would think the patch would help with the w/d. But it doesnt one bit.
Any and ALL thoughts are welcome. I really wanted to post this because i have read on the addiction boards that hydro is a horrible thing to have to get off of, and yet my doc tells me that oxy is worse.
Ill try to jump on and see your responses, because Im really really, confused about this. Thx again for all of the well wishes...Ill check in as soon as I have a chance~
xoxoxoxo,
IZZY'SMOM
PS. please read my post "PLEASE HELP" If you need any previous info...it saves me repeating all of this...
Re: How Can I Have Wd From Hydro And Not The Patch?
If you are continualy needing to take oral hydrocodone, why not just increase the patch to cover your pain, and use oral hydrocodone when you get breakthrough pain.
If you need oral drugs 4 times a day every day, i would say you need to up your patch.
OR change from short acting meds 4 times a day to a long acting one twice aday to even out the peaks and troughs.
If you need to quit, cut the dose back over a couple of weeks (you take 8 tabs a day, so reduce by one tab every 2 days) and you sould go fine... as for running out, maybe keep 10 or 20 tablets as an emergency backup
Re: How Can I Have Wd From Hydro And Not The Patch?
Thx...Ive been thru this with my doc, as far as changing my patch dose. It doesnt matter.
Even when i was on the 75, 0r lower, and on lower hydro, it still happened.
For all of you who know me, you know that my patch is my base, and my LA is also there 4X every 24 hrs as needed, and the next dose up is too much, if you read any of my other posts youll see that next does is too much for me, and I cannot afford to mess with what is working. I play golf for a living, and one stoke can cost me more than anyone can imagine. It iIS about my living financially, but also my life. Im a mother, first off, and that is my most important thing in life that I could ever imagine. Then wife, ect...
Thanks for the info, but what Im doing works, I really just want to know whay hydro would give me w/d and the patch doesnt. I understand what you are trying to say. My base meds are the patch AND the hydro LA and its working. I also do have a stash when I need it, but I was leaving for a trip for 10 days. Read my thread..."please help" then I wont have to repeat oll of the story. sorry, i should have done a "continued" thread.
The 10 mg is for b/t. its wierd, but it works, and it took me 3 yrs to get it right. i have no problems except when something comes up that I have an emergency or drama like this weekend.
I have been on the 75, 50 and 25. It has occured no matter what dose of the patch I am on.
Maybe its b/c the patch is synthetic, but isnt hydro as well? Thank for the reply,
xoxoxox,
IZZY'SMOM
Re: How Can I Have Wd From Hydro And Not The Patch?
I guess everybody is different... I took tramadol sr twice a day for six months, and stopped it cold one day... no problems at all, yet some find it hell.
Re: How Can I Have Wd From Hydro And Not The Patch?
Hey Izz, Could it be because your hydro is compounded and pure hydro, and the Fent patch is mass manufactured? I'm no expert, by any stretch, but I thought about it after reading your other thread.
I'm sure Ex or Steve or Dave or someone will have a better answer, but I thought I'd throw it out there. CMP/MM
Re: How Can I Have Wd From Hydro And Not The Patch?
My gut feel would be that your dose of patch isnt high enough to supress withdrawl symptoms from 80mg of hydrocodone per day, but conversely, your hydrocodone dose is enough to supress withdrawl from the low dose patch.
Similar to if you were taking an 80mg oxycontin twice a day and a two tylenol with codeine three times a day twice a day, the oxy could supress any withdrawl from the tylenol codeine, but the tylenol with codeine couldnt supress withdrawl from the oxy.
I would say if you cant take your hodrocodone for some reason, up the dose of th patch for a few days to cover the withdrawl period.
Last edited by aussiejono; 05-15-2008 at 09:42 PM.
Re: How Can I Have Wd From Hydro And Not The Patch?
Hey Izz....And just when I thought we had you squared away (lol).......
It's because the meds (narcotics) appeal to different receptors...Thus, when you're low on one or the other, WDs begin. The Fentanyl (patch) appeals to one set, while the Hydro another.
This is also why a "cocktail" of meds, or combination of two or more, help control chronic pain. Pain is felt by more than one receptor, but certain meds appeal better to one set or another. Although they work together in fighting pain, they work independently in terms of tolerance and dependance.
IMO, your dosages are roughly the same. The 12.5mcg of Fent is about the same as the 100-120 or so mg of Hydro. As you know, although the Fent is a very small dose, it's extremely potent. If you went up significantly on one or the other, it would help alleviate WDs from the other, but not 100%. Furthermore, if you went up on one or the other, you could probably cut back on the other and ween from there (if desired).
