Discussions that mention morphine

Pain Management board


Alan,

Morphine is Morphine. Yes, Kadian has a different release mechanism. The Contins work by releasing half of its dose at .6 hours and the rest at around the 6th hours. Kadian is Polymer coated pellets that release at different times over the period of 24 hours. However a 12 hours dosing schedule seems to work best.

So with Kadian 30 mg BID, you are getting 60 mg daily or 120 mg every 24 hours. If you are taking MsContin 100 mg daily, that is 200 mg every 24 hours (100 mg every 12). So they are doing their math incorrectly.

The other point is that Fentanyl is much more potent than Morphine. For instance, 30 mg of Morphine is approximately compares only to 0.1 mg of Fentanyl. Thats a big difference.

So if you are taking 100 mcg/hr Fentanyl, that is no where near 60 mg daily of Morphine. It is a huge drop. As far as WD's, there is a big chance you will go through them. Sorry for the bad news.

Your Dr can go to Kadian's website and it advised what dose of Kadian a person should be on if they were taking were on 100 mcg/hr Fentanyl patch. Of the top of my head I believe it is 200-240 mg of Kadian daily. I posted it on your previous post.

If it was me I would be looking for another Dr. Just my opinion though. Hope everything goes well for you. Take care.
Hey Allen, I really don't know how many ways there are to interpret each 20 mg capsule contains 20 mgs of morphine. If you had insurance that paid for MSC and not kadian and had been takiking kadian, THe MSC would likely create slightly higher serum levels because it's releasing 100 mgs over 8- 12 hours VS 100 mgs over 16-24 hours. I think your doc may simply be falling back on the full pescibing info that suggests you do the conversion and then start at half and titrate up.

Changing meds sucks but I don't think an article or conversion chart is going to make a doc change the way he does things. Hopefully after a few years of having to switch patients from one to the other for insurance reasons he would catch on that 100 mgs of morphine a day is the same regardless of the brand you take as far as safety. The only difference is the way it's released over however long the med is supposed to last.

My insurance changed after 9 months on Kadian and my doc simply switched me to generic MSC , same dose, same schedule, I was taking 200 mgs of kadian TID and went to 200 mgs of gerneric MSC TID. I didn't find much difference other than the slight ups and downs the shorter acting med creates.

I don't think many of us have the option of changing docs if we don't like a conversion so we simply work with them on titrating to an effective dose. In your case Allen, It sems your doc has very defintie limits on what's he's comfortable doing, regardless of what the med is. This has been going on for a while and it probably is time to change docs if he hasn't titrated any med to a level that's effective.

Even though I feel my docs have agressively treated my pain, they always start low, even when converting back to a med I previously took. The therory behind it is incomplete cross tolerance and medication holidays are an effective way to manage tolerance. Meaning even though a chart may say that 100 mgs of Oxy is equal to 150 mgs of morphine, just because your have become tolerant to the oxy you wouldn't neccesarrily be equally tolerant to morphine or any new drug.

He's hoping you will respond better to morphine after takng a break from it for a year with Duragesic. All you can do is give it a shot and report how your feeling, but what the doc or nurse told you is BS. The ideal way to titrate to a LA med is use SA meds. Titrate SA's and then convert the daily amount into an equal amount of LA med. The release has nothing to do with the daily intake. IMO

After years of being jerked around and not knowing there will be light at the end of the tunnel and your doc will eventually get you where you need to be, I would be looking for a new doc.
Good luck, Dave