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Question on meds


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Old 07-23-2004, 01:29 PM   #1
Kissa
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Question on meds

Got a quick question what is the difference between Oxycontin and MS Contin other than one is a hydrocodone and the other one is a morphine sulphate.
Do they offer the same type of relief or are similar medications? Is one deemed stronger than the next at a base level of dosage or would they be equivalent and just a preference of the prescribing doctor?

Thank you

 
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Old 07-23-2004, 06:18 PM   #2
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Re: Question on meds

Actually OxyContn is Oxycodone and MSContin is morphine. There are several distinct classes of opiates and opiods. Opioids are derived from the extract of opium, the opioids are Morphine, codeine and Heroin. They tend to carry more side effects like stomach upset and constipation.
The synthetic opiates , Hydrocodone, Oxycodone, Hydromorphone and Oxymorphone are derived from Thybaine synthesis, one of the extracts from the opium.

Since '79 all opiates are synthetic when they figured out how to synthesize the thybaine and other molucules that make opiates work. Morphine is just the standard to which all other opiates are compared and the first to be used intrevenously with the invention of the syringe.

The comparison charts are called equialgesic charts. They either give a mg to mg compartison or a ratio to do the math to convert a patient from one to the other with pretty good certainty the patient will not over dose. It's just ballpark, doesn't gaurentee relief or equal relief. The common conversion ratio for Oxy to morphine are 1:1 or 1:5:1, meaning oxy is either as strong or 50% stronger.

But what your getting at is even better, Is there a specific opiate or opiod that will work better on certaion pain. There is a lot of info that suggests that the synthetic class of drugs that include Methadone, Darveon+Darvecet with apap, and Levorphanol
work better on neuropathic pain due their it's NMDA receptor blocking ability. Block this receptor and people also seem to slow their tolerance down and their pain threshhold increases. Other drugs, including non opiate that bind to the NMDA have shown to cause Hyperalgesia :increased pain" or sensetivity and rapid tolerance.

There have reports that the synthetics, particularly Oxycodone working better on visceral pain. Pain is catagorized as Neuropathic, Visceral, Somatic,and Mechanical. You can have a combination of pain and allthough there are other keto synthetic opiates like Oxycodone. Hydrocodone, Hydromorphone and oxymorphone are in the same class of opiates, there are sub classes of opiate receptors, It's not just the MU, kappa and Delta, each one of those have 3-5 subclasses of receptors. I do think, there is the beginning of proof that shows different opiates work on different types of pain.

For example, Using the standard conversion from Oxy to morphine of 1.5:1
20 mgs of Oxy would be equal to 30 mgs of morphine.

When I had the pump implanted, the 30-60 mgs of morphine I use for BT pain for my back, didn't touch the visceral pain of the incision and the pump moving around while it created enough scar tissue to hold it in place. I took 60 mgs of morphine and it didn't touch the visceral pain, But 20 mgs of oxycodone worked quite well. Oxycodone has some Delta receptor activity that morphne does not.

The morphine works well on my back, I don't have neuropathic pain, but do have mechanical pain from the screws shifting, when they shift it sends a jolt through my body that nothing really prevents me from feeling it. I would have to be numb, but a lesser dose oxy worked better on the surgical pain for me, and surgical is a different class of pain than what I'm used to.

The constant back pain would be classified as Somatic and the mechanical pain is from the hardware shifting and the failed fusion that causes movement when there shouldn't be.

So there are no gaurentees, even with charts and with ratios to make conversions. Those charts are to get a doc in the right ball park without ODing the patient. It doesn't gaurentee you will get better relief because a chart says your dose of opiates is now 25 or 50% higher because your getting the same number of mgs of a stronger drug. Morphine is just the gold standard to which others are compared.

Some drugs are much more potent some are equal mg to mg and some are much weaker. Like codeine is much much weaker, doesn't usually even make it on the same chart as the stronger meds.
Hydrocdone is considere 1:1 OR .8:1.

Hydromorphone "Dilaudid" is 7.5 to 8 times stronger 7.5:1 or 8:1 meaning one mg of dilaudid is roughly equal to 8 mgs of morphine. or 20 mgs of oxy is equal to 30 mgs of morphine. The charts and conversion ratios are just to make it safe to switch from one drug to another.

