It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Pain Management Message Board
Post New Thread   Closed Thread
LinkBack Thread Tools
Old 05-18-2008, 05:46 PM   #1
Veteran
(female)
 
Join Date: Mar 2007
Location: ct
Posts: 438
eyesworld HB Usereyesworld HB Usereyesworld HB Usereyesworld HB Usereyesworld HB Usereyesworld HB Usereyesworld HB User
a question_opana_percocet

My brother had back surgery last year and is still in a lot of pain. He had been taking percocet 10mg about 8 a day. His surgeon just turned him over to PM and the doc put him on opana er 20 mg -2x a day and told him not to take the percocets any more.
He just started today and I just talked to him and he says he feels awful, sweaty and joint achy. I told him to call the doctor right away.
What do you think? Reaction to the new med? or W/D from the percocets??? I think the latter.

PS-he is also going for a second opinion on what he considers a failed back surgery.

 
Old 05-18-2008, 05:54 PM   #2
Inactive
(male)
 
Join Date: Jan 2008
Posts: 4,017
Executor HB UserExecutor HB UserExecutor HB UserExecutor HB UserExecutor HB UserExecutor HB User
Re: a question_opana_percocet

Absolutely, he is having WDs. 80mg of Percocet was a lot of Oxycodone per day. Opana is stronger, but I'm not sure how much more so. Steve would probably know. It's not 4X stronger, I know that. Additionally, Opana targets different receptors than the Oxycodone.

If he was taking 8 Percs per day, some form of LA med is appropriate. He may need BT meds, however. He will have to discuss this with his Doc.

I would wait until Monday, then if things haven't changed, call the Doc. Some BT meds would help alleviate the pain and the physical symptoms.

Ex

 
Sponsors Lightbulb
   
Old 05-18-2008, 07:05 PM   #3
Senior Veteran
(male)
 
Join Date: Feb 2008
Location: Australia
Posts: 575
aussiejono HB User
Re: a question_opana_percocet

If he has any percocet left, he could take them in a step down over 4 or 5 days, say 4 today, 3 tomorrow, 2 the next day etc.

If he doesnt, he could take an extra opana today and tomorrow to get him over the worst.

 
Old 05-18-2008, 07:54 PM   #4
Veteran
(female)
 
Join Date: Mar 2007
Location: ct
Posts: 438
eyesworld HB Usereyesworld HB Usereyesworld HB Usereyesworld HB Usereyesworld HB Usereyesworld HB Usereyesworld HB User
Re: a question_opana_percocet

Quote:
Originally Posted by aussiejono View Post
If he has any percocet left, he could take them in a step down over 4 or 5 days, say 4 today, 3 tomorrow, 2 the next day etc.

If he doesnt, he could take an extra opana today and tomorrow to get him over the worst.
I told him basically the same thing but also to BE SURE to call this new PM doc ASAP. He said he has @50 of them left.

 
Old 05-18-2008, 08:03 PM   #5
Inactive
(male)
 
Join Date: Jan 2008
Posts: 4,017
Executor HB UserExecutor HB UserExecutor HB UserExecutor HB UserExecutor HB UserExecutor HB User
Re: a question_opana_percocet

Worst case scenario.....If his Doc doesn't budge, I'd use the 50 or so left over Percs to taper down.

However, conventional wisdom says he'll probably need something for BT. Very seldom does a LA med control all the pain....Unless it's post op and the Doc expects the body to heal.

Ex

 
Old 05-18-2008, 09:22 PM   #6
Senior Veteran
(female)
 
Join Date: Feb 2008
Location: NY
Posts: 1,884
cmpgirl HB User
Re: a question_opana_percocet

I would say this doc is one of those who probably doesn't like prescribing opiates/opioids in the first place. He may not understand that long acting meds usually require some amount of breakthrough meds. I am a bit appalled that he didn't even know to tell your brother to taper the percs.

To me, it means the doc doesn't know much about narcotics at all. I agree with the rest, that 1) He should call the doc and tell him he is having these symptoms, and 2) He should take the percs in a taper in the meantime.

I would also consider a different PM doc, if he has the option. This one doesn't seem to know what he's doing.

 
Old 05-19-2008, 08:19 AM   #7
Inactive
(male)
 
Join Date: Dec 2006
Location: CA
Posts: 1,569
forginon HB User
Re: a question_opana_percocet

No pain patient should be switched like that without the help of BT meds. As others have already written, this is a sign of either an opiophobic doc or he just knows very little about the meds he's prescribing here (probably the Opana).

