Greetings to all and happy holidays. I hope everyone is well and not suffering.
I have questions about the drug Kadian....I have recently been referred to a new pain management doc and he is in the process of adding/switching me over to Kadian for long-acting pain control vs. just the Norco I have been on....my question primarily is how long will it take for me to adjust to the change from short acting opiate to the extended release meds...it seems as though I am not experiencing much relief yet and am curious if I would be premature in thinking that my dosage needs to be titrated upwards or should I give it a little more time to adjust?? I have been on norco 10/325 2 every 4 or 5 hours for quite a while and am now on Kadian 20 mg every 12 hours and am experiencing significantly increased pain levels as well as withdrawal symptoms from the reduction in the short acting norco...is this normal or should I speak with my pm doc on tuesday when they re-open?? Thoughts and comments are welcome....
Kadian is morphine in long acting form. And Norco contains hydrocodone along with acetaminophen (tylenol). Based on the opioid conversion table, 17 mg of hydrocodone is equivalent to 10 mg of morphine. Therefore, 20 mg of Kadian is equivalent to about 34 mg of hydrocodone. So, if you take 20 mg of Norco every 4 to 5 hours, the norco is stronger than the current dose of Kadian you are taking, as over a 12 hour period, you would have taken 40-60 mg of norco (or 23 - 35mg morphine equivalent). If I interpreted your post incorrectly and you really take 10 mg of norco every 5-6 hours, then the Kadian is about the equivalent of your norco dosing over a 12 hour period. How many norcos did you normally take a day? and How long have you been on Kadian?
Doctors typically titrate down when switching a patient over to a different opioid medication due to cross tolerance factors that can make some people feel too drugged if given the equivalent dose from a different opioid medication. And, it can also be dangerous as some experience severe respiratory depression if started on a new opioid medication at the equivalent level of medicine that the old opioid medication was providing.
So, it is not unusual for you to feel more pain from the Kadian than from the norco after the initial switch. There are some that feel the exact opposite from a switch such as yours which is why doctors always titrate on the safe side when converting patients to a different opioid formulation.
It can take a little time for the Kadian to build up in your system; however, you should begin to feel it working within 30 mins or so after taking it. If you don't feel anything, it isn't strong enough...this is what my pharmacist told me when I was switched to MS Contin. MS Contin is also morphine in long acting form but is made by a different manufacturer.
Given what you provided, I think you should consider discussing this with your pain management physician. After crossing over to a new opioid medication, it can take 1-2 or several titrations before the medicine is optimal.
Another option in addition to increasing the Kadian dose, is for your physician to add back in part of your norco dose to be taken for breakthrough pain. Even after you have achieved sufficient analgesia from the Kadian, there may still be times that you get what is called "breakthrough pain". This pain is sometimes brought on by an increase in activity or it can occur "out of the blue". Many of us chronic pain sufferers deal with this type of pain frequently. This type of pain can happen within a few hours from when you took the Kadian. The norco would then be taken in these instances to get you through the pain flare so that you don't have to suffer until you can take another dose of Kadian again. So for me, I am on MS Contin daily and also take Percocet daily for breakthrough pain. So it is not unusual to be on both long acting and short acting opioid formulations.
I am sorry that you have to deal with chronic pain and I do wish you the very best on your journey to pain relief. Please let us know how things go at your next appointment.
thanks for your insightful response...everything you said makes sense and I think I will call my new PM doc tomorrow when they re-open after the holidays to discuss......he did give me half of my usual norco script for breakthrough pain it just doesn't seem to help enough @ 1 every 6 hours as needed and I find that I am still needing to take 2 every 4 to 6 hours (except at night) I am now sleeping 6-7 hours straight through after taking my 20 mg kadian at around 10 or 11 pm and then maybe taking 1 norco an hour or so afterwards as the kadian seems really slow to kick in and by the end of the day my pain level is high, especially recently with all the additional holiday activities and babysitting/playing with my grandkids ( which while they are a HANDFUL they are also quite a blessing and a major source of joy and inspiration!!!!!!) I guess maybe not having been on any long acting opiates for the past 5 or 6 years and only on the short acting hydrocodone my body is expecting the quick peak of med relief???? If the kadian provided more initial relief then perhaps I could do without the norco, at least not as often anyway.....
I have been on the norco at 2 every 4-6 hours level for 3 years or so, so I guess it may take a little while for my body to adjust to the different medication as well as dose difference??? Thanks again for your response and I will keep posting as it is very helpful to talk with others who are or have been walking the same path.....
