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Old 06-11-2012, 07:01 PM   #1
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Opana

My pain management doctor wants me to switch to 2/day of 5 mg Opana only using Oxycodone 5 mg for breakthrough pain. I have been using 6/day oxycodone for months. I'm nervous about changing my routine. Can someone fill me in on Opana please.

 
Old 06-11-2012, 08:36 PM   #2
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Re: Opana

Welcome! Is the doctor wanting to switch you to a long acting or short acting (immediate release) form of Opana? Either way, then need to start you on a low dose when switching meds to make sure you don't OD. I would not be scared of how low the dose sounds, but instead have an open dialogue with the doctor. I assume its the long acting form, where dosing twice a day is typical. At an appropriate dose, its a step up from taking a short acting med 6 times a day...you should get much better pain coverage this way without the ups & downs. If its the short acting, then I'm confused.

Each person responds to each med differently. I'd discuss any specific concerns you have with your doctor and give it a try. If you are concerned about committing to a full month, ask if you can get 2 weeks worth of meds and have a follow up visit then. I responded well to Opana but for me, I needed a lot more of it than other meds (equal converted doses), so it wasn't a good choice.

There are plenty of options. A couple problems you may have with this one specifically are that it is brand name only (higher cost and often difficult to find) and that it recently changed its formulation (quite a few folks have said it doesn't work as well). If cost is a concern for you, ask your doctor about trying a generic med first. As far as your schedule, this should be easier as you don't have to remember to take something 6 times a day and deal with pain spikes from the short acing med. Plus, you will have something to take when you do get pain spikes. Best wishes.
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Old 06-11-2012, 10:30 PM   #3
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Re: Opana

Quote:
Originally Posted by tortoisegirl View Post
Welcome! Is the doctor wanting to switch you to a long acting or short acting (immediate release) form of Opana? Either way, then need to start you on a low dose when switching meds to make sure you don't OD. I would not be scared of how low the dose sounds, but instead have an open dialogue with the doctor. I assume its the long acting form, where dosing twice a day is typical. At an appropriate dose, its a step up from taking a short acting med 6 times a day...you should get much better pain coverage this way without the ups & downs. If its the short acting, then I'm confused.

Each person responds to each med differently. I'd discuss any specific concerns you have with your doctor and give it a try. If you are concerned about committing to a full month, ask if you can get 2 weeks worth of meds and have a follow up visit then. I responded well to Opana but for me, I needed a lot more of it than other meds (equal converted doses), so it wasn't a good choice.

There are plenty of options. A couple problems you may have with this one specifically are that it is brand name only (higher cost and often difficult to find) and that it recently changed its formulation (quite a few folks have said it doesn't work as well). If cost is a concern for you, ask your doctor about trying a generic med first. As far as your schedule, this should be easier as you don't have to remember to take something 6 times a day and deal with pain spikes from the short acing med. Plus, you will have something to take when you do get pain spikes. Best wishes.
I was taking Opana before the formulation switch and it worked wonderful for me. Now that I'm taking the new formulation Im finding that its only working maybe half-65% as well as the old formula, I find its not lasting as long either. And one weird day, I found I guess it looked like a little round pill in my stool,Im guessing thats the opana which I didn't digest properly? Maybe thats why I feel its not working as long?

My Co-pay also increased with the new formulation which I found strange I'm paying close to $100 now. Im going to be asking my Dr if they would switch me to the generic version, Activis makes it and its 15mg, Im taking 20mg, so now sure how they would work that out.
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Old 06-11-2012, 10:36 PM   #4
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Re: Opana

Opana is oxymophone. I take it your Dr. did not discuss the conversion rates with you? Oxymorphone is much stronger than oxycodone. It is also a long acting medication which is taken twice a day or every 12 hours unlike oxycodone which is a short acting medication taken every 4 - 6 hours.

The conversion rate of Opana to oxycodone is .5 to 20. The 10 mgs of Opana a day the Dr. prescribed you should be plenty to cover your base pain, along with the 5 mgs for bt pain. You didn't say how many times he is allowing you to take your bt meds each day.

