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Old 01-04-2011, 08:03 AM   #1
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What is the next step up from Norco?

As many of you know, I'm not getting good relief from the norco 7.5 four times a day anymore. My pain is much worse and I've grown tolerant. I dont know much about other meds and am wondering what is the 'order' of them? So whats the next step up?

 
Old 01-04-2011, 12:47 PM   #2
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Re: What is the next step up from Norco?

Mom-

There are quite a few options depending on your particular situation. Norco is considered a Short Acting medication that is better for Acute Pain when used Short Term, or as a Breakthrough (BT) medication when used with a Long Acting medication. Hydrocodone is somewhat stronger than Codeine but less so than Oxycodone and Morphine.

I've found that Hydrocodone makes a good BT med that strikes a good balance between sedation and activation, offers decent pain relief for a few hours, and can be 'called in' to the Pharmacy. Morphine is a bit stronger and tends to be slightly sedating (I've heard).

OxyCodone and OxyContin are almost twice as powerful as Hydrocodone and Morphine. It's works well in both forms, IR and long acting form. I've found it to be slightly activating, revs me up.

Hydromorphone and Oxymorphone are very strong (5-7 times that of Morphine), and expensive. Hydromorphone is available in a long acting form called Exalgo, and as an IR BT med called Dilaudid. Oxymorphone is also available in both forms under the Opana name.

Here is a comparison chart of the various Opiates.

~
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Last edited by Isotope; 01-04-2011 at 08:27 PM. Reason: typo

 
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Old 01-04-2011, 02:19 PM   #3
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Re: What is the next step up from Norco?

Thank you. I'm not sure if I'm reading the chart right; are the meds listed in order of strength? So, I DEFINITELY dont want something sedating. I wonder if oxycodone would be my best bet? Where does percocet fall into this? My mom takes that for her knee and I believe thats stronger than norco isnt it? I dont want to go to my next appt blind; I want to know what she's giving me before I agree to it.

 
Old 01-04-2011, 02:35 PM   #4
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Re: What is the next step up from Norco?

I just looked it up; so percocet IS oxycodone? I also just remembered my Dr mentioning a patch once, I assume that's fentanyl? Is that a narcotic? How well does that work?

 
Old 01-04-2011, 06:57 PM   #5
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Re: What is the next step up from Norco?

most people would probably say oxycodone/percocet. Percocet is a brand name drug that contains oxycodone as one of it's active ingredients. The other ingredient in Percocet is tylenol.

Also, never been on the patch myself, but I heard one person say that moving from hydrocodone to the patch would be going from the mildest drug to the most potent. Fentanyl is the most potent narcotic, and some would say it's the "big guns" along with maybe methadone.

When I first went on long-acting meds, my doctor first mentioned the patch. However, I (try to remember to) work out and we were concerned that the sweating would make it fall off. Some people have problems with it sticking. hope that helps

 
Old 01-04-2011, 08:33 PM   #6
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Re: What is the next step up from Norco?

I agree with Toonces, that Fentanyl will (generally) not be your Doctor's first choice. Percocet may a good choice but it will still be fairly short-acting which is part of the problem with Norco.

A long-acting med (like OxyContin or MS Contin) will help you feel more stable, will lessen the ups and downs, control your pain longer and may lower the anxiety related to repeated dosing with SA meds.

~

 
Old 01-04-2011, 11:48 PM   #7
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Re: What is the next step up from Norco?

All the high potency opoids are equipotent in absolute terms, it is only the mg dose that differs. morphine, oxycodone, hydromorphone, oxymorphone, fentnyl, methadone, all are high potency opoids. There are basicly three potencies of opoids:

- Weak, codeine, tramadol, dextropropoxyphene

- Intermediate, hydrocodone, dihydrocodeine

- Potent, morphine, oxycodone, oxymorphone, hydromprphone, methadone, fentanyl.