He is experiencing withdrawals. The advice to taper down by using the percs is probably what I would do, but he has been advised to stop the percs immediately. I certainly cannot suggest going against doctor's orders, he needs to make up his own mind on this. If he has an appointment anytime soon, he faces possible urine testing. The implications are obvious.

The oxymorphone in Opana is potent, but poorly used by the body when taken orally. 90% is lost to first pass metabolism, leaving only 10% for pain relief. 10% of this potent med does not equal the total amount of percs he was taking. The way this med is being prescribed just frustrates the heck out of me.

steve

Last edited by forginon; 05-19-2008 at 08:19 AM.

 
Old 05-19-2008, 01:34 PM   #8
Veteran
(female)
 
Join Date: Mar 2007
Location: ct
Posts: 438
eyesworld HB Usereyesworld HB Usereyesworld HB Usereyesworld HB Usereyesworld HB Usereyesworld HB Usereyesworld HB User
Re: a question_opana_percocet

Thanks everyone for the expected responses. The doctor's office called him back today after he left a message last night. It turns out it is the PA who gave the meds.
When he explained his symptoms the PA said, oh no, you didn't have a dependency after 2 years! Stop taking the percocets the opana will be fine. (DOH)
He has an appointment on Friday and knows he'll make it til then with the remaining, which he has cut back on. But it was and is definitely W/D's. He's going to make sure he sees the doc not the PA..

Remember, this is his 1st PM appt after the surgeon didn't want to prescribe anymore.

 
Old 05-30-2008, 09:15 AM   #9
Newbie
(male)
 
Join Date: May 2008
Location: Las Vegas, NV USA
Posts: 8
3ding HB User
Re: a question_opana_percocet

Hi,
I am in the EXACT same position. I had my second back surgery (fusion) January this year along with a neck surgery 2 years ago and have been on percocet 10mg since about July 07. I just called my pain doc yesterday to ask him if i should taper down or what i should do because its taking more and more medicine to make me not sick (withdrawal) and relieve pain. Just barely making it 3 hours now with the perc 10mg and I am just really tired of dealing with these withdrawal symptoms all the time after a few hours or maybe there not withdrawal I don't know but either way it does not make for a very happy day for me. I usually take 6-7 now a day and so my pain doc has put me on Opana ER 20mg 2x day along with lyrica 150mg 2x day and Indocin 75mg 1x day. So my question finally is will i be able to taper down from the perc easily and how long of a schedule should i try. like 7 , 6, 5, etc or 1/2 pill taper over a week or two. I can use it for break through he said about 3 a day but i would really like to be at the point of not having to take any and then just use it as needed but not daily. He said I shouldn't have much WD with Opana. Ya right !!! Should I wait a few days until the Opana is in my system. I am only taking one per day until Monday and then start twice daily opana 20mg er. So any advice is greatly appreciated.




Quote:
Originally Posted by eyesworld View Post
My brother had back surgery last year and is still in a lot of pain. He had been taking percocet 10mg about 8 a day. His surgeon just turned him over to PM and the doc put him on opana er 20 mg -2x a day and told him not to take the percocets any more.
He just started today and I just talked to him and he says he feels awful, sweaty and joint achy. I told him to call the doctor right away.
What do you think? Reaction to the new med? or W/D from the percocets??? I think the latter.

PS-he is also going for a second opinion on what he considers a failed back surgery.

 
Old 05-30-2008, 10:16 AM   #10
Senior Veteran
(male)
 
Join Date: Jun 2003
Posts: 3,458
Shoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB User
Re: a question_opana_percocet

Hi Eyes Docs usually start on the low side and I would bet there isn't a true CP patient that has ever gotten the dose right on the first visit. I have done cold switches from short acting oxycodone to SA opana and didn't experience withdrawal. On a single dose comparison I replaced 30 mgs of oxycodone with 10 mgs of opana, 15 really felt closer although opana does have a different feel and I felt more impaired by opana so rarely took 15 mgs.

There is no reason two drugs in the same class like oxycodone and oxymorphone, Both keto synthetics can't be easily swappped if the right dose is used. However given this is the first time this doc has prescribed anything to your brother, it's reasonable to expect him to start on the low side,not that 2:1 would be considered low by any doc or equianalgesic table I have seen.

I really don't understand the doctor bashing for not getting a brand new patient comoftable on the first vist if he was given the acurate previous dose. The process of finding the right dose is called titration and nobody gets it on the first go round, to expect more is unreasonabale. It doesn't make him a bad doc, It makes him a safe doc and compasionate enough to squeeze him in to make an adjustmentbefore his next monthly apt if he was given a month supply. If he was given less than a month than the doc never intended to make him waight a month although 2:1 is generous enough to think you could get away with waiting a month to check on a patient.

