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Old 06-09-2012, 06:52 AM   #1
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Question how long between er & immediate release morphine

have been and will continue kadian ER 30 mg. every 12 hours at 6 & 6
went back to pain doc he added 2 15 mg immediate morphine sulfate to be taken 12 hours apart. my question is after i take my extended release how long should i wait to take immediate release

 
Old 06-09-2012, 08:46 AM   #2
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Re: how long between er & immediate release morphine

The ir is for breakthrough pain. When you have a flare or any period of bad discomfort, that's when you take it

 
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Old 06-09-2012, 10:31 AM   #3
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Re: how long between er & immediate release morphine

thanks so much for your response but to be more specific i understand it is for breakthrough pain i am trying to find out if i take kadian ER at 6 and then an hour or two later feel like i need to take immediate release. Being as of this point i am on nothing for inflammation or anything keep a evening low grade fever with white count normal my fingers and hands stay swollen and inflammed to the point one time they starting weeping fluid out them so at this point my pain is really bad 24/7. I am praying that since i have first visit with rheumy on tuesday that we can get it under control and i can get off some of my meds and get back to nursing school.
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Old 06-09-2012, 10:46 AM   #4
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Re: how long between er & immediate release morphine

If your body can tolerate NSAIDs like ibprofin, naproxen then you should add those to your regimen. They are great anti inflamitories IMO. I hope things get better

 
Old 06-09-2012, 12:38 PM   #5
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Re: how long between er & immediate release morphine

Hi Mandy,

Sorry your having such a rough go of it. Your Dr. added the IR Morphine for BT pain as you know. Generally they don't RX those at a certain time they allow you to take them as needed when pain flares and then give you a guidline as to how many hours you need to wait to take the next one. You can take your IR Morphine at any time that you have a flair, you don't need to schedule it around your LA med.

As for your lowgrade fever and swelling you can take an OTC anti-inflammatory that will cover both of them for the time being to hold you until you see your Rheumy. Ibuprofen will handle both the fever and swelling, you can take up to 1600mgs per day safely. Hopefully that will give you some relief.

I hope things settle down soon for you.

Hang in there,

Kat

 
Old 06-09-2012, 12:43 PM   #6
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Re: how long between er & immediate release morphine

I would ask your doctor specifically. Typically the breakthrough med can be taken anytime you need it. I don't understand why your doctor said that the morphine IR would have to be taken 12 hours apart, as it lasts about 4 hours. So, thats another question to ask. I'd also be clear if he intended these to be part of your daily meds or only for breakthrough, as the 12 hours apart almost sounds like its part of your daily meds, which doesn't make since to me.

I can say that I typically wait at least a couple hours after my LA med to take an IR med, as for me it can take that long for the LA med to kick in. I also typically won't take an IR med right before I am due for my LA med. Sometimes after the LA med kicks in I don't feel the need for the IR med anymore.

Since I am on a schedule with my LA meds of every 8 hours for one and every 6 hours (but only twice a day) for the other, that actually doesn't leave too many opportunities to take my IR med for breakthrough. That said, if I am in a very tough bind I will take them together at the same time, and that actually works very well (I've felt safe doing this).

I haven't actually discussed this with my current doctor (as it was kinda tough to get him to continue to give me bt meds), although I should. I did discuss it with my previous doctor, who was fine with me taking bt meds anytime I needed them, as long as I didn't take any doses of it closer together than every 6 hours (for Oxycodone for me), and I didn't go over my monthly allotment.

On my bottle it says to take 4 pills as needed. My bottle actually used to say take 4 pills every 6 hours as needed. So, I think my current doctor should have put how often I can take it. I only get 15 doses a month. Sometimes the bottle is helpful on the specific instructions, sometimes not.

Many doctors would expect you stick to less than 2 doses a day of bt meds if you are prescribed 60 doses a month, even if it was safe to take 4 doses in a day. ie. if they called you in for a pill count halfway through the month and you had less than half of your pills left, that would be bad. This is definitely a question for your doctor so you are clear with the instructions. Its great you were given an IR med though; most of us do have bt pain. Best wishes.
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Old 06-09-2012, 04:32 PM   #7
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Re: how long between er & immediate release morphine

HI Mandy-

i know as well as many others who post/read this forum that severe and chronic pain can really push you to the "brink", physically and mentally.

you are on kind of a low dose of Kadian(morphine)-also you sound as if the LA med(kadian) is not lasting 12hrs, this is not unusual, infact a lot of the LA drugs are dosed at three times a day(every 8hrs vs 12hrs) for that reason. I would hope your doctor is aware of this.

