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    Old 07-29-2008, 02:04 PM   #1
    IZZY'SMOM
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    How Many Times Can Oxycontin 20 Mg. Be Prescribed?

    Hi everyone.,..Im on oxy 20 mg. twice daily...can it be prescribed 4 times daily? is anyone on any level of oxycontin 4 times a day?? Thanks in advance~
    xoxoxoxo,
    IZZYSMOM

     
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    Old 07-29-2008, 02:11 PM   #2
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    Re: How Many Times Can Oxycontin 20 Mg. Be Prescribed?

    Izzy,

    I think I read of one poster here who was taking it four times per day. I'm sorry but I just can't recall who it was.

    As we all know twice per day doesn't cut it for most users, so three times per day seems to be the average number of doses per day.

    I can easily see where four times a day could be needed.

    Have you tried three times per day yet?

    steve

     
    Old 07-29-2008, 02:15 PM   #3
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    Re: How Many Times Can Oxycontin 20 Mg. Be Prescribed?

    Hi Steve...
    No I havent, and IM going to speak to my doc tonite. This just isnt cutting it. My BP hasnt been below 165/113 for over two weeks. Im calling him tonite to tell him that I know he is doing what he can to help me, but I need a change. He told me on the 10th, just to try this for a month or so and let him know. Do you think its wrong to intervene? Im really worried..
    xoxoxoxo,
    IZZY'SMOM

     
    Old 07-29-2008, 02:41 PM   #4
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    Re: How Many Times Can Oxycontin 20 Mg. Be Prescribed?

    Hey Izzy,

    When I was on Oxy, I did take it 3 times/day, but only after being on a twice a day dosing for a couple of years. It just doesn't last 12 hours....ever! I think you should definitely inform your doc of your b/p. You don't won't to blow a gasket!!

    I really do think you need to get in with a good PM doc, Izzy. I just have "this feeling" that your doc is going to drop you at any moment, for whatever reason, or if he even has a reason. Why do you want to go to 4 times a day dosing? Why not try 3/day? I've never heard of anybody being on a 4/day dosing regimen before, although I guess it's possible depending upon the doc's comfort level and the patient. From my experience, if after a while on 3/day dosing isn't cutting the pain, then it's time to try a different med, or increase the 20mg up to 40mg 2/day to start out with, then go to 3/day dosing, if needed. Is Purdue making the 30mg Oxycontin yet? If so, maybe going from 20mg to 30mg would be better than doubling your dose. If there is no 30mg yet (I know the 30mg is in the process of hitting the market soon, if it hasn't already) then you could always get an RX for the 10mg Oxy and take 3 of them at a time to make the 30mg dose. I'm just trying to come up with some options.

    My PCP, whom I loved dearly (he retired from his practice) would NEVER prescribe C11 meds. He did prescribe me some Lortab 10's for a couple of months before I could get in to see my PM doc. He did this only because he knew I had an appointment with the PM doc (the one I'm still with now for almost 8 years) and didn't want to see me in pain.

    He said the Lortab 10's was all he would prescribe. He's usual rule of thumb is only to prescribe any type of controlled substance for a total of 3 times. He helped me out for those few months and went against his own prescribing practice to hold me over until I could get in with my new (back then) PM doc. I would have NEVER asked for anything other than the Lortab, for I knew his comfort level with pain meds and I didn't want to alienate him or hurt our doc/patient relationship. He truly cared about me. The day he left the practice, October 2007, he was in tears at our last appointment. He said he constantly worries about me and how I'm feeling. God, I wish he was still practicing!! He was such a wonderful, compassionate doctor.

    Anyway, Izzy, I don't want to see you get dropped from your doc. I can tell how much you care about him and he cares about you. I believe you need to take his warning to you to heart and try to back off. Izzy, we all care about you here and just want the best for you and your pain care. That's why we all think you need a good PM doc, ok??? Please think it over. Bye for now.

    Shay

    Last edited by friendly_one; 07-30-2008 at 10:20 AM. Reason: add info

     
    Old 07-29-2008, 03:52 PM   #5
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    Re: How Many Times Can Oxycontin 20 Mg. Be Prescribed?

    I was taking

    4:00 10 mg
    10:00 10 mg
    4:00 10 mg
    10:00 10 mg.

    Was moved to

    4:00 20 mg
    10:00 10 mg
    4:00 20 mg
    10:00 10 mg.

    So yes it is possible to be moved up; however, keep in mind some docs because of insurance reasons will write take 40 mg. 2x daily. I suspect if you are taking 20 mg. He may move it up to 3x a day. For me the 4x dosing schedule works much better.