If someone was alergic to the opioid class, morphine codeine and heroin, then they will probably do OK with the synthetic classes like Hydrocodone, Hydromorphone, Oxycodone and if they are alergic to that class you go to a 3rd which has methadone, Levorpahnol, and darvon, IF you have an alergy your not out of luck, You have another class of synthetics, the fentanyls, Fentanyl,suffentanyl, affentanyl, carfenntanyl and demerol is in that same class.

I think in the future, they will be able to target specific type pain with the right opiate. They will probably call them something catchy like smart drugs, when it really just took this long for a human to figure out what opiate or opioid works best on what type of pain.
Sorry to be long winded, Take care, Dave

Last edited by Shoreline; 07-23-2004 at 06:30 PM.

 
Old 07-23-2004, 08:08 PM   #3
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Re: Question on meds

Thanks that as pretty informative and helpful as always.

It is interesting to see that certain meds do work differently on different types of pain. I do know for example when I have a severe headache or migraine that Vicodin does nothing for it at all however if I take Darvocet which is considerably weaker it actually does help if my standard migraine meds fail.

They started me on the MS Contin today for a two week period just to be sure it is strong enough or that I don't have any side effects. It did seem to take about an hour to kick in, used to the vicodin in about 30 mins and made me rather tired. Generally because my body processes medications different than most folks meds like the hydrocodones usually make me hyper if you will and cause inability to sleep. The MSC seems to do the opposite so we'll see over the next few days how it goes and if I adjust to being tired.
I can say overall I've gotten much longer period of relief than I have in many years which is a good thing.

Thanks Dave appreciate all you do for us

- Barbie

 
Old 07-24-2004, 04:23 AM   #4
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Re: Question on meds

I was on ms cotin when i first started pain management.They made me tired a lot,and the morphine didn't agree with me.Then i tried the patch[fentnol,something like that] and i had some kind of reaction to that,so then i went to oxycotin,wich at first,i had trouble sleeping.I use to say to my self,how the heck is oxycotin keeping me awake! My god,its a narcotic painkiller,i thought it would make me drowsy! Today i prefere the oxycotin becuase it doesn't make me drowsy[ironic hah]and i guess my system adjusted,so i do sleep.

 
Old 07-24-2004, 08:31 AM   #5
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Re: Question on meds

I had a bad time trying to sleep last night, barely got 4 hours sleep and I'm pretty sure it's from the new meds, par for the course with me. Hoping I adjust over the next few days as no sleep or little sleep doesn't help much. The pain has diminshed quite a bit however.

 
Old 07-24-2004, 11:09 AM   #6
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Re: Question on meds

Hey Kissa, Although Morphine and Hydrocodone are in different classes, Hydro, oxycodone and Hydromorphone, the synthetics are considered pro drugs and have more of an uplifting effect, this is caused by the histamine response opiates cause. Hyistamine release is also what causes itching.

Although Morphine generaly does cause more drowsiness, that side effect does go away after a few days or weeks. Morphine also causes a histamine release that can prevent sleep and morphine breaks down into two metabolites, the M3g and the M6g, The M6g is responsable for most of the anelgesic effect but can also cause restless leg or jerking and twitching as you try to fall asleep.

There is an answer for the morphine twitch, The anti-parkinsons meds can be used, , I believe it was Niacin that I tried when on morphine and eventually after trying Miripex and Requip "parkinsons meds" we settleed on Klonopin which works well for restless leg and the twitching some opiates can cause.

Some meds are better for headaches too, and some not so good. Morphine increases inner cranial pressure and can cause headaches as a side effect which is not a good thing if your problem is headaches.

The Darvecet, that worked well is in the same class as meth only 100 times weaker than meth mg to mg. But it has some NMDA blocking ability which could explain why it worked better.

There are several drugs in clinical trials where they have added a drug like dextromathorphan which is a strong NMDA blocker and they have mixed it with morphine , called Morphidex to add the NMDA blocking ability to Morphine that it doesn't have on it's own.

