Hey Pika, a 15 mg increase spead over 8 hours shouldn't be so great that you won't acomadate to the side effects just as you acomadated to 300 mgs a day, you should acomadate to 345 a day.
AS far as an effective dose of BT meds the ratio can be calculated jnin 2 ways, but 1 10mg pers certainly wouldn't be enough
With OxyContin Purdue suggest 20-30% of the Bid dose, "twice a day dose"
With MSContin you could use 20-30 of the TID dose or divide the total daily dose by half and and use 20-30% of that.
If you use the first way and go by 20-30% of 115 you would need the equivelent of 0mgs of MSIR, 30mgs of roxicodone or 4 mgs or dilaudid. The reason it's a peercentage is because you not going to feel a BT dose that is only 3.5% of your daily dose, and that's where you are at with the 10 mg percs. 10 mg of oxy =15mgs of morphine and 15mgs of morphine is 3.5% of 345mgs. Nobody is going to feel a 3% increase.
Likely he would use the 20-30% of the TID dose which puts you around the above numbers. Oral dilaudid has a very short half life and is nowhere near as effective as IV dilaudid you may have had post surgically. Only have of oral morphine crosses the blood brain barrier making it weaker than drugs like oxy and meth and dilauddid that cross more efficiently.
I agree that oxy sis probably your best choice, You can get generic Roxicodone in 30mg strenght, he simply writes 30mg oxycodone tablests or rwrites Roxicodone 30mg and checks generic, He neds to open his PDR if he's not familiar with pure oxycodone. 30 mgs of oxy would be equal to 45 mgs of morphine and put you right at 30%.
Using oral morphine will simply nincrease thyour tolerance to morphine, bind to the exact same receptors and increase the side effects you haveing a hard time with now. Oxycodone is a pro drug and tends to be stimulating where morphine, "Morpheus , god of sleep" is very sedating and takes a while to become acommadated too. You do becaome acomadated to everythng but the constpation, urinary retention and restless leg with the more morphine you take.
3 norco at a time or 3 percs at a time means huge count scripts, why not use pure opiates like 30mg Morphine, It also comes in 15mg, but if your using 5 doses a day you daily dose is inadaquate and if you ever had a large flair you would have no means to manage theflair even with 150 10mg percs a month. Whicjh no ER is going to understand.
Your next choice is methadone60-80 mgs ofmeth and the same amount of roxi would be another chocice if you haven';t tried meth. Untill OxyMorphone LA is marketed "already has aproval" and Pallidine "LA Dlilauadid hits the market which already has aproval, meth is your only opton. It's better on nerve pain, It helps with tolerance, increases you threshold to ain by limiting NK-1 and substance P. Howvever not every PM doc is familiar with methadone or how to prescribe it. The first dauy you take 60 mgs you would be miserable, BUt by the end of the 5th day you would have the equivelent serum level due to the long ghalf life as if you were taking 117.5mgs a day. Which is a healthy dose. Most states have limits on meth maint dosing of 100 mgs per day. So 60-80 is a very potent dose coming from 350 mgs of morph plus another 50 of oxy.
If you don't want to switch everything and just need a better BT med and he's not famliar with Roxicodone or oxycodone in that strength. You can go to either the Amide pharma site and print out the prescribing info or go to the Mallinckrodt site and print out the full prescribing info from their.
At Mallincrodts product list page. Go here
http://pharmaceuticals.mallinckrodt.com/Products/ProductList.asp?BusinessUnitID=1
use the search feature and type in oxycodone, click enter
what you want is product 19018, 15 and 30 mg oxycodone tablets, generic for Roxicodone.
With your tolerance to side effects peaking you may have to switch to methadone to control tolerance and reset some of the neurotransmitters by meths ability to block the N*** receptor.
Alot of people struggle to find the right med but once they find it can go years on the same doses and by rotating your BT med you can continue to get relief from BT meds. Meth prevents most of the euphoric effects of other opiates but does not prevent the anelgesia of other opiates. They are 2 seperate things that come from 2 different receptors. one of which is blocked by meth preventing the buzz, but the receptor responsable for anelesia is not blocked. So the use fof BT meds is still effective for pain relief.
Good luck Dave.
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