    Last edited by ms_west; 07-29-2008 at 03:54 PM.

     
    Old 07-29-2008, 04:41 PM   #6
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    Re: How Many Times Can Oxycontin 20 Mg. Be Prescribed?

    Thanks for the responses. I talked to my doc and he is keeping me at 20 twice daily. Im really upset. He had started me at 20 oxy twice a day and 20 oxydodone four times a day for BT.
    Then since the oxy 20 couldnt be made compounded because you cannot have ANY strength compounded because of copyright issues, he moved me to 10 oxycodone compound which is HALF the strength he started me out as.
    How do I point out this mistake to him? Tonite he was *itchy...Im really tired of dealing with a doc who doesnt uinderstand that THAT 10mg he originally prescribed for me probably was the right dose. So now Ill suffer again for the next month. Does this make sense? I hope so to you all. when I asked about more strength of the oxy, he stated that he wasnt aware of the 30, and also he has only one other patient on the 40 twice a day and it is a fusion patient who is WAY worse off than me. What I got from that was..."dont ask for anything higher."
    Opinions and comments more than welcome...
    xoxooxoxo,
    IZZY'SMOM

     
    Old 07-29-2008, 06:16 PM   #7
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    Re: How Many Times Can Oxycontin 20 Mg. Be Prescribed?

    Izzy don't get upset with me but I think you asked for a big jump and it might have made him nervous. I know you have an excellent relationship with your doc and it is very obvious from your past posts. For that, I am sure you are very thankful.

    I will pray that he does some research and next month he will adjust accordingly. Also, I pray that you find some relief with this increase.

    I have been the ringer trying to get an increase and finally succeeded today and feel blessed. I know how frustrating and painful it is. Please know that I am here for you. I DO CARE.

     
    Old 07-29-2008, 06:36 PM   #8
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    Re: How Many Times Can Oxycontin 20 Mg. Be Prescribed?

    I hate to say this Izz, and you're gonna hate to read it, but I think you need to go see the man again. You can't suffer for the next month. Then what? Will he simply renew the script or will you see him then? I'd get in the car and get it over with and then hopefully, you'll be back on the road to feeling good again.

    I know you and your Doc have an excellent relationship and I've advised you in the past to stay with him. I still stand by this assertion....For now. However, if after you go see him, and things don't change much, it may be time to start looking for a PM Doc. 40mg of OC isn't that much for a LT CPer, and this is where I think GPs just don't see enough PM cases to really understand how high some must go to get adequate relief.

    Rx protocol, however, calls for increasing the amt before moving to more than 3x day. Thus, before going to 20mg 4x, one should go to 30mg 3x first. If that doesn't work, then you could try 20mg 4x.

    Hope this helps, and good luck.

    Ex

     
    Old 07-29-2008, 07:13 PM   #9
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    Re: How Many Times Can Oxycontin 20 Mg. Be Prescribed?

    sorry, but Ill post tomorrow when Im in a better place. I hope you'll all understand.
    I just decided to delete the first post because I didnt feel like I was explaining everything, and id rather have everything correct.
    Thank you to all who always follow my posts, and are here for me. Ill try again tomorrow. My father had a heart attack this morning, and Im just not myself.
    xoxooxox,
    IZZY'SMOM

    Last edited by IZZY'SMOM; 07-29-2008 at 07:33 PM.

     
    Old 07-29-2008, 11:35 PM   #10
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    Re: How Many Times Can Oxycontin 20 Mg. Be Prescribed?

    Hey Izzy, Sorry your not feeling well, But I think you likely already know that this doc has a very defined comfort zone. It may only be with oxyContin because of the repuation, but Do you really want to be a GP's guinea pig if he's presscribing doses or meds he hasn't before and obviously insn't comfortable with. A lot of docs simply use PM docs as a way to shuffle CP patients out of their practice and if you do have a good relationship with your GP, than use that to find a PM doc that's comfortable treating your pain and capable of offering more than a script.

    Personally I don't believe in burning bridges and you can either push a good GP to the point where he doesn't even want to be your GP or you say you understand your pain condition may require someone that specializes in that field and can offer more as far as different modalities and the latest research and trends in PM.

    I've seen and experienced amazing things from adding adjunct meds and additional treatment options. At one point my wife was using 100 mgs of MSC 3 times a day. She was still miserable and this was at the hight of finding she has chiari 1 after an MVA that whiplash induced seizures in addition to all her other problems. Insteasd of increasing her dose or prescribing it more frequently, her PM doc added Nemanda, then started using Botox and Occipital blocks. Now she takes 30 mgs 3 times a day and does the injections every 3 months and contues the nemada. She's been at the same dose of every med for the last 3 years. She was offered something else and gave it a shot just like we both have with every modality that's ever been offered .