I am happy I was able to provide the information you requested. Children are the BEST!!! :) I have a little 5 year old at home and he is definitely a handful but I couldn't imagine life without my little buddy! And I know Grandparents are in love with their grandkids. I think you should bring up at your appointment how much you love spending time with your grandkids but sometimes the increased activity level brings on pain that forces you to withdraw from the fun with the grandkids. I know this has been true for me. The zoo just kills me!!! Oh! And, after the zoo, I am a complete vegetable! I can sometimes reduce the amount of pain experienced after an activity by taking my breakthrough medicine before beginning the activity as it is easier for the medicine to prevent pain than to cease it after it begins.
I am so glad to hear that your sleeping patterns improved with the Kadian. I have been on MS Contin since April and I have found that I am able to sleep better too. You aren't alone with feeling like the Kadian is slow to work. The long acting opiods reach their peak much later than the short acting opioids. This makes the onset of pain relief slower. I have discovered that I can "boost" the pain relieving properties of the MS Contin by taking 1-2 Percocet about 2 hours after taking the MS Contin.
Given that you are still on the norco for breakthrough pain, I think an increase in the Kadian would be very helpful for you.
I also wanted to mention that you are not alone when you say your pain ramps up in the evenings. Mines does the same thing and I have done some research and found that there are many patients that take MS Contin or Kadian every 8 hours versus every 12 hours. I'll tell you that for me, the MS Contin begins to tail off at about 6 hours after dosing and the pain relieving properties are completely gone 8 hours after dosing. So, if you are still experiencing a lot of pain after the Kadian is titrated up, you may need to have your physician change the frequency of taking the Kadian to every 8 hours versus every 12 hours. I plan to look into this option myself next year.
An increase to your breakthrough med may be helpful if you are still experiencing pain after the Kadian is titrated up. If you still have pain after the breakthrough med is titrated, then you would typically go back to titrating the Kadian and so on and so forth.
Lastly, there are many adjuvant medications that can be added in which may provide additional pain relief such as anti-convulsants, anti-depressants, muscle relaxers, and benzodiazepines. I actually have a medicine from all four categories. So, there is a lot of leverage to get you comfortable and back to doing all the great things you love to do with your grandchildren.
I tried Kadian a few years back. I hope it works for you. I hated it, but I hate morphine. I had the worst dreams on it. Like devil, satanic, nightmares. I would scream in my sleep and my husband could not wake me up. I ended up not sleeping for 3 days because I was afraid. I ended up flushing the whole bottle and ended up in the ER. My Dr refused to take me off of it so Ii left her practice and was then put on oxycontin and have been on that ever since. Me & morphine do not get along. I wish you success. You can always go to a web site called http://www.askapatient.com/. It has alot of info on meds and others experiences on the drugs. Good Luck!
Hey......thanks for the info/reply. So far I haven't noticed any change in my dreams, that would be a horrible side-effect that I don't think that I would tolerate very well, it sounds horrible!!! I am hoping that it will be a good med for me if they get the titration of dose better....hopefully....i do know that after all my multiple surgeries over the years that morphine IV didn't really provide a lot of relief post surgery and they would usually change to demerol or even fentenyl after my femural arteries embolectomy (sp?) especially, so maybe morphine just doesn't work well for me period...perhaps I should bring that up to my new pm doc....thanks for the info and the website referral......peace
I should have probably told you before but it spaced my mind. Some people don't metabolize morphine very well. So if you aren't noticing a difference after a couple of titrations, it may be time to ask your doctor if you could try something different.
The morphine makes me super sedated sometimes but on the plus side, it is great for my heart. I know you are probably saying to yourself, "What is she talking about?!?" I have hereditary hypertension but it is managed well with a low dose of a couple of blood pressure medicines and the morphine. Morphine is a blood vessel dilator and it is the first line medication that paramedics use to stabilize victims of a heart attack. It dilates the blood vessels so the heart doesn't have to work as hard and it also relieves the pain from a heart attack. But, I am curious about Oxycontin as my physician told me to ask my new physician about next year (I am switching insurances Jan 1st and my current insurance carrier doesn't offer it) as he thinks it will control my pain better. Oxycontin costs about $800 for a 30 day supply if you don't have insurance and there isn't a generic for it. I called my mail order pharmacy and it will cost me $187 for a 90 day supply (if my doctor agrees to write for 90 days, most don't and prefer to write for a 30 day supply) and $75 for a 30 day supply. This is affordable for me and would be paid for by my healthcare spending account. I just don't know if I am ready to make that big of a leap...it is basically starting over. I know there are only minor tweaks needed to the morphine and it protects my heart but I wonder how much more pain control the Oxycontin could provide.
If Morphine via IV didn't do much for you, then you may need a really high dose of oral Morphine to really help your pain as Morphine is very potent via IV but the bioavailability orally is about 25-30%, which is a fraction of the dosage listed on the bottle. Oxycontin is 1.5 to 2 times stronger than morphine and I know the Percocet I take is doing 70% of the work while the morphine is doing 30%. In case