As to why you haven't noticed much WD when stopping the patch, I can't answer that question completely.....Other than:
(A) The patch builds up your blood plasma levels (BPL) over time, and when you stop, it takes several days for it to go through several half lives....Any med takes 3-4 half lives to be eliminated from your system. So, LA meds have longer half lives while SA have much shorter. Thus, for the Fentanyl, it's an automatic weening matrix so to speak (which helps minimize WDs) because it's such a long acting med
and
(B) Because the Hydro is short acting, you get very large spikes in your BPL upon taking it, which probably helps minimize your WDs. You also indicate that you're taking it 4-6 X day, which would help "mask" the Fent WDs.....That's a lot of spikes in your BPL. I'm also willing to bet that when you've stopped the patch, you've taken more of the Hydro...Maybe without consciously paying attention. Just a guess.
Hope this helps explain things.....And most importantly, I hope you feel better!
Ex
P.S. When you get back, you may want to discuss all of this with your Doc b/c it sounds like your LA med isn't high enough...To be honest. If the absence of hydro is causing you this much trouble, you need an increase in LA med. Or, maybe you're not getting good life out of the patch due to your very active lifestyle....The patch just may not be working very well. Also, you mentioned you can change 2 or 3 days...You need to get on a schedule an stick to it...That's also part of your problem if you're fluctuating. Just trying to help.
Last edited by Executor; 05-15-2008 at 10:34 PM.
Reason: Added Text
Re: How Can I Have Wd From Hydro And Not The Patch?
Quote:
Originally Posted by IZZY'SMOM
For all of you who know me, you know that my patch is my base, and my LA is also there 4X every 24 hrs as needed,
Thanks for the info, but what Im doing works, I really just want to know whay hydro would give me w/d and the patch doesnt. I understand what you are trying to say. My base meds are the patch AND the hydro LA and its working. I also do have a stash when I need it, but I was leaving for a trip for 10 days. Read my thread..."please help" then I wont have to repeat oll of the story. sorry, i should have done a "continued" thread.
The
IZZY'SMOM
IZZY'SMOM....Please explain something to me. Reading your post, it sounds like you are on a "long-acting hydrocodone"???? I did not know that such a drug exists?? If it indeed does exist, this sounds like the miracle answer that I am looking for in my nightmare of dealing with LA narcotics that are too strong for me with debilitating side effects.
Let me know if you ARE truly on some sort of "long-acting" hydrocodone.
Re: How Can I Have Wd From Hydro And Not The Patch?
Hi Lou~
I have a moment to post...I am on a LA hydro. Actually you can get such at a compound pharmacy. I know our Walgreens has even started doing compounding. Your doc will have to write you a script for it. Since it is pure hydro, it has to be hand written and cannot be called in.
Ex? or anyone? Can you please help Lou? I only had a sec to check in and I wanted to help him. Im tired and cold and soggy from today and more, Im sore.
Thanks!
Lou, I know someone will chime in and help you better...
Ill be able to check in in a couple of days. Id be happy to answer ANY questions you have then. If I get a chance later to get back onto my laptop, Ill write more~
xoxoxox,
IZZY'SMOM
Re: How Can I Have Wd From Hydro And Not The Patch?
I know somthing of pharmacy (my mother is one)... I asked her, and she said that they can compound SA meds using methylcellulose and the active constituent, it gells in the gut and diffuses the drug over time
Not as certain as a preoper LA medication, but they arnt unheard of
Re: How Can I Have Wd From Hydro And Not The Patch?
Quote:
Originally Posted by aussiejono
I know somthing of pharmacy (my mother is one)... I asked her, and she said that they can compound SA meds using methylcellulose and the active constituent, it gells in the gut and diffuses the drug over time
Not as certain as a preoper LA medication, but they arnt unheard of
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~
Thanks~ shes right...The gel has it dissolve slower, and even if you opened the cap, it wouldnt make much difference. maybe 20 min if EVEN. My pharm told me about the gel component. It has nothing to do with the outer encasing.
I put one in a glass of water b/c i didnt want to be paying for two scripts that could be the same, and on the LA cap, and the SA cap, the outer capsule dissolved the same. BUT the med on the LA dissolved a LOT slower. Even though its not a true LA, its probably the best we can get until they have something better.
Hope this helps! Thanks EX, and everyone else, for helping me out! hope everyone is doing well! Cant wait to catch up with all of you after the weekend, I need to get to bed, the rain really messed me up, today. hopefully tomorrow will be better~Im so thankful I got my meds.
I was checking my email, and you guys are hard to not check in on! Talk to all of you after the weekend~ Thank you for being my PM family~ You all are the best~
xoxoxoxo,
IZZY'SMOM
Re: How Can I Have Wd From Hydro And Not The Patch?
