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    Old 11-13-2006, 12:33 PM   #1
    aprildawnrules
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    Question Kadian question

    Hi There!
    My PM doctor put me on Kadian 20mg and Roxicodone 15mg( break through pain) for fibromyalgia, endometriosis, and a recent rectal resection. I was wondering if anyone knew how much morphine is released each hour with the Kadian 20mg? I am still in a bunch of pain and I am wondering why this medication isn't working. I recently had a rectal resection due to endometriosis and was on 5mg of IV morphine whenever I pushed the morphine pump button. I wondered if that increased my tolerance to morphine?I know that 1mg of IV morphine is equaled to 3mg of oral morphine. I was also on the Duragesic patch a few years back and wondered if that increased my tolerance. I have an appointment to see my PM doctor on the 27th.I have waited a few weeks to see if the pain would get any better and it hasn't. What should I do and how much morphine does the Kadian 20mg release every hour? Any advice would be helpful. Thank You!

     
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    Old 11-14-2006, 04:20 AM   #2
    mpvt
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    Re: Kadian question

    20mgs is a very weak dose for a chronic pain patient.Just tell the doctor the truth when you see him.......Dave

     
    Old 11-14-2006, 05:45 AM   #3
    RobinD21283
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    Re: Kadian question

    Theoretically, Kadian is a 24 hour long lasting drug and should have an even release, so you can do the math. For me, Kadian didn't last all 24 hrs, so now I'm on 60mg 2x per day.

    There is a chart out there that converts Duragesic out to the equivelent amount of morphine which is how my doc figured out what to start me on when I switched from Duragesic to Kadian.

    robin

     
    Old 11-14-2006, 05:51 AM   #4
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    Re: Kadian question

    Dave is right, 20 mg of 12 hour or 24 hour morphine is a very low dose. LA meds are compared to their short acting counter parts. Kadian is a 12-24 hour med, even usin using 12 hours as a comparative, It would rougly be the same as taking 6 mgs of IR morphine every 4 hours 3X6=18, If we call it a 24 hour med, divide 20 mgs into 6 equal doses taken every 4 hours and you have about 3 mgs every 4 hours.

    The Roxicodone should certainly bring relief but BT meds shouldn't be your mainstay , what's the point of even taking a LA med when the BT med is 6 times more potent than what the LA med sustains. The prescribing info for all LA meds suggests usng 20-30% of the twice a day dose for BT pain. A 20% increase in serum level should provide enough additional relief to manage BT pain. He's setting you up to be dependent on the BT med for all your pain relief. I hope he gave you 6 doses a day, If you were taking 20 mgs of kadian twice a day the Break through dose should be no more than 5 mgs of oxycodone. You have one of those backward docs that doesn't understand the benefit of using LA meds that leaves you dependent on the BT med for any relief.

    Your BT dose is so disproportionate to your LA med, don't over due the Roxi or when you run out you will have the rest of the month to get by on fraction of what you are used to taking. You will get your first taste of true opiate withdrawal if you run out of oxy before you run out of Kadian.

    Ideally you should be able to skip BT meds and not experience withdrawal. But that won't happen when one dose of BT med is stronger than your entire 24 hour dose of LA med. Oxy is 50% stronger than morphine. Is this a PM doc or just any old doc that feels qualified to prescribe the most potent opiates available, for long term use because a factory rep spent 3 minutes explaining the new med ?

    Very scarry when docs that have so little understanding of pain meds start prescribing.
    Good luck, Dave C.

     
    Old 11-14-2006, 07:54 AM   #5
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    Re: Kadian question

    Thank you for all the help. My doctor is a PM doctor and he should know better then to prescribe me BT meds that are 50% more potent then the Kadian. I do take the Kadian twice a day and 20mg seemed like a very low dose to me too. He use to prescribe me the Duregesic patches( 20-100mg patches too) a few years ago too so he knows my tolerence. I have been good about not taking to many of my BT meds, they tend to make me have mood swings so I lay off of them unless I am terrible pain.Mainly when I use the bathroom due to a botched rectal resection in May. I will talk to him on the 27th and see what we can do to get all of this under control. In the mean time I am tolerating what I can, taking baths and avoiding any triggers to my pain ( except going to the restroom, I can't help that). I have a pain dairy so my PM doctor knows exactly what is going on. Thanks for your help!

     
    Old 04-19-2007, 10:08 AM   #6
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    Re: Kadian question

    Hi All, I am new here, and I have a ? about Kadian. I have been on Methadone for many years,I only have 2/3 of my stomach left because of surgery for ulcers and scar tissue. They removed a part of my bowels.
    The doc changed me from the methadone, which I took 30 mil a day, now to Kadian 50mg X 2 a day. I guess the word Morphine scares me, and I was just wondering if anyone has any advice. Or been thru the same thing. Thanks a bunch.

     
    Old 04-19-2007, 12:02 PM   #7
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    Re: Kadian question

    Hey Jackson, I bounced between Kadian "morphine" and methadone for about 4 years, most of the time was meth, But the monthss before I maxed my insurance benfit or lost all benefitss I was switching between 120mgs of methadone and 600 mgs of morphine per day. That's a 5:1 conversion. The unique thing about meth is how different everyone responds. Conversions can range from 3:1 to 10 :1 and the stranger thing is, the higher the dose of morphine the less methadone you need to replace.


    Because your on the lower side, it kind of makes sense your conversion rate would require more morphine than 3:1 or 10:1 but everyone is different and rarely do docs get the conversion correct on the first try. They usally start low. The preBescibing info on Kadian tells them to do the math, come up with the conversion dose and start at half. Most PM docs know that they are just going to get you in the ball park on the first try, sometimes your lucky if you hapen to make it in the parking lot of the ball park.

    I certainly wouldn't be more scared of morphine than meth. Morphine is just the gold standard to which other opiates are compared. Oxycodone is stronger than morphine by about 50%, Dialauaid is stronger by 300-700%, meth is stronber by 300-1000% Morphine was just the first opiate used IV Durung the civil So morphine is just the med used to compare the strength of all others. The drug closest in strength to morphine mg to mg is HYdrocodne, They just don't make a pure version of hydro so patients are limited to the amount of hydro they can take by the amount of tylenol in each pill Unless they have long acting hydro specialy compounded into a long acting version as some patients do.

    All you can do is give it a try, allow time for your body to adjust and report how things are going. Methadone is so unique that you may even experience some differential withdrawal even if the dose for pain is right on. Meth has properties that morphine doesn't, conversely meth has every poperty and then some that morphine has. So switching from morphine to meth is usally easier than switching from meth to morphine..

    The dose sounds reasonable and most docs should epect to make some type of adjustment to fine tuen things to provide equal or better relief. no doc gets it right on the first try.

    No worries, Dave

     
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