    People do improve with the right treatment and people get worse when given the wrong treatment, sometimes more or more frequent opiates aren't the right treatment. Just beause we have access to medical info doesn't mean what we read means anything more to your doc than what a total stranger without a medical education suggests is protocol.

    If we need to tell a doc what he needs to do, that should be a giant warning sign you are at the wrong doc. QID dosing would leave even the most respected PM doc in troubkle should something negative happen to his patient. He has nothing to fall back on as far as justifying his actions. Particularly when all a prosocutor has to do is read the prescribing info from the manufacturer that has kept this drug in court for the last decade based on it's claim of 12 hour duration. I'm sure Purdue could turn over thousands of copies of those letters that were sent to pharmies and docs instructing them not to prescribe this drug other than twicea day. You may get by on 3 times a day, but when you are completely disregarding the manufacturer, that is negligence. I doubt the better PM docs wouldn't have a problem testifying to that. There are alternatives to QID dosing if you can't find relief with TID.

    It was only 6 years ago when Purdue was writing to every Pharmacy chain telling them to refuse scripts for oxyC if written for anything greater than twice a day. They also wrote every large PM group and told them absolutely do not prescribe oxyC more than twice a day. Purdues' PAP programs won't supply more than twice a day dosing to a terminal cancer patient.

    I've never believed a GP is any more qualified to practice PM than he is to practice psychiatry. Aside from the years of extra training there are the years of experience were patients are closely monitored, GPs don't have that kind of time to spend on med checks.

    His discomfort and experience level with PM doesn't make him a bad doctor, but if you push and push regarding the opiates your liable to become the bad patient that he simply gets tired of dealing with. I would hate to see trying to change his opinion interfere with finding better PM because someone told you something rediclous is actually protocol. Sure their are a few people taking OxyC 4 times a day and throwing more than a couple doses of BT meds on top, but that's not the norm, protocol and makes no sense whatsoever.

    How does a patient benefit from long acting meds if you take them like short. You not only have the psych aspect of needing to take something every 4-6 hours, clock watching, living from dose to dose and planning your day around dosing schedules, but the serum levels would be a roller coaster from the overlap of each dose plus BT meds. Find someone that knows what their doing and take the advice of the people that know what their talking about and have actual experience with what their talking about, recomending or doing.

    Good luck, Dave

     
    Old 07-30-2008, 04:16 AM   #11
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    Re: How Many Times Can Oxycontin 20 Mg. Be Prescribed?

    I have to agree with shoreline here. Izzy your pushing and pushing this Dr out of his comfort zone. I really wish you would go and see a PM Dr. Even you say this isn't his field and he has very few CP patients so he isn't up to date on pain meds. It seems you make all the calls and get him to do what you ask him to do, than it doesn't work after a period of time. This is getting to a critical point and a lot of people have suggested this to you but you havn't made that step yet. I fear for you, that he will cut you off and than you will be in W/D with nothing waiting to get into a PM Dr. You have mentioned there are several PM DR'S in your area, have you called them yet to see if you can get an apt? some PM Dr's dose this medication 3 times a day, including my Dr. I hope you get some relief soon. Your last post a week ago stated the meds were working GREAT. now a week later its not cutting it, and your DR has told you he isn't comfortable increasing you to 3 times a day, so now what are you going to? The 8 hour drive seems like a lot to me but I know you love this DR and want to try and make it work, I guess you can make the drive up there again and ask him again for an increase but the time is going to come where is not going to want to help you anymore. I hope you can change his mind but I am fearing for you again. You really need to see a PM Dr and I hope you make the step soon!!!

    good luck, SS

     
    Old 07-30-2008, 05:15 AM   #12
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    Re: How Many Times Can Oxycontin 20 Mg. Be Prescribed?

    Izz:

    (((((((((((IZZY))))))))))) Big ole fat hugs to you Izzy!!!

    I still think your best bet would be that sports med doc that your friend referred you to. If not that, then a GOOD PM. I've said for a long time that this doc is tiring of you and quickly. His last comment to you is scarey "Don't ask for an increase"..... YIKES!!

    Having to try to drive to see this doc for a "FACE TO FACE" visit when you're in such pain just makes things compounded in the pain department, yet in order to get things "sorted", it's almost a requirement. See what I'm saying hun?? Just my 2cents!

