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Old 04-01-2011, 08:24 PM   #1
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Question Changing Pain Meds



I've been going to the same PM Dr.'s for over 7 years...I've been on Methadone 120 mg. a day along with Oxycodone 30 mg. 5 times daily for 3 years now. They aren't working as well and I've got other health issues that have concerned the Dr. and he wants to change my meds...I go back on April 7th. Here's what I want to know....What does anyone think of Opana ER? Also has anyone tried Exalgo?
I tried to switch to Morphine once before and that only lasted a few days due to Withdrawals...it was Horrific....

I need to change but am terrified of what might happen....

Rhonda

 
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Old 04-02-2011, 08:24 AM   #2
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Re: Changing Pain Meds

Rhonda, You are on a very high dose of opiates at this time and I'm quite sure that if you swithched meds you are going to experience some type of discomfort, however if the switch is sucsessfull and you can persurvere you will be better of in the long run.

 
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Old 04-02-2011, 12:59 PM   #3
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Re: Changing Pain Meds

R-

Opana and Exalgo will not be potent enough, not to mention the cost of taking 3 Opana ER (40mgs) or 2-3 Exalgo (16mg) a day would be steep.

Fentanyl would be an option. Also, a relative of Methadone is Levorphanol, which comes in 2mg doses, but it is still very inexpensive. Levorphanol was dubbed 'The Forgotten Opiate'. They are working on an ER version which will likely be expensive -and a bit redundant since Levorphanol is long acting.


Last edited by Isotope; 04-02-2011 at 01:11 PM.

 
Old 04-02-2011, 01:09 PM   #4
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Re: Changing Pain Meds

The Opana conversion for Methadone and Oxycodone is (0.5), which implies that you would need roughly 100mgs of Opana/d to equal your current intake.

Many complain about the low bioavailability of Opana ER (It hasn't bothered me much), but given your situation you may want to try the generic Oxymorphone IR instead of the Brand ER version. The TimeRX release is good, smooth etc... but, like Levorphanol, it may be redundant because Oxymorphone is fairly long acting in the IR forms. Your dosing will be high and frequent which will be better suited to the IR delivery.

 
Old 04-02-2011, 01:44 PM   #5
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Re: Changing Pain Meds

I know that I am on a high dose in general...but I've been taking these for years at this dosage and it's finally not working as well....I have an appt. on April 7 to discuss my options. The only meds that even come close are the Exalgo and Opana ER....Exalgo is covered by TennCare, which I have...and so is Opana ER. So the cost isn't a problem. Finding them might be. I've read bad reviews on both from other CP patients...but it's all personal. I just don't know what to do...I tried to change to Morphine once and had severe Withdrawals.. so I went right back....what is that other one? I've never heard of it...

 
Old 04-02-2011, 01:50 PM   #6
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Re: Changing Pain Meds

If cost is not an issue then you have some good options. Try Opana ER (40mg/TID) with some Opana IR for breakthrough. I haven't heard many reviews of Exalgo.... Some really like Hydromorphone for BT, but find it horrible as an LA med.

 
Old 04-02-2011, 08:41 PM   #7
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Re: Changing Pain Meds

haven't tried either....but from all of the information I've gathered they are my best options...I'd like to stay on Oxycodone 30 mg. for BT pain....but the Methadone has to go...

 
Old 04-02-2011, 09:47 PM   #8
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Re: Changing Pain Meds

Hi Rhonda,
The best person to discuss what your real options are in switching medications, would be with your PM doctor. None of us here are PM's, just a bunch of other patients and us making any recommendations/suggestions or dosage conversions would be wrong since we aren't doctors or aware of your other medical conditions or what medications that you may take for those conditions that might negatively impact any suggestions.
If you trust your doctor, know that any conversions /medication suggestions that he makes would be in what he considers to be your best interest.
We can tell you the experiences any of us have had with a particular medication but not make recommendations for what medications you might be switched to.
Good luck,
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Old 04-03-2011, 10:30 PM   #9
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Re: Changing Pain Meds

Hi Rhonda,
I also have been taking methadone and 30mg Oxycodone for roughly 7-8yrs. I have been in a very similar place where I began not getting the pain relief that was needed. My pm doc has been great as far as letting me try different opiates to see what would help. I recently had a compounding pharmacy make me 1600 mcg sugarless fentanyl lozenges and have been using about 2 per day when I feel I need them. These have been pretty helpful with no negative side effects. I also tried the new generic Opana 10mg ir tabs. Oxymorphone seems like a good medication but I found that I needed a high dose to get relief. I had similar results with Hydromorphone (Exaglo,Dilaudid) as both of these meds have a very low bioavailability when taken orally. It's tough when your body gets used to the meds your taking and you no longer get the relief you need. You are very lucky to have such good insurance. I know you will eventually get your meds working for you again. Best of luck to you.

Last edited by acman3960; 04-03-2011 at 10:48 PM.

 
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Old 04-04-2011, 12:06 AM   #10
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Re: Changing Pain Meds

What is the best way to bring the lozenges up to my PM Doc? He had me try the patches many years ago..even before he put me on Methadone and they made my arm break out in a rash...never thought about using it any other way...How well does it work for the Long Acting pain? do u still use Oxy for BT?

 
Old 04-05-2011, 04:05 AM   #11
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Re: Changing Pain Meds

The fentanyl lozenges I use are very helpful to me but really aren't a long acting medication. When I use them I usually get a few good hours of relief though. Also, the reason I get them compounded is because the amount of sugar that is in the regular "Actiq" is ridiculous and will quickly rot all your teeth.
Yes, I still take the oxy and methadone so this was basically added to what I already was taking to help where I was no longer getting the pain relief I needed. I get a prescription for 180 lozenges and they usually last me 3-4 months. If you were to try them you could use them a little more often than I do since you are looking for somthing long acting. Just be honest with you doctor. Nothing works better than honesty. I know you want to eliminate the methadone and as a long time user I can definitely understand that. That is a tough one! You will need somthing quite strong to compansate for the 120mgs/day. I actually take a higher dose than that. Keep me posted.

 
Old 04-06-2011, 11:36 AM   #12
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Re: Changing Pain Meds

After all the years taking Methadone...I thought I'd be on it forever...I think I have to change. I am also Diabetic and have HBP...so the methadone has a lot of effect on my heart and breathing...I had an EKG last year and it was fine...going to have another one tomorrow...that will determine if changing is My idea or something I have to do for my heart...thanks for your help...Tomorrow is the day I find out for sure.. I'd like to ask about the Fentanyl Pops... I doubt he would ADD them without taking something away...I want him to start decreasing Methadone as he brings in another pain med...we'll see...

 
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