Med Adjustment Question

[Phlox]

I have been doing alot of reading in here since having my meds changed several times recently, and have been given some great advice by the wonderful regulars on this board! I am hoping you can all help point me in a direction once again

Im looking for suggestions on what to tell/ask my doctor about my current meds. I was recently changed over to 10mg Oxycontin, and its kind of funny---some of you may have read my other post where I was afraid of even taking it. Well, its funny because it is just not effective! First, I was getting more relief from the Vicodin and Vicoprofen I had been taking prior to the OxyContin. Second, it does not even come close to lasting 7 hours---let alone 12!! Also I am still experiencing the headaches from this medicine, and its been over a week since I started it. I have read the other threads about the TID that some of you recommended, but even tho my doctor is great and open minded, I get the impression that the 12hr guidelines are not something this office would go against. This is based on past experience with them, and I might even still bring the possibility up, but dont expect it really. These are the main reasons I hated the idea of changing from the meds I found that were working well for me. However, because of the Tylenol/APAP/Acetaminonphen in Vicoden, and the Ibuprofen in Vicoprofen, my doctor had no choice to change me to a medication that doesnt include either(long story short---ive encountered problems with both the apap & ibu).

So now Im left wondering.....what should I recommend/ask for? Here are three ideas I was thinking of mentioning to my doctor (other than the TID/stronger Oxycontin...but the stronger itself wont matter if it doesnt last beyond 7 hours, and Im not sure they will go beyond the BID), so what do you all think of this, and suggest?
1) Initially, my doctor mentioned a duragesic patch to me, but since I have problems with dry, itchy skin (worse in winter) I didnt like the sound of that being on me. I am not beyond trying it, however:
2) I am inclined to think that since the Hydrocodone meds were working---just the extra meds in with them were a prob---wouldnt straight Hydrocodone be a possible solution? The only problem I see with this, is from what Ive read its rarely prescribed and is hard to find a pharmacy with straight Hydrocodone.
3) I was reading positive posts about the relief some people got from straight Oxycodone, and also liked that it was similar to Hydrocodone from what I read, but was confused about something: Is the straight Oxycodone(no ibu/apap) like OxyIR a very short duration med, so it wouldnt provide relief the same amount of time as the "Vico" meds did (3-4 hours)? If not, or if there is another specific Oxycodone I could mention to my doctor that doesnt have the Tylenol or Ibuprofen in it--but would provide relief up to 4 hours, what is the name and its strengths?

Im grateful for everyones help so far, this board and community has really eased my visits with my doctor during a time when, the less stress the better! Its more of a discussion now with my doctor, and less of a Q&A. And of course Shoreline is---as called by many others in this area---the Master! :P Thanks for any input, all your suggestions are appreciated!!
- Phlox

[Streetcar]

Hi Phlox,

I know how aggravating meds changes can be, I hate when that happens. I don't rememger how much vico you were taking from your earlier post, but for some types of pain a small amount of APAP can be beneficial whereas with other tyoes of pain it has NO beneifit at all. One of the types where APAP has no benefir is pain caused by nerve damage so someone with nerve damage would get no benefit from the APAP.

If vicodin was working for you and your dr was concerned about the amount of APAP, you might want to try NORCO (10/325) every 6 hrs. insted of the vicodin (5/500).

Straight Oxycodone is a short acting version Oxycontin or more appropreatialy Oxycontin is a time release of oxycodone. The time duration of a single dose of oxycodone for me any way is 3-4 hours whereas I was only getting 1.5 - 2 hours od good relief from vicodin, but then again everyone is different and reacts differently.

If you are not getting good relief from the Oxycodone and the side effects continue, you should probably move to a different tpye of LA med. MScontin (long acting morphine sulfate might be something for you to discuss with your dr. It's available in 15Mg doses and can be taken TID. Purdue Pharma states in their full Rxing to take it every 12 hours but that it can be taken more frequently if pain relief doesn't last the full twelve hours ie. TID.

Sorry if I seem to be rambling or a little unclear, But my pain levels are shooting way up there right now.

Hope this helps you out a little and be comfortable!

[Shoreline]

Hey Phlox, A compounding pharmacy would be able to create a long acting version of Hydrocodone with a script from your doc and the mix instructions. They combine Dextromathorphan with Hydro to produce a longer lasting version. I've met folks using this at doses up to 100mgs of hydro/Xmgs of dex TID.

Your right, a stronger dose won't last longer but will give you much better relief. 10 mgs is compared by purdue to 1 percocet every 6 hours. That would be fine if Percocet actually lasted 6 hours.