When starting a new LA med, especially when starting an LA med for the first time the rule of thumb is to start on the lower end and see how it does with your pain. You should give it a full 2 weeks, unless you just have awful side effects or adverse reactions, to see how it controls your pain. If after 2 weeks your pain is not down to a liveable level, then talk to your Dr. about increasing your dose.

Any time you begin a new medication it is prudent to do your research and learn as much about the medication as you can.

Kat

 
Old 06-12-2012, 10:15 AM   #5
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Re: Opana

Thanks so, so much, Kat! My pain doctor wants me to have a catheter put in as he says Opana ER is urine retentive. I have had a really difficult time urinating with several other opiods, Oxycodone being the least troublesome. He is starting me out on 5 mg twice a day with my using Oxycodone 0.5 for breakthrough pain. Presumably he will increase the dosage down the road. Joel

 
Old 06-12-2012, 10:41 AM   #6
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Unhappy Re: Opana

Quote:
Originally Posted by Oldbookman View Post
My pain management doctor wants me to switch to 2/day of 5 mg Opana only using Oxycodone 5 mg for breakthrough pain. I have been using 6/day oxycodone for months. I'm nervous about changing my routine. Can someone fill me in on Opana please.
I could not afford this med at over 380.00/mo....

 
Old 06-12-2012, 07:22 PM   #7
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Re: Opana

Quote:
Originally Posted by Oldbookman View Post
Thanks so, so much, Kat! My pain doctor wants me to have a catheter put in as he says Opana ER is urine retentive. I have had a really difficult time urinating with several other opiods, Oxycodone being the least troublesome. He is starting me out on 5 mg twice a day with my using Oxycodone 0.5 for breakthrough pain. Presumably he will increase the dosage down the road. Joel
Is his plan for the catheter just to get your bladder emptied and then see if it will start perking up on its own, or is this a longterm plan?

I can tell you from experience, having a catheter in is not the easiest way to go about life. I had one in for 3 months a couple years ago in between surgeries.....

There are meds that can help your bladder work the way its supposed to, has he tried these?

My bladder's been cut up so many times, I don't have much of one left, but it still works okay with the occasional med boost.

Kat

 
Old 06-12-2012, 08:44 PM   #8
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Re: Opana

I would definitely consult with a urologist about the urine retention with opiates. I too am curious whether this doctor thought it would go away (and the catheter was a stop gap or to use in case of an emergency), or if that was really a long term plan? Also check your pharmacy benefits to see if you can afford this med so you can advise your doctor on that. Often the copay for brand name meds is steep. There is nothing wrong with telling your doctor you cannot afford certain meds or brand name meds in general. My plan isn't so bad, but I definitely exhaust all generic options first due to a large cost difference for me. Best wishes.
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Old 06-13-2012, 10:22 AM   #9
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Re: Opana

I didn't see the OP post that he's having problems with the cost but I thought I'd post this anyway. When I was prescribed Opana ER, my PM doc gave me a Opana savings card and I only pay $20 for my script. It's worth asking about IMO.

 
Old 06-13-2012, 12:33 PM   #10
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Re: Opana

Although I can afford the $65/60 pills, I'm Definitely interested in saving money! I'm in an HMO & I've never heard anything about savings cards, scripts, etc. Any ideas welcomed.

 
Old 06-13-2012, 01:00 PM   #11
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Re: Opana

Quote:
Originally Posted by tortoisegirl View Post
Also check your pharmacy benefits to see if you can afford this med so you can advise your doctor on that. Often the copay for brand name meds is steep. There is nothing wrong with telling your doctor you cannot afford certain meds or brand name meds in general.
I just started on BuTrans and the cash price was like $230 / month. I have a pharmacy savings card, but that only brought it down to $160. My PM did give me a savings card specifically for BuTrans though, which reduced the price by half. My PM knows (and I always remind him) I need to go with the cheapest options available. Unfortunately, there isn't generic BuTrans, but I was also offered MS Contin which I do not know if there is a generic for either (after all Kadian and similar formulations aren't very old). Tortoisegirl makes a good point in asking the PM for generic options and also see if you can get reduced co-pays with a manufacturer and/or pharmacy discount. I am actually hoping to get Opana as my BT med while on BuTrans (MSIR and Norco are options for sure according to my PM, but I read Opana and Dilaudid have lower abuse potentia compared to MSIR).