Given that codeine and hydrocodone are such useful and widely used drugs, I am suprised that noone formulates a SA version... the technology isnt difficult (spansules have been around for 60 years) and isnt expensive (12 hour cold capsules are cheap enough)
It could help people with chronic, moderate pain get 24/7 releif withot needing to start on the stronger stuff.
Re: How Can I Have Wd From Hydro And Not The Patch?
You are going through withdrawls because Hydro controls different pain receptors ...So the patch keeps on controlling the other pain receptors but when the hydro receptors stop getting there fuel(hydro) they go berzerk thus causing withdrawls because those receptors will not bind with the fentyl ...I think there are 4 different receptors. That is why doctors try different combonations for pain medications... I hope this helps,
Re: How Can I Have Wd From Hydro And Not The Patch?
We need to get straight on this matter of receptors.
There are three main opioid receptors, mu, kappa and delta. All full agonists (morphine, hydro, oxy, fentanyl) these are all full agonists at the mu opioid receptor. A few of them also partially occupy one or the other of the other two. But the mu receptor is the main player, and, along with pain relief, it is also responsible for tolerance and dependence. This is opioid receptor 101.
Many don't realize how potent hydrocodone is. One to one it is equal to morphine. All the main tables will tell you this. Izzy is taking 4-6 15mg LA hydro caps daily. That's a lot of hydro. Plus, she takes up to 4 10mg hydro BT caps as well. That's about 130mg of hydro daily if she uses the full allotment of BTs daily. The 12mcg/hr patch is nothing next to the hydro. I believe that 130mg of hydro daily equals more than a 100mcg patch. In addition, as Ex pointed out, Izzy is probably getting the purest hydro on the planet by getting it compounded. So it's easy to see why loss of hydro is more troublesome than losing the 12mcg patch, or even a larger patch.
Even though the mu receptor is the main player, these various opioids 'activate' different descending pathways for pain relief. Hydro is conspiuous in its activation of an 'excitatory' pathway. This causes many to get all jacked-up on hydro. Oxy and Demerol also activate this excitatory pathway. This makes getting off of these opioids that much harder, and causes withdrawal from them to be that much more difficult.
Re: How Can I Have Wd From Hydro And Not The Patch?
Izz, I don't mean to hijack your thread, but I had to ask Steve a question, in light of his receptor 101 class......
Steve, My PM is planning to increase my Oxy fro 20mg 3x/day to 30mg. 3x/day. He also said something about switching my BT from 7.5mg hydro to 10mg. percs. Because the percs are oxycodone, like my Oxycontin, would I be better off just going with 10mg hydro?
Re: How Can I Have Wd From Hydro And Not The Patch?
According to Janssen, the maker of Duragesic, each 12.5 patch is equivalent to 45mg of morphine. They do not have a conversion table for Hydrocodone, unfortunately.
Re: How Can I Have Wd From Hydro And Not The Patch?
Quote:
Originally Posted by cmpgirl
Steve, My PM is planning to increase my Oxy fro 20mg 3x/day to 30mg. 3x/day. He also said something about switching my BT from 7.5mg hydro to 10mg. percs. Because the percs are oxycodone, like my Oxycontin, would I be better off just going with 10mg hydro?
Cmpgirl- I know you didn't ask for my advice per se, but I would think that "mixing" meds may result in better pain control. From my own experiences, as well as a lot of research I've done, attacking the pain with different meds can often result in better pain control than just a lot of one med. Just my .02. Steve may have a different answer. Good luck.
Re: How Can I Have Wd From Hydro And Not The Patch?
cmpgirl,
It depends on what you mean by 'better off.'
Ex hit the jackpot regarding the mixing of opioids. It's called 'polypharmacy,' and the very latest research is bearing this out. There's even one drug in phase 3 human testing that has oxycodone and morphine combined. The hypothesis is that by taking smaller amounts of each and combining them the synergy is better than by using either one alone in larger amounts.
In your case it really depends on the level of pain you are experiencing and how much more med it's going to take to get you to the level of relief desired.
The increase in LA med is pretty substantial. So is the proposed increase in BT meds. If you want to be a bit more conservative, why not try the hydro at 10mg first (along with the inc. in LA) and see how you do? Have an agreement with the doc that if the 10mg hydro doesn't cut it, then you'll step up to the Percs.
We'll call this Polypharmacy 101 and I'll go now and try to fit my ever-growing head through the door.
Back to try sleeping again - knees are really yellin' at me and it's only 3:50am!!!
at is why doctors try different combonations for pain medications... I hope this helps,
