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Old 11-10-2004, 12:19 PM   #1
vamp36
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Join Date: Jul 2004
Location: Wisconsin
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Want to decrease BT meds

I am currently taking 2 mg Dilaudid for BT pain. I personally do not think I need this strong of a BT med anymore as my liver is feeling better and the pain is not as intense anymore. I want to request a less strong BT med. What are some good choices for this? Thanks, TIna
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Old 11-10-2004, 12:48 PM   #2
Shoreline
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Re: Want to decrease BT meds

Hi Vamp, 2mg of dilaudid is roughly equal to 15mgs of morphine or 10 mgs of oxycodone. Morphine is just the glod standard to which other meds are compared in strength. The smallest morphine pils I have seen are the 15's so that would pretty much be the same. Oxycodone 5mg would be about half the strenght, but last a little longer. You way want to start with 7.5mgs of Oxy as not to cut your dose in half which could cause withdrawal depending on howe long you have been taking it.

Oxycodone without Tylenol is available in several forms, I imagine you don't want Tylenol if you dmaged your liver?
Oxycodone without apap, comesin OxYir 5 mgs capsules and there are generic version of the same 5mg capsule and it comes in pill form, the doc just writes OxyCodone 5mg and the quantity. The tablets are scored and pill splitters are cheap and work well. You could work down from 7.5 or 1&1/2 pills to 1/2 a pill if you making a full recovery.

The Hydrocodone products are weaker than oxycodone by by 20-50% depending on what chart you read. But they all have tylenol, some have as little as 325 mgs, but depending on your liver.... You could also get pure hydrocodone capsules compounded by a compounding pharmacy in any strength you want. I wouldn't exceeed 15mg per dose or your still pretty much at the same strength as 2mg Dilaudid, but 10mg of hydro would be step down.

The idea is to make small decreases if you may have become physically dependnet so you don't experience withdrawal. Now if you are on a high dose of a long acting med and this is just BT med, You could totally elimiante all BT meds and not experience a thing if your BT was propertionally small enough compared to your base dose of LA meds.

If your BT use was less than 10% of your total daily use than you could probably stop all BT meds and not feel it at all. I skip taking BT meds for days at a time and haven't had a problem but my base dose is a little higher than the average bear. I also have a pump that delivers a bolus dose in the evening, so wear the bulk of my BT meds were being used, I now simply get a higher flow rate from 7pm-1am and haven't needed the BT meds nearly as often.

Folks that have incorportated their BT meds into their daily med use each and every day at the same dose, may have a harder time switching or stopping BT meds. They really aren't BT meds at that point anyway, just part of the routine. Although a bottle may say take 1 or 2 pills, 2 or 3 times a day, as needed for rescue pain or break though pain, It doesn't mean you have too take that much every day.

The doc is just giving you the means to deal with BT or incidental pain if you have it. Some docs won't prescribe BT meds for that very reason, They think everone will take the prescribed X a day whether they need it or not. Then you still have the trips to the ER and the calls in between vists with every increase in pain. The idea of BT meds is to give you the means to handle an increase in pain so you don't have to go to the ER, get treated poorly, and then have to report to the PM doc you were in the ER again.

Oxycodone should do fine, but you need to check for drug interactions if you have liver problems or are taking other meds.

Hoped this helps, Dave
PS. That's just my usual BT med reminder, LOL not directed at anyone in particular. My first doc to prescibe LA opiates didn't use BT meds and that was her reason and I see BT meds just become part of the daily schedule happen alot. Whether it's misunderstanding, or the base is too low. IF you use them everyday, they won't be effective when you need them.

Last edited by Shoreline; 11-10-2004 at 12:53 PM.
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Old 11-10-2004, 01:00 PM   #3
vamp36
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Re: Want to decrease BT meds

Thank you Shoreline. IT has helped. I do get that extra pain sometimes but I just don't think I need something as strong as DIlaudid anymore. Thats why I want something less. And it's not every day anymore. I haven't needed any for 4 days, Then I needed one this morning. I want to take less of the pain meds if I can. Thanks for you help, Tina
and thanks for remembering my liver issue. That info helped. I will be seeing my doctor next week.
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