Often patients are instructed to take dextromathorphan, yup the cough medicine, to increase the effectiveness of opiates and give them NMDA blocking ability.

But I have no doubt specifc classes of drugs do work better on specific types of pain. You also have the human factor where everyone responds differently, But with the morphine your testing, every bit of literature I have read about morphine speaks of the initial drowsiness and suggest the patient tries to ride it out untill it passes. It's a shame when a drug isn't given a fair chance through proper titration or waiting for side effects to pass.

Some folks overcome adverse side effects more quickly than others so 2 weeks is a fair amount of time to see if you tolerate it, It doesn't mean this present dose is going to be your final dose. It may need adjusting to really ease your pain.

The charts are helpful but Just because you got relief at an equal amount acording to the chart of another drug doesn't gaurentee the same level of relief. You may need considerably more morphine although Hydro and morphine are reletively equal in strength. No docs gets the right dose out of a book or off the top of his head. They usually start low, especaially if it's a drug you have never taken and then work their way up untill you find suitable relief or side effects that won't demnish.

On the other hand, some docs routinely swap meds to allow the metabolites to clear and you can hop back and forth from one med to the other every 6 months and attempt to control tolerance using a different drug. Using one med for your base, a long acting and a different med for break through pain means more receptors will be covered and in this case 1+1 may equal 3 by mixing or combining opiates. Using the same BT med as your base med, IMO just increases your tolerance to that specific med used all the time. Where rotating BT meds may allow you to stabalize longer on a base LA med.

I hope the morphine works, Give it a chance for the drowsiness to wear off and your sleep paterns to return to normal. There are meds that can be used to help, but honestly, the fewer meds the better.

Rather than not increasing an opiate and throwing adjunct meds like Clonidine, Neurontin or the anti seizures, Zanaflex and anti-depressants, I would prefer to take the right amount of opiates and forget about the meds that really don't work, and have additional side effects to deal with. It also greatly adds to the monthly expense.

I will and have tried all the adjunct meds but if they have no impact I won't continue to take them simply because the doc won't bend on an increase and thinks the shotgun aproach, blast you with all kinds of meds rather than enough opiate to manage your pain is something he or she feels more comy with.

My first doc had the shotgun aproach and had me on som many meds , not enough opiates to the pont I was still taking 2400 mgs of Ibuphrofin a day and 400o mgs of APAP a day. Along with antiseizure, antidepressants, sleeping meds, and two types of muscle relaxers, Soma and Zanaflex. All those other drugs would wack me hardeer than any opiate she prescribed but she was more than willing to increase anything but the opiate.

I had to switch docs because my first doc stopped taking my insurance. The first thing my new doc did was increase the opiates which allowed me to stop taking Remeron,. Neurontin, Zanaflex, Ambien ,Tylenol and Ibuphrofin.

It's just a matter of phylosophy of the doc. Use all the adjunct meds to keep the opiate dose down or do away with the adjunct meds that don't helkp and simply increase the opiates.

I feelt much better without all the other mess in my system and my new group of docs had no problem increassing my dose to one that was effective without all the other junk that was supposed to help.

If the sleeping at night thing continues, there is nothing wrong with treating that side effect if the pain med works well. If the med doesn't work well, then they can add everything under the sun and it may not make a difference. There are also docs that won't treat the side effects, they will switch you if you complain of nausea, which is common and easily controlled with meds. Due to an easily controllable side effect docs will switch meds before giving them a fair shot, and that's a huge shame. I see it more with the 24 hour meds like Kadian and Avinza, I jus don't think they have a true understanding of the24 hor meds. A 20 mg Avinza does not sustain 20 mgs in your system as if you have taken 0 mgs every 4 hours. A 20 mg Avinza only contains 20 mgs of morphine and that gets spread so thinover 24 hours I don't know why they make such a low strength other than for children..
I have seen folks that didn't get relief from 20mgs so the doc switches them to a different med rather than doing a proper titration.

MSContin releases half it's contents at about the 1.2 hour mark and then the other half around the 6 hour mark VS hydrocodone that starts releasing at about 40 minutes and has reached peak effect by 1.5 hours. LA drugs have a slower onset and slower peak than imediate release meds like Hydro products or any short acting med that has a faster onset and faster elimination.