As someone already stated you take your bt med(msir)when you have a spike of pain; it's important to take the bt a soon as you experience the spike or flair, if you wait too long, the bt won't help.

my experiance with morphine ER was, i was prescibed to take it every 8 hrs, alot of the LA medications dont last the 12hrs as the pharm co. states, and most PM doctors are aware of this. i also was prescribed the msir for bt, along with 10mg oxycodone.
, i would some times take 1 of each of the bt's for really bad flares; or 1 or 2 oxy because i got better relief from the oxy-i was allowed 3 of each bt a day and could take them prn.

you should mention to your doctor that the kadian 30 is not helpin or lasting th 12hrs, if this is what the case is. i had the same problem and told my PM doctor and he changed the dosing to every 8 hrs, but about a month later he increased the strenght of the morphine(kadian) and kept me with the same bt's msir 30mg and oxycodone 10mg at no more than 3 a day of each of the bt meds.

discuss how you are feeling and how this pain is affecting your activities of your daily living. Hopefully you have an empatheic pain specialist and will hear you.

Good Luck and please let us know of your progress! Most of us have been where you are and more than once-chronic pain is very complicated and difficult to treat-what helps some wil not help others.
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Last edited by BB07; 06-09-2012 at 04:58 PM.

 
Old 06-09-2012, 06:37 PM   #8
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Re: how long between er & immediate release morphine

As far as I know, Kadian is advertised as lasting 24 hours but is often dosed every 12 hours. Dosing every 8 hours for Kadian would be quite unusual. Its the regular morphine ER which is advertised as lasting 12 hours which is often dosed at 8 hours. Kadian is a form of morphine in capsules which recently went generic. There is also an even longer lasting morphine formulation called Avinza, which is advertised as lasting 24 hours; I haven't heard too much about it being dosed more often (its also still only brand name and doesn't seem to be as popular as Kadian).
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Old 06-09-2012, 08:19 PM   #9
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Re: how long between er & immediate release morphine

mandy-

it is NOT unusual at all to have KADIAN dosed every 8hrs; depending on the severity of the individual's pain. just google it and you will find many examples.

i do hope your doctor adjusts your meds so you are not suffering needlessly. kadian is very good for folks who cannot swallow pills.
they are capsules filled with tiny pellets and can be sprinkled on foods, like oatmeal or applesauce,ect.

best wishes
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Last edited by BB07; 06-09-2012 at 08:24 PM.

 
Old 06-10-2012, 10:44 AM   #10
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Re: how long between er & immediate release morphine

I used kadian 3 times a day back before I had the pump put it, as long as you take it the same time of day every day at 8 hour intervals the release and serum level is very smooth. I do agree that the Kadian dose is low. Kadian was also advertised as 12+ hour med and you have to consider that only 30 mgs is being released over a 12 hour period, That would be like taking 7 to 8 mgs every 4 hours . So taking just one 15 mg MSIR is going to more than double the amount of morphine in your sytem. Please be careful when driving or doing anything that requires concentration or might be hypnotic, like driving.

Normally break through meds are meant to increase your base level of medication by 20 or 30%, in your case where the MSIR is doubling the level in your system for a 4 hour period and then wearing off, if you find the only time your truly getting relief is after taking breakthrough meds or your having rebound pain when the BT med wears off, the answer would be to increase the base dose rather than give you 6 doses of BT medication to take around the clock. When you use BT meds around the clock they realy aren't BT meds any longer, they have simply become part of the daily routine and when you actually have a big flair in pain caused by weather changes or a fall or whatever, you dont have anything extra to take that you are not already used to taking every day.The whole purpose of LA meds is to stop the clock watching, waiting for the next dose and living your life in 3 or 4 hour increments between doses. If you find you only have satisfactory relief while taking BT meds, I would certainly explain this to your doc and let him know you were hoping to have more freedom with the LA meds as far as being able to go 8 to 12 hours between dosing.
Good Luck, Dave

 
Old 06-13-2012, 04:14 PM   #11
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Re: how long between er & immediate release morphine

As Kat, Tortoisegirl, Shore, and others have mentioned, BT meds are generally used whenever needed without regard to when LA meds were taken. Your PM may have said to take it every 12 hours as a way of saying no more than BiD / twice daily. Either way, until you talk to your PM, I would take it no more often than 12 hour intervals. If you do need the MSIR every day both doses, you probably should talk to your PM about increasing the LA med dose (Kadian?). I was offered MS Contin with MSIR for BT pain but elected for BuTrans. I am considering trying to MS Contin if it is cheaper, but either way will likely use MSIR for BT. BuTrans lasts only about 5 days from what I have read instead of the advertised 7, and my dad has told me MS Contin only lasted 8-10 hours as apposed to 12, so if I go on MS Contin I will mention that and request Q8 dosing. I may ask for some MS Contin anyway to bridge the 2 day gap at the end of the BuTrans 7 day lifespan. This is all to say you should be in your target pain relief the majority of the time from just your LA med. Right now I am having to take Norco every 18 hours or so to boost the BuTrans, so I will request a higher dose so I don't regularly need the BT med. I have flares about once or twice every 24-48 hours and my understanding was I would be getting 60 MSIR a month for BT, which is fairly typical. My PM said I could take the MSIR without regard to MS Contin (had I chosen those meds), and could take MSIR up to twice daily but if I was needing to do so he would increase the MS Contin.

Pill counts are an important consideration. If you are taking the MSIR a lot you might be short if called in for a count. Since both your LA and IR med are the same compound, testing negative for either on a UA probably wouldn't be an issue, but still watch how often you're taking them. Good luck!
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