Anything more than a 2:1 conversion would be excessive/dangerous and leave him liable for anything negative that might happen when you don't bother to follow at least the manufacturer guidelines. They say 3:1 to morphine which equate 2:1 to Oxy and thats where a doc that want to avaoid law suites and over doses is gong to start.

It sounds like he has a good doc that is willing to see him rather quickly to work towards finding the right dose.

When oxymorphone was avaialable as an injectable only the standard conversion for IV use is 10:1 to morphine, Oxymorphone isn't as effective oraly as the injectable version so the conversion is knocked down to 3:1 for oral oxymorphone. Oxy is 1.5 to 2 times stronger than morphine so giving him half his prior dose in opana should leave him in full blown withdrawal. Some discomfort wouldn't be abnormal, but isn't he chronic pain patient, he hasn't had bad days before?

I'm just not as quick to attack any doc that doesn't prescribe anough opiates on the first dose, He's a new patient, he has no trust built with this doc, it would be crazy to start someone any higher than 40 mgs of Opana iven the previous daily dose was 80 mgs of oxy. That's 2:1 and in the ballpark, now heit just needs to be fine tuned. Complete relief on the first visit is a fantasy and when changing meds it's normal to take a step back and hope the patient hasn't developed complete cross tolerance and they can get away with even less of a new drug than the guides suggest. Some guides actually allow the docs to calcualte the suspected degree of cross tolerance based on duration and previous exposurre to other medications.

Empethy is nice, I can empethize, but he's right where the best docs in the country would have started.

Tell him you read about docs that don't return calls and patients whos requests are ignored. Encourage him there is light at the end of the tunnel purely based on the fact this doc is the first to offer opiates and is squeezing him in so quickly. We aren't going to die from chronic pain or some mild withdrawal, so waiting a couple days to be seen after reporting a problem is impressive to me. Espeically when he's seen other PM docs that won't prescribe any pain meds.

There are other methods to manage pain that can be tried prior to concluding you have to spend the rest of your life dependent on opiates. He has a choice as to whether or not he wants to try them. Whether they are appropriate or not comes down to are they helping him more than hindering.

Good luck, Dave

 
Old 05-30-2008, 12:30 PM   #11
Senior Veteran
(female)
 
Join Date: Sep 2006
Location: US
Posts: 863
butrfligirl28 HB Userbutrfligirl28 HB User
Re: a question_opana_percocet

I think Dave nailed it on the head. Most doctors never get the dosing right the first try, we are all just too different to manage to do that, and safely. I have actually read posts from people who started a new med, or dose and were falling asleep standing up, sleeping 12 hour stretches and slurring their words.............wondering what was wrong with them! All I could think is Thank God they didn't die, as they were so obviously over-medicated. I'm with Dave. I would rather my loved one be under-medicated for a little while, then over-medicated with a doc who wants to stroke his own ego and see how "on the mark" he can be, instead of being cautious with someone's life and well-being.

Just my 2 cents!

Amanda

 
Old 05-30-2008, 12:57 PM   #12
Newbie
(male)
 
Join Date: May 2008
Location: Las Vegas, NV USA
Posts: 8
3ding HB User
Re: a question_opana_percocet

Ok so does this answer my question from earlier today ? How do i taper the percocet 10 after just starting the opana 20mg 2x day. i am taking about 6 percocet a day. Will i have withdrawl symptoms just as if i wasn't taking opana and just tapering percocet ? I am so tired of feeling the WD's after 3-4 hours of percocet i want to be at the point where i dont have to take this all day long and only as needed but how do i get to that point. is there something the doc can give me to sooth over the symptoms while tapering he says there shouldnt be any WD but i can tell from my first dose of opana that its going to be a crappy week.


Quote:
Originally Posted by butrfligirl28 View Post
I think Dave nailed it on the head. Most doctors never get the dosing right the first try, we are all just too different to manage to do that, and safely. I have actually read posts from people who started a new med, or dose and were falling asleep standing up, sleeping 12 hour stretches and slurring their words.............wondering what was wrong with them! All I could think is Thank God they didn't die, as they were so obviously over-medicated. I'm with Dave. I would rather my loved one be under-medicated for a little while, then over-medicated with a doc who wants to stroke his own ego and see how "on the mark" he can be, instead of being cautious with someone's life and well-being.

Just my 2 cents!