LA meds have designed release systems to release X amount at specific times. to maintain a longer and more constant serum level. The idea is that it's easier to keep pain in check than to bring a high level down. A short acting med taken every 6 hours would allow you pain to wind up so high by the 6th hour , you would need twice as much to bring it back down. So maintaining a constant level helps prevent pain from spirraling out of control

Sometimes it takes changing docs or seeing several PM docs throver the course of tim to find what works best. In 11 years I've seen a dozen PM docs and only the last 2 would even consider using opiates to treat pain.

If you don't mind, How much Hydro were you taking daily and what dose of MSContin are you on, mgs and frequency. MSContin really needs to be dosed every 8 hours. Purdue actually allows it in their full prescribing info, where they are rock solid on twice a day dosing with OxyContin.

Good luck and drowsiness and sleeplessness are pretty common at the beginning until you become acommadated to the new drug. Morphne is also more constipating so you should be taking some type of maint med to keep things soft and moving. Even if it's only every other day. The softeners work better because you can become dependent on the stimulants to keep things moving. But constipation is definitely treatable and manageable in most cases. Good luck, Dave

Last edited by Shoreline; 07-24-2004 at 11:15 AM.

 
Old 07-24-2004, 05:49 PM   #7
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Re: Question on meds

Having bad problems with headaches today, possibly could be either my allergies as I've missed a dose of my allergy meds the last few days or could be the meds. Not quite a migraine category just irritating.

I was on vicodin regular strength 6 - 8 times a day. Averaged honestly like 5 - 6 the last month and more like 4-5 the first 4 months. He has me on 30 mg twice daily to start to see if I can tolerate the medication then a recheck in 2 weeks to up if needed. He's actually pretty good about titrating and not one to throw many meds at a person. I believe less is better as well. I do take a med to sleep and hopefully this will pass soon. I seem to be more tired with the first dose than the second. It is actually helping far more than I expected initially, and of course I don't get 12 hours relief but the last few hours the pain is a shade more tolerable than when on the short acting meds.

I have taken morphine before during/after various operations, I tolerate it better than the new med that's out, I wish I could remember what it was, deemed non narcotic and something they used on me during my ACDF that was put in my pump at the hospital. It's not ultramm though and it kept me up 24 hours straight even with 10 mg of valium every 4 hours to try to knock me out. I was miss jabber jaws and I think the nurses wanted to hit me over the head with a hammer.
I know it's partly due to how my body processes things and that this is normal. I get the same effect from ultramm and sinus pill. I get an initial tiredness then wide awake for days.
With the MSC it is more of I'm still tired but can't sleep much where as with the others it's like drinking a gallon of coffee and I gotta get up and go play on the pc or something.

I too hope this soon passes and will give it some time to adjust. I think that if after a month at the most if the tiredness still remains then some modifications should be made. I was on a previous med for depression/anxiety that actually the side effects decreased after the med was increased, who knows if MSC is the same. I just don't want to be playing the medication switch again, I am sure you can appreciate that feeling.

Right now I feel like I do after I've had surgery or a proceedure, laying in bed all day doing puzzles or napping, which isn't bad because then at least I'm not up running around doing stupid things like re-arranging furniture and hurting myself (I've done that with the hydrocodone class). Hubby is very understanding about it and has been taking over alot of the house responsibility with our son which helps alot. I'm treating the headache with some tylenol at the moment, afriad to take a sinus pill right now because if I do I'd be knocked out again for a few hours then up for a very long time so I'm trying to limit the things that I know give me big side effects. I hope that's the proper thing to do given my situation with medications overal

Thanks Shore for your advice I appreciate it!

Hugs
Barbie

 
Old 07-25-2004, 07:28 AM   #8
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Re: Question on meds

When I started MS CONTIN and whenever I had an increase in dosage, I would initially be very sleepy. This passed rather quickly. Right now I am taking 60mg of MS CONTIN every 8 hours with 30mg of MSIR as BT. I agree with Shoreline that 8 hour dosing of MS CONTIN is a much better way to control pain as it does help greatly.

Give yourself a few days to see if the tiredness does start to get better.

Alan

 
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