I was on Norco about every 4 hours, but as Kat said, a LA med like Opana ER is almost always preferable to IR / short acting meds in treating chronic pain. This is the reason I opted for the week long activity of the buprenorphine patch even over twice daily dosing with MS Contin. With the constant continuous release of meds I don't have to worry about peaks and troughs in my pain relief and I don't live life with one eye on the clock. I wouldn't worry too much about the dosing - again as Kat said, the conversion ratio is fairly large between Opana and oxycodone and it is fairly standard to start at a low dose when switching to a LA med to avoid OD. I was started at 10 mcg/hour of transdermal buprenorphine, but only because I'm not opioid naive and have taken buprenorphine sublingually before; I plan to get the dose increased at my next appt. It is not unlikely your PM will titrate the dose up to where you need it.
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Old 06-13-2012, 07:17 PM   #12
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Re: Opana

Yes morphine ER/CR (MS Contin) is generic. Kadian, which is an even longer acting form of it, just went generic. Avinza, which is even longer acting than Kadian, is still brand. Opana and Exalgo (long acting Dilaudid) are the only other brand name only narcotics besides Avinza that come to mind.

The savings card that was mentioned is likely a limited time offer from the manufacturer to encourage patients to start it (similar like giving doctors samples to give to the patients), such as reducing the price of the brand name medication for a time such as 6 months. Something like that is great while you have it, but if the price won't be affordable after it, I'd rather not even start the med. A lot of patients get excited about samples, but I don't...as this means its a brand name med!

Recombinant-Unless you have a very low dose requirement for bt, Norco seems way below the others you are mentioning for bt. Plus, it has the Acetaminophen which I'd rather avoid. If you have used any of these before and found them helpful, I'd ask for it again. If not, I'd just ask your doctor what they thought would be the best fit. Seems odd for the doctor to ask the patient what they prefer unless they had tried all the options before (or have a preference due to cost or form of the med, such as liquid vs. pill). Best wishes.
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Old 06-13-2012, 11:51 PM   #13
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Re: Opana

Quote:
Originally Posted by tortoisegirl View Post
Seems odd for the doctor to ask the patient what they prefer unless they had tried all the options before (or have a preference due to cost or form of the med, such as liquid vs. pill). Best wishes.
Yeah I have tried some (but not all) of the meds mentioned. My minimum dose of Norco for BT relief is 2 - preferably 3 - 10/325 tabs. I have taken Norco so long I likewise don't like the APAP content and continued stress on my liver. He asked my preference for two reasons: the most economical meds, and the meds I was most comfortable taking with regard to dosing frequency and side effects (I prefer the least frequent dosing / the longest acting LA med). He asked about preference on BT meds to see what was effective enough to cut through the BT pain. For instance he asked if Tramadol helped - No, dose Norco help - Only in high doses - Dose MS help - yes, but limited experience using it. So he went up the list of meds I have taken starting with the weakest until I said one that was effective at low to moderate dosing.

My BuTrans savings card my PM gave me is exactly what Tortoise mentioned - a marketing ploy by Purdue to get people started on BuTrans, and the benefits expire in March 2013. Because of that I may eventually need to come off BuTrans and on to a PO LA med. On the printout my friend at the pharmacy gave me even generic Kadian was like $900. With a discount it was about $500. I can't figure out why that would be, but oh well. She did confirm it was just recently off patent and available generically. MS Contin was far cheaper though, like $100. Opana was quite expensive, due to the lack of a cheap generic form of both Opana IR and Opana ER. My MedScape account says the cheapest Oxymorphone IR formulations are: Oxymorphone IR 10 mg tab - Roxane/Qualitest - $6.69 per unit and Oxymorphone IR 5 mg tab - Roxane/Qualitest/Stat RX USA - $3.68 per unit. So that's what, $220 for #60 5 mg tabs, and over $400 for 10 mg tabs.
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Old 06-14-2012, 12:37 AM   #14
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Re: Opana

Scripts is just shorthand for prescriptions. Each pharmacy pretty much has their own discount plan that gives members a price break if they don't have insurance and have to pay cash. Since your in an HMO, it's not going to do anything for you really, your co-pays are set at a pretty low price already.

Kat

 
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