In the doses commonly used, hydrocodone/dihydrocodeine arnt realy any stronger than codeine or tramadol - they have a higher absolute potency, but arnt usualy prescribed in maximal doses

Momboms, have you tried ER Tramadol plus an NSAID yet? It is about as potent as 7.5 norco, but provides 24/7 pain coverage. You could also try adding an NSAID to your Norco (an easy way to do this is to take 2 otc ibuprofen along with your Norco tablet). Given that you have an inflamatory pain (tendonitis), an NSAID would make sense as part of your regimen, provided you have no contraindications.

Beyond that, you are looking at any of the high potency opoids, Oxycontin is usualy the first one tried, but that has more to do with agressive advertising that it being any better than the others. Your doctor probably has his own favorite he will try first, and if that doesnt suit you, will try another.
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Last edited by jonnstar; 01-04-2011 at 11:50 PM.

 
Old 01-05-2011, 12:40 PM   #8
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Re: What is the next step up from Norco?

A few of the Brand Name offerings in my dose range.

This is a correction from my previous post; these are my annual costs as an insured subscriber -not monthly, sorry.



OxyContin - $760

Exalgo - $1,570

Kadian - $850

MS Contin - $1,410

Opana - $987


Pretty outrageous!

~

Last edited by Isotope; 01-06-2011 at 10:47 AM.

 
Old 01-05-2011, 03:34 PM   #9
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Re: What is the next step up from Norco?

Those prices are disgraceful, given that all of those drugs were developed decades ago - there are no R&D costs being recovered, its just pure profitering.

Price to Pharmacist in Australia for 60 x Oxycontin 20mg is AU$90, price for 60 x 40mg is about AU$150, Methadone syrup 5mg/ml, 1000ml, price is $40 (that would be a three to six month supply for a chronic pain patient) - because we have a national health insurance scheme, the insurance commission is buying enough drugs for 20 million people, and can thus drive a hard bargain (you dont pay the $150, it is subsidised, there is just a copay to be made by the patient)
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Old 01-05-2011, 04:29 PM   #10
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Re: What is the next step up from Norco?

I don't know where those prices come from, but ms contin 60 tabs would run me about $45 for generic.

 
Old 01-06-2011, 08:51 AM   #11
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Re: What is the next step up from Norco?

Iso I'm not sure where you are getting your prices from, but I'm pretty sure you are getting bad info.

I get 150 MsContin a month and without insurance it would be $206.00. When I was on Oxycontin for 120 a month it was $196.00 without insurance.

Kat

 
Old 01-06-2011, 10:35 AM   #12
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Re: What is the next step up from Norco?

My info is directly from my CVS Pharmacy web page (logged-in to my account).

Sorry, I goofed.

I was looking at my Annual cost thinking it was my monthly retail. Generally my scripts run from $12 to $72 a month for most drugs -as an insured subscriber.


~

Last edited by Isotope; 01-06-2011 at 10:51 AM.

 
Old 01-06-2011, 10:18 PM   #13
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Re: What is the next step up from Norco?

Quote:
Originally Posted by Isotope View Post
My info is directly from my CVS Pharmacy web page (logged-in to my account).

Sorry, I goofed.

I was looking at my Annual cost thinking it was my monthly retail. Generally my scripts run from $12 to $72 a month for most drugs -as an insured subscriber.


~
That sounds more like it, ), because with my insurance I only pay $3.00.

 
Old 01-06-2011, 11:17 PM   #14
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Re: What is the next step up from Norco?

One think i wish Australia had was Walmart, with their $4 prescriptions!
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Old 01-07-2011, 02:50 PM   #15
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Re: What is the next step up from Norco?

Quote:
Originally Posted by jonnstar View Post
One think i wish Australia had was Walmart, with their $4 prescriptions!
Believe it or not, walmart isn't always the least expensive place to fill prescriptions! True, they do have lots of $4 generic meds, but some of their meds that aren't on the $4 list are as high, and sometimes higher, than other pharmacies. I check around before filling any new prescription.

Carol

 
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