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    Old 07-05-2009, 10:55 AM   #1
    Toonces1
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    alternatives to Kadian

    Hello. I am undergoing the knife tomorrow morning. I'm having a posterior cervical fusion to fix a failed anterior fusion. I normally take Kadian as my long-acting pain med, but my PM doc told me late last week that the hospital I am having the surgery at does not carry this drug and that they would have to special order it. I know there are a couple other long-acting morphine drugs that a few of you take. Can you give me the quick scoop on those and tell me if they compare mg to mg with Kadian? I do not want to take MS contin, because it will not last 8 hours for me. I will only get 5-6 hours out of it. My PM said they will probably put me on a long-acting pill after a day or two, and I'll be in the hospital for 4-5 days.

     
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    Old 07-05-2009, 12:12 PM   #2
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    Re: alternatives to Kadian

    When My insurance changed I swithced from Kadian to the exact same number of mgs of generic MSContin. Just spread the doses out acourding to the MSC directions.
    Good luck, Dave

     
    Old 07-05-2009, 04:41 PM   #3
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    Re: alternatives to Kadian

    My friend has taken Avinza and Oramorph in the past and said they both worked well for her. Do you know what your options are? I will keep you in my prayers and I wish you a safe, successful surgery;0)
    weezi

     
    Old 07-05-2009, 05:47 PM   #4
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    Re: alternatives to Kadian

    Kadian and Avinza are nearly identical. Both are LA morphine...Both are capsules full of little beads...20% of the beads are IR, 20% are released in 4-6 hours, 20% are released in 8-10 hours, 20% are released in 12-14 hours and 20% are released in about 16-18 hours.

    I was initially on Avinza and it worked great. The only reason I switched to Kadian was because the dosage strength my Doc wanted to use wasn't available in Avinza, so he switched me to Kadian. Avinza is available in 30mg, 45mg, 60mg, 75mg, 90mg, and 120mg. Kadian is available in 20mg, 30mg, 50mg, 60mg, 80mg, 100mg.

    I have taken OC, the patch, and LA morphine. LA morphine has worked the best for me by far. I could not tell any difference between Avinza and Kadian. I have not tried MS Contin.

    Hope this helps, and best of luck with your surgery.

    Regards,

    Ex

     
    Old 07-06-2009, 05:33 PM   #5
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    Re: alternatives to Kadian

    Actually your information is incorrect. The products do both contain morphine, but have very different release patterns.
    Kadian contains no immediate-release morphine. Following oral dosing the first 50% is released over 8 hours. Kadian is typically dosed twice daily.
    Avinza contains both immediate release (10%) and controlled-release portions. Following oral dosing peak blood levels are acheived in 30 minutes and then maintained for 24 hours. Avinza is dosed once daily.

     
    Old 07-06-2009, 09:22 PM   #6
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    Re: alternatives to Kadian

    Welcome to the boards Bristol! Many here a wide variety of experiences and can offer lots of support and guidance.

    Kadian is recommended by the manufacturer as 1-2x. Initially, it was marketed as 1x, but the manufacturer has since changed the rating to 1-2x. Avinza is recommended as 1x. However, both meds are often prescribed more often...Many take either or 2-3x. For example, my anethesiologist PM Doc prescribed both as 3x, or every 8 hours.

    Both meds contain an immediate release portion, as all LA meds do...This is how they maintain one's BPL (blood plasma level)....An initial release, followed by some formula of sustained release, over some time period. The small bead technology that both employ is almost identical...The time release mechanism is wrapped in the wax coating of the beads. In fact, both manufacturers say that the beads can be spread in applesauce or something similar, if one has trouble with the pills.

    Regards,

    Ex

     
    Old 07-07-2009, 06:39 AM   #7
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    Re: alternatives to Kadian

    I am sorry, but again Executor you are incorrect.
    Kadian contains no immediate-release morphine.
    Many LA or extended-release products do not have immediate-release portions.
    Use of either Kadian or Avinza products more frequently than BID for Kadian or QD for Avinza has not been studied clinically and should not be recommeded, despite your personal experience.
    Ask your personal pharmacist or visit http://dailymed.nlm.nih.gov/dailymed/about.cfm for full prescribing information.

    Last edited by bristolqueen; 07-07-2009 at 06:43 AM. Reason: typo

     
    Old 07-07-2009, 07:30 AM   #8
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    Re: alternatives to Kadian

    Quote:
    Originally Posted by bristolqueen View Post
    Kadian contains no immediate-release morphine.
    According to the graph in the manufacturer's prescribing information, plasma concentration reaches 20ng/ml after 1 hour of administration. Peak plasma concentration is achieved at the 4 hour mark (28-30ng/ml), and declines from there. The graph stops at 12 hours. I presume this is why the med is 1-2 x daily.

    Regards,

    Ex

     
    Old 07-07-2009, 05:29 PM   #9
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    Re: alternatives to Kadian

    Well, regardless-I just left the hospital (after just one night!) and I was sent home with Kadian 2x/day now rather than the 1x I had previously been taking. I was also given a script for the new Nucynta, but when I took it to the pharmacy (Walgreens) they said it wasn't even in their system. WEIRD, considering Walgreens is by far the biggest pharmacy chain in the region where I live. I think there was another post on this, so I am going to look it up.