    We love you Izzy, and are hurting right along with you. Please consider everyones suggestions in the way in which they are intended, with love, caring, and your best interest at heart.

    Like Slip, I'm so afraid this doc (and have been for months now) is going to dump you with no where to turn but terrible w/d's to face. No one here wants to see that.

    Lots of love for you Izzy!! I pray that you can get the comfort and relief and peace of mind you need! (And someone a bit closer to home too!)

    Many prayers and blessings for rapid relief!


    ~!~ Becky ~!~
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    Last edited by SpinalMalady; 07-30-2008 at 05:20 AM.

     
    Old 07-30-2008, 07:49 AM   #13
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    Re: How Many Times Can Oxycontin 20 Mg. Be Prescribed?

    I take 30mg 4 times a day.

     
    Old 07-30-2008, 07:56 AM   #14
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    Re: How Many Times Can Oxycontin 20 Mg. Be Prescribed?

    ditto on what shore mentioned and the others izzy. most actual PM docs KNOW that oxycontin just does not actually last the touted 12 hours. not with my pain or alot of others as well. as soon as i told my at that time"new" PM that the two times a day just was not lasting long enough we immeditately went to the three times a day and it worked for me soooo much better. you simply NEED a good PM who can better manage your pain hon. why put yourself thru all of this crap(i just hear SOOO much stress in your posts hon) when you most likely would not have to with a good PM who could also try other modalities as well that could help even better than the narcotics can in some cases.

    you are also on a very low dose of the OC to begin with and that could be changed by a PM since it appears you have kind of reached the end of your rope here with your GP,ya know? depending upon what your pain is like,just going to 20mgs at three times a day could be the key to getting and keeping things much better controlled for you.the right dose and times per day is the key to good pain control izzy. i would just hate to see you lose the great relationship you now have with your GP hon. all over something that could have been done,better managed with another doc who just understands pain.

    i too have a really great primary doc who has managed to get me thru some of the worst experiences of my freaking life here(and was treating my pre op pain) but when we both knew that he simply could not offer me what i needed with regards to good pain management after my spinal cord surgery just created nightmare levels of pain,we just discussed my options. i was referred to my current PM that very day and it was the best possible move for my pain,and our good relationship that is still there today.

    everything everyone has told you about moving onto a good PM to try and get your pain better manged really IS the best thing for you at this point hon. your doc is really being pushed here and i would really hate to hear that you no longer have that great relationship that you did,do now. i know what losing my primary would do to me.once you move on to a good PM,your primary will be overjoyed izzy that he no longer has to deal with that aspect of your care anymore,trust me on that one. it is just a really huge thing for any primary to have to keep Rxing oxycontin to any patient. family practice settings in alot of cases,wont even touch that stuff with a ten foot pole just because of the potential liability and the connotations it can bring to any family practice setting. so simply moving onto a docs office in a real pain management setting would be much more acceptable/appropriate and your real pain needs much better understood there hon. you will simply have so many other good options and other modalities availiable there that you cannot possibly get thru your primary doc izzy.

    i know there is fear of the unknown also guiding the reasons for not just doing this sooner,but you have to get past that fear and just look at what you will gain in both pain management and knowlegde and giving your primary doc a huge break here too. your relationship will be much better once you go to the right place to have your pain managed properly. its a win win izzy. i really do hope you will just make an appt with that PM and see how things go hon. it really could be the best possible thing you ever did for your pain hon. it certainly was for me and others who have gone this route as well. good luck izzy. Marcia
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    Old 07-30-2008, 11:18 AM   #15
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    Re: How Many Times Can Oxycontin 20 Mg. Be Prescribed?

    As one cper to another, I think sometimes you have to look at the full picture. Don't let things get out of hand like I have, end up in the ER, and being in total misery before everything blows up. I think your doctor is FANTASTIC but obviously you are not stablized and to make changes and get your needs met I feel you have to do it face to face. Over the phone is not good, it is hard to read and see that someone is suffering. I highly recommend based upon my recent experience that all med changes take place face to face so there are not misunderstandings/confusions. Maybe until you are stabilized you need to go to weekly/biweekly meetings. This way you are not having to make mid month calls or wait a full month before a change. I know the distance is a pain but you have to decide is it worth it to keep your doc or is it time to find a doctor closer.

    Good luck and I pray that you are able to bring this to resolution soon. Uncontrolled pain is hard on everyone involved including your adorable son. God Bless & take care of yourself - you deserve to have your pain controlled.

    Last edited by ms_west; 07-30-2008 at 11:19 AM.

     
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