This is from the full prescibing info Page 8 and 9 that can be found at Purdues site if you have adobe. It basically says that patients recieving 10mgs of Oxy BID recieved no more anelgesia than from a plecebo. Basically the serum level; never reached a point of anelgesia.

Pharmacodynamics
A single-dose, double-blind, placebo- and dose-controlled study was conducted using
OxyContin ® (10, 20, and 30 mg) in an analgesic pain model involving 182 patients with moderate to severe pain. Twenty and 30 mg of OxyContin were superior in reducing pain compared with placebo, and this difference was statistically significant. The onset of analgesic action with OxyContin occurred within 1 hour in most patients following oral administration.

CLINICAL TRIALS
A double-blind placebo-controlled, fixed-dose, parallel group, two-week study was conducted in 133 patients with chronic, moderate to severe pain, who were judged as having inadequate pain control with their current therapy. In this study, 20 mg OxyContin q12h but not 10 mg OxyContin q12h decreased pain compared with placebo, and this difference was
statistically significant.

You just have to go through the process of titration, the weakest version didn't work, le4t the doc know and continue titrating it. You may reach a point where you can creeate a 3rd dose or use your BT meds to bridge the gap. Not the intended purpose but it may work.
Good luck, Dave

[Phlox]

Thanks for the replies!!

Shoreline, as far as the 10mg being basically a placebo---I am going thru that right now, its like Ive started all over from scratch! I hate the idea, not to mention the obvious---the pain is back to the old "8" levels---and wish I could just go back to what I know worked. I think Im going to ask about plain Oxycondone or Hydrocodone when I hear back from them, since I know the SA meds were working for me, it was just the added medicine in them causing problems. I will mention the compound idea to my doctor, but why cant I seem to find much of just plain Hydrocodone, dont they make it by itself or something? All I hear of for plain (no APAP or Ibu) meds is the Oxycodone, but Im a little confused on exactly what its called.

Streetcar---the plain Oxycodone you were on, was/is that the OxyIR? Or was it just say Oxycodone 10mg or something? I just wanted to know so I can get it right when I mention this to my doctor, since actually reaching them can be a pain---it can take my doctors office several days to return a call sometimes (and I suffer in the meantime, so getting it right is important). If you say it had a better relief time(full 3-4 hours) than even the hydrocodone, I would much prefer to ask my doc about that, than to go thru this Oxycontin experiment period until they get it right, and/or take their time in contacting me.

Is OxyIR the only plain Oxycodone with no APAP, it seems from searching that it is. Percocet is not plain Oxycodone, theres Tylenol or Ibu in that, right? (I cant have either until after I see my GI specialist--which is kind of weird, since the OxyContin must be sitting in my stomache all that time anways, so isnt that as bad as Ibu?). Basically, Im not sure what to do at this point, what the heck the straight meds actual names are as opposed to those with something bad for your Liver and/or GI Tract in them, and am feeling a little bit inundated with this stuff. Should I ask for Oxycondone, OxyIR, plain Hydrocodone? Im getting even more confused at this point, so Ill stop for now, lol.

[Shoreline]

Hey PHlox, There is no manufactured pill or liquid that contains plain Hydrocodone, so you can't ask for a specific med, OTher than suggesting using a compounding pharmnacy to create pure Hydro capsules and extend the duration with dex.

As far as plain Oxy, OxyIR is Purdue's name brand capsule that disolves very fast and begins working a little quicker than a tablet. It comes in 5mg capsules.
If a generic substitute is checked you can get the mallinkcrodt 5mg capsules. Roxicodone tablets, "pure oxy" comes in 5mg, 15mg and 30mg strenghts, It's a brand name product now distributed by AAI pharma, There are 2 generic manufactures of this on the market in all strengths.

Amide pharma makes a 5,15 and 30 mg tablet, Mellenckrodt has their version of the same strength, 5,15 and 30mg tablets.

You also have Oxyfast, name brand liquid Oxy 20mgs per ML in 30ml bottles. 30 20 mg doses per bottle. Another brand name liquid By AAI pharma called Roxicodone intensinol available in 5mg per ml and 20 mg per ml. There are generic version of this called Oxydose and Mallinckrodt makes a geeneric in both strengths.

All you have to ask for is the generic version of OxyIR or Roxicodone in whatever strength you need. Or Oxyfast in generic form. I would give the OxyContin a chance though, you may get significant relief from a higher dose and simply need to address the gap or increase in pain waiting for the second BID dose.

Hope this helps, Dave