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  • Oxycodone Questions (No Longer Working, Liquid, etc.)

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    Old 02-20-2008, 09:16 AM   #1
    lizzybrog80
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    Oxycodone Questions (No Longer Working, Liquid, etc.)

    Hi,

    I took Percocet for a long time, then was put on LA drugs, but still given Percocet for BT pain. Then, as concerns over Tylenol consumption grew, I was given Roxicodone, which is OK, but I have required a LOT to get any relief (4-15mg tablets at a time). I am seeing my doc tomorrow, and want to address my concern that Oxycodone simply isn't working well for me. Is there another drug to try? Or do they all work so similarly that one is going to be the same as the other? Also, is there a ceiling to how much oxycodone one can take per dose or per day? Like, I'm now taking 45-60mg PER DOSE, and I feel like that's a ton. There is no Tylenol in it, so that concern is gone, so can it be titrated up more? Anyone on here take more than that? Just curious. Thanks!
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    Old 02-20-2008, 06:07 PM   #2
    gorgee
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    Re: Oxycodone Questions (No Longer Working, Liquid, etc.)

    Lizzybrog80, I just have a couple of questions. You mentioned that you were on long acting meds, maybe they need to be increased, or add an extra dose. Also, you said you are taking roxicodone, and is that what is not working for you anymore? I take oxycontin 40 mg every 12 hours, and I take vicoprofen 4 tabs for breakthrough pain as needed. I wish I could help you more about the oxycodone and if there is a max dose, but I am not sure. I am curious through, because I am worried that vicoprofen is not enough for my breakthrough pain. My doctor likes me taking the ibuprofen. If you do not mind, can you write me back about your medicine experience with LA and breakthrough meds? I am taking them for chronic pain in my jaw, and throughout my body. I would appreciate any help and information you can give me. Thank you so much. Kass

     
    Old 02-20-2008, 08:48 PM   #3
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    Re: Oxycodone Questions (No Longer Working, Liquid, etc.)

    Yes, you can take more. Oxycontin is the long acting form of oxycodone and though highly addictive it very effective for pain. For chronic pain and pain management or otherwise taking pain medicine long term. The fentanyl patch sold under the name duragesic is very effective. Fentanly has a short half life though it is infused continuously through the skin with the patch. Fentanly is often given to women during child birth because its effects last only an hour due to its short half life. It is a very clean pain medicine though because the dosages are 25mcg/hr., 50, and 75 some people may need to be switched to something with smaller increments when it is time to taper off the drugs to avoid more serious withdrawals.

     
    Old 02-21-2008, 06:49 PM   #4
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    Re: Oxycodone Questions (No Longer Working, Liquid, etc.)

    lizzybrog:
    The good thing about narcotic medications like oxycodone (oxycontin) is that there is no maximum. The thing is that insurance companies and doctors will dictate how much they will allow you to take. I think that I heard about someone on here that took as much as 400mg/day of oxycodone which is pretty high. If your dose of oxycodone gets to be too much it probably is time to switch to either a different BT med or increase your LA medication.

    Brian

     
    Old 02-23-2008, 12:43 PM   #5
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    Re: Oxycodone Questions (No Longer Working, Liquid, etc.)

    Lizzy, what LA meds are you on? And as fas as someone writing there is no minimum of oxycotin you can take, I have had friends die from oding on it. Just becareful. I think they wrote oxycotin, sorry if I am wrong.

    Last edited by HBMod07; 02-25-2008 at 05:34 PM. Reason: Please only quote the portion of text you are responding to

     
    Old 02-23-2008, 02:46 PM   #6
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    Re: Oxycodone Questions (No Longer Working, Liquid, etc.)

    Your LA med needs to be increased. It sounds like you are counting on the roxi to control your pain. It s/b the other way around.

    steve

     
    Old 02-24-2008, 02:22 PM   #7
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    Re: Oxycodone Questions (No Longer Working, Liquid, etc.)

    When treatment is started, and when a dose is raised, you need to count on BT meds a little more than at other times.

    I'm so glad for you that your dose got raised. If this still does't cut it I recommend adding a 12.5mcg patch to the 75mcg patch. Your patch dosing should work well enough so you only need to count on 3-4 BT doses daily (much lower doses than before).

    Best of Luck!

    steve

     
    Old 02-25-2008, 08:17 AM   #8
    lizzybrog80
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    Re: Oxycodone Questions (No Longer Working, Liquid, etc.)

    Hey there, Steve.

    Thanks for all your advice. I think the 75 eventually will work. I did a lot of walking this weekend, and think I caused a flare-up. I'm in a lot of pain, and actually stayed home from work today, for the first time in 3 years of pain!!! But Saturday night was pretty good & yesterday morning was good.

    The problem with my BT meds is that they just don't work!!! To make oxycodone work, I have to take 60-75mg at a time!!! I keep asking him if there is any other short-term med and he keeps brushing me off. Oh, well! Thanks again for your help.

    -Beth
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    Last edited by HBMod07; 02-25-2008 at 05:33 PM. Reason: Please only quote the portion of text you are responding to

     
    Old 02-25-2008, 11:09 AM   #9
    forginon
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    Re: Oxycodone Questions (No Longer Working, Liquid, etc.)

    I hope you'll allow me one more post on this? Don't get mad, OK? Here goes...