Amanda

 
Old 05-31-2008, 08:35 AM   #13
Senior Veteran
(male)
 
Join Date: Jun 2003
Posts: 3,458
Shoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB User
Re: a question_opana_percocet

You shouldn't have to taper the Oxycodone, Oxymorphone and oxycodone are in the same family, the dose is acurate so all you will do is increase your tolerance and then decrease the effectiveness of the Opana once you run out of percs. If you are experiencing true withdrawal, Vomitting, shaking, restless leg, etc etc, then take as little oxycodone as needed to stop the worst of the symptoms. The whole point of placing you on Opana was to do away with the oxy. If you use the oxy to boost the effetiveness you going to create a need for more opana than you would have needed had you not combined the two drugs. Opana is twice as strong as oxy, it's in the same family, and if the doc didn't instruct you to take the percs on top of the opana you may actually hurt yourself by doubling up on the meds you happen to have available.

What's wrong with trusting your doc and using the meds he prescribed. Not all docs use BT meds, Not all docs use opiates. You really need to show your willingness to comply with the docs instructions. When my doc makes a med change mid stream we turn the remainder of our old meds in so that we don't have both to double up on. Of course taking both will provide additional relief, but having limited exposure to a new drug twice as strong really doesn't make it safe to start tapering down from 6 or 8 a day when that amount has already been replaced by the long acting med.
Good luck, Dave

Last edited by Shoreline; 05-31-2008 at 08:59 AM.

 
Old 05-31-2008, 08:52 AM   #14
Newbie
(male)
 
Join Date: May 2008
Location: Las Vegas, NV USA
Posts: 8
3ding HB User
Re: a question_opana_percocet

Thank you that is what i wanted to know. I am only on one 20mg until sunday night when i will start the two a day. I am actually feeling ok right now took it last night around 10pm and no perc since then and its now 9am zero symptoms so this might work out ok.. I was told i can take up to 3 perc a day if needed once my opana dose is at full strength. I guess reading other posts people had withdrawals so that is why i was a little worried not knowing what to expect.


Quote:
Originally Posted by Shoreline View Post
You shoukldn't have to taper the Oxycodone, Oxymorphone and oxycodone are in the same family, the dose is acurate so all you will do is increase your tolerance and then decrease the effectiveness of the Opana once you run out of percs. If you are experiencing true withdrawal, Vomitting, shaking, relteless leg, etc etc, then take as little oxycodone as needed to stop the worst of the symptoms. The whole point of placing you on Opana was to do away with the oxy. If you use the oxy to boost the effetiveness you going to create a need for more opna than you would have needed had you not combined the two drugs. Opana is twice as strong as oxy, it's in the same family, and if the doc didn't instruct you to take the percs on top of the opana you may actually hurt yourself by doublinhg up on the meds you happen to have available.

What's wrong with trusting your doc and using the meds he prescribed. Not all docs use BT meds, Not all docs use opiates. You really need to show your willingness to comply with the docs instructions. When my doc makes a med change mid stream we turn the remainder of our old meds in so that we don't have both to double up on. Of course taking both will provide additional relief, but having limited exposure to a new drug twice as strong really doesn't make it safe to start tapering down from 6 or 8 a day when that amount has already been replaced by the long acting med.
Good luck, Dave

 
Old 06-01-2008, 08:36 PM   #15
Newbie
(male)
 
Join Date: May 2008
Location: Las Vegas, NV USA
Posts: 8
3ding HB User
Re: a question_opana_percocet

So far the switch is ok its not great i have alot of pain still during the day from walking ,etc.. and very anxious, jittery from not taking percocet ? is there anything i can take that will help this transition go smoother..

 
Closed Thread




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Join Our Newsletter

Stay healthy through tips curated by our health experts.

Whoops,

There was a problem adding your email Try again

Thank You

Your email has been added








TOP THANKED CONTRIBUTORS



tortoisegirl (159), gmak (156), Shoreline (152), BB07 (94), backhurtz (84), katlin09 (69), Ilovemycutedog (53), galalena (50), jonnstar (35), Isotope (34)

Site Wide Totals

teteri66 (1180), MSJayhawk (1013), Apollo123 (909), Titchou (856), janewhite1 (823), Gabriel (763), ladybud (755), midwest1 (670), sammy64 (668), BlueSkies14 (607)



All times are GMT -7. The time now is 11:49 PM.



Site owned and operated by HealthBoards.comô
Terms of Use © 1998-2014 HealthBoards.comô All rights reserved.
Do not copy or redistribute in any form!