     
    Old 07-07-2009, 06:34 PM   #10
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    Re: alternatives to Kadian

    Yeah the Nucynta is a brand new medication. It was approved by the DEA on June 22, 2009 so less than a month old. It's no wonder that your Walgreens did not have it in stock. It's amazing that doctors think that some brand new med that is not even a month old will be in stock at all the pharmacies.

    Anyway if you do manage to get it then let us know how it goes. So how are you doing since you got out of the hospital. Keep us posted.

    brian

    p.s. If you are taking any anti-depressants including Ultram(tramadol) then PLEASE ASK THE PHARMACIST OR DOCTOR before trying the Nucynta since it is a norepinepherine reuptake inhibitor (anti-depressant qualities).

     
    Old 07-07-2009, 07:03 PM   #11
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    Re: alternatives to Kadian

    Quote:
    Originally Posted by brianpain33 View Post
    It's amazing that doctors think that some brand new med that is not even a month old will be in stock at all the pharmacies.
    Isn't that the truth Brian....Great point.....

    Ex

     
    Old 07-07-2009, 09:17 PM   #12
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    Re: alternatives to Kadian

    Welcome to HB Bristolqueen, it's great to have new memebers - there's so much support to be found here and most of us find that supporting others helps to take our minds off our own pain.

    Unfortunately you are incorrect about Kadian (Kapanol in Aus). All LA meds on the market have an immediate release component as well as an extended release component - all meds accepted by the FDA and TGA in the 'LA' class must contain both components as well as clinical proof that these components act as they say they will. Some websites do contain incorrect information so it's probably a good idea to get a print out from the pharmacy on Kadian next time you're there. Kadian is basically 20% immediate and then released 20% each couple of hours from there depending on a person's metabolism. There has been extensive clinical usage of Kadian at 3 X per day though it's most commonly recommended at 2X. As you probably know, as pain patients, we develop a tolerance over time and a reduced response to the 'extended release' component is seen. Oxycontin is commonly seen at 3X a day also though I personally take it more often because I have a particularly fast metabolism. Most who take Kadian 3X a day would also have a fast metabolism. I hope this clears up any misunderstanding if not, I again recommend reading the actual prescribing information for Kadian, it should help. I've personally been bamboozled by so many websites and their misinformation that I just stick to the prescribing information and clinical trials now.

    Toonces, I'm so sorry you don't have access to Nucynta yet, it's not surprising though, considering that it was only just released - it would have been nice if the hospital checked it for you before sending you home though! Can your doc or pm give you a script for your usual BT meds? I also second the caution of making sure you're not taking any anti ds (especially Cymbalta and Pristiq - SNRIs) or Tramadol. I wonder if we'll soon have this med available in Aus. The US seem to have picked it up really quickly. Would you mind telling us what you think of it when you finally get it?

    How did your surgery go? I'll have a look on the SCD board to see if you've posted there. You were sent home very quickly for a posterior fusion, I hope you're coping ok. I've been thinking of you and I hope it all went well, you've been through so much.

    Take care,

    J

     
    Old 07-08-2009, 10:19 AM   #13
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    Re: alternatives to Kadian

    Thanks everyone. I had my surgery on Monday, and was feeling pretty good yesterday so they sent me home. I think though that I was feeling so good because I had quite a bit of Dilaudid and I think some was still in my system. I went home last night partially because I had a shared room, and my roommate was kind of loud and was the attention-seeking kind, so I did not get any sleep the first night. She was constantly calling the nurse all night and turning on the light. I figured I would be in a little more pain, but I would at least get some sleep at home.

    The recovery room nurse worked so hard to get my pain under control when I woke up. She stayed at my side for about 45 minutes and pumped me full of demerol and dilauded. She gave me more if needed every 6 minutes. She was very aware of my tolerance and I feel grateful to her. I think the aggressive pain control plan upfront led me to be in less pain for the next 48 hours while I was in the hospital.

    I did wake up at 4 this morning in terrible pain, so I got up and took some oxycodone and went back to sleep until 8. I was stupid and didn't bring any meds up to my bedroom, so I had to go downstairs to get them at 4am. I will remember that mistake! I have some at my bed now. At this point I have oxycodone and diazepam in addition to kadian, so I am maintaining. I already feel much less pain in my arm and scapular area which was constant before surgery. When the surgeon went in, he said that there was significant movement in the vertebrae where I was supposed to have been fused, so he assumes that was the major problem. Anyway, I'm rambling. Thanks everyone for your concerns and responses.

     
    Old 07-08-2009, 08:36 PM   #14
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    Re: alternatives to Kadian

    Glad to hear you are doing better! Make sure you get lots of rest...Your body has been through a tremendous amt of trauma, and the more sleep and rest you can get, the better.

    Take care, and please keep us updated.

    Regards,

    Ex

     
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