Executor

Thanks for the kind words Liz. I try to help others as much as I can. This is a great site where many here have a wide variety of experiences and thus, can offer lots of support and guidance.


Everyone is different, so you have to take my comments with a grain of salt. PM is a very difficult field because it's so individualized....What works for one may not work for another.

Given your general question, normal protocol is for the LA dose to be consistent. This keeps the BPL steady and avoids the "ups and downs." If one of your doses is quite a bit lower than another, invariably, you may have more pain at that time, or you'll suffer from minor WDs at some point.

It is common, however, for a night time dose to be different....To ensure a restful night's rest. For example, when I first started in PM years ago, I was on OC 10mg 2 x day and at some point, I started to have trouble at night....Waking up in pain (can't really use BT pains while you sleep). So, the Doc went to 10mg 3x, but still every 12 hours, but (2) pills at bed time to help get me through the night....It worked well. Thus, sometimes, it takes some trial and error by the Doc to get one completely dialed in. Sounds as if you have a really good Doc who is open to trying things, which is good.

Ms Contin is the shortest acting of all the oral morphines. It's a 10-12 hr med at the most. Kadian is 1-2 x per day, and Avinza is 1 x. However, some do take Kadian 3 x (I do) and some take Avinza 2 x (I did). I was on Avinza, but switched to Kadian because I moved to 3x and Avinza doesn't make the strength dose my Doc wanted to use. I have found both Kadian and Avinza to work very, very well.

If you go 60/60/30, your BPL may be built up enough by the night time dose to get your through. If not, then you'll have to be consistent throughout.


I don't know the exact release mechanism for MsContin. Solid pills usually all use the same methodology....It's probably similar to OC or any other type of time release...Half is released right away, and the other half is released in 5-6 hours.

With Kadian and Avinza, they come in capsules and there are "beads" in each. The directions actually indicate that one can open the capsules and spread the beads, or pellets, on one's food, or put in apple sauce, peanut butter...That type of thing. 20% of the beads are IR, 20% are released in 4-6 hrs, 20% are released in 8-10hrs, 20% in 12-14hr, and 20% are released in 16-18 hours. This is all dependent on one's metabolism of course, and is just an average. Those who have higher metabolisms, will burn through the med faster and vice versa.

It's also important to note that oral morphine has very poor bioavailability. This means one has to take much more of it vs other pain meds to get the same effect. Think of bioavailability as "efficiency", or like miles per gallon (MPG) in a car...If oral morphine was an automobile, it would have poor MPG. Conversely, Oxycodone has very good MPG. As a general rule, Oxycodone has at least twice the oral efficiency compared to oral morphine.

Hope this helps, and please let me know if I can help further.

Regards,

Ex