    It's because you need so much BT meds that your around-the-clock medication needs to be increased.

    It's just how PM works, because you don't want to have to count on your BT meds for pain control. Like other "full agonist narcotics," oxycodone has no ceiling. No dose is so high that it can't be used any more, unless side effects are intolerable. So, theoretically, you could get a boost in your dose of oxy, maybe even double it (I'm being kinda crazy here to make a point). But that would be an inordinately high dose and would constitute very poor pain management. Even if you practice "opioid rotation," and switch to another narcotic for BT, you'll still need a high dose according to conversion charts for 75mg of oxy. Too high for mainline PM theory. So the idea is to get your regular LA dose to the point where you only need 3-4 doses daily of BT meds, at a much lower dose than you now require. How much higher would your LA dose need to go? To whatever dose is necessary to control your pain to the point that you require much less BT meds.

    OK, I'll stop now. I promise. I don't want to become a pest, I just want your meds to work for you as well as possible.

    steve

     
    Old 02-25-2008, 03:23 PM   #10
    lizzybrog80
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    Re: Oxycodone Questions (No Longer Working, Liquid, etc.)

    Steve, I love your insight, so please don't be shy!!! Trust me, I want my meds to work, too! You said that the idea is to get me to where I only need 3-4 doses daily of BT meds, at a much lower dose than I now require. My question is: how would I get that dose down? Does it work like this: the higher the LA med, the less SA you need to get BT pain reduction? I wasn't sure of that. I thought maybe I was screwed with the Roxicodone - that I would always need as much as I now need to get relief. But it would be nice to get that down - really nice. I know my doc would love that. He is great, but he did note last time I was there that I'm on a "very high dose of narcotics." Anyway....thanks again, don't hesitate to comment again, and I look forward to corresponding with you in the future

    -Beth
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    Last edited by HBMod07; 02-25-2008 at 05:33 PM. Reason: Please only quote the portion of text you are responding to

     
    Old 02-25-2008, 03:47 PM   #11
    forginon
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    Re: Oxycodone Questions (No Longer Working, Liquid, etc.)

    You got it!

    Your LA med should keep you at the appropriate pain level nearly all of the time. It is preventative, and supposed to keep the pain under control. BT meds are reactive, or also called abortive, trying to bring down pain that has beaten your LA med. At that point your pain is uncontrolled and that is what the BT med is for. So long as your LA med is doing its job, you should be able to get better performance from BT meds, even at a lower dose.

    But I do recommend you switch to another BT med. You've become accustomed to the oxy. I know Conductor speaks highly of Dilaudid, which is a bit stronger than oxy. MSIR is also good (morphine).

    Hope this helps,

    steve

    Last edited by HBMod07; 02-25-2008 at 05:34 PM. Reason: please only quote the portion of the message you are responding to

     
    Old 02-27-2008, 05:49 PM   #12
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    Re: Oxycodone Questions (No Longer Working, Liquid, etc.)

    There are two separate issues here. The first is that if you are RELYING on your breakthru medication too often, then your long-acting medication probably needs to be increased.

    The second issue (and I think this is more what you are talking about Beth) is when the breakthru medication just doesn't work like it used to, or does not seem to have any effect at all. This could require either an opioid rotation (a switch to a different breakthru medication) and/or an increase in dosage (of the breakthru medication).

    As your long-acting medication is increased -- whether due to tolerance or an increase in pain -- it is only natural that your short-acting medication would be increased as well. Because the dosage of the short-acting medication has to be high enough to make a dent in the overall opioid levels. The suggested dose of the breakthru medication is 15-30 percent opioid equivalency. This means that one dose of short-acting medication should be about 15-30 percent of the daily long-acting medication.

    For example, let's say you are on 300 mg MS-Contin per day, and your breakthru med is oxycodone (Roxicodone 15 mg tablets). The suggested percentage of short-acting to long-acting is 15-30%. So at 300 mg morphine (long-acting), the recommended amount for short-acting morphine would be 45-90 mg per dose. We convert this to oxycodone equivalent and get 30-60 mg per dose.

    So, if one were taking 300 mg MS-Contin per day, an appropriate level of breakthru medication roxicodone would be 30-60 mg (2-4 Roxicodone 15 mg tablets). This is the amount it would take to increase opioid levels sufficiently to affect the breakthru pain levels.

    The 75 mcg Duragesic patch is equivalent to 220 mg morphine. A suggested amount for oxycodone (Roxicodone) used as a breakthru medication would be 22-45 mg per dose.

    Of course, these are just guidelines to be used as a frame of reference. When it was explained to me thusly, I found it very helpful. I was worried I was needing too much breakthru medication, but actually the amount I was taking was not enough to make a dent in my pain levels because it did not raise my opioid levels significantly. If your short-acting to long-acting ratio is less than 10% it is like a drop in the ocean -- not much of an effect.

    -Wren

     
    Old 02-27-2008, 06:18 PM   #13
    lizzybrog80
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    Re: Oxycodone Questions (No Longer Working, Liquid, etc.)

    Wren, that was beautifully put and made more sense than anything anyone else has ever said to me. It makes me wonder: (1) does the doc know this, and (2) if so, why the heck hasn't he shared it with me!!! Gotta love it Thanks a ton! -Beth
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    Last edited by M08; 02-27-2008 at 08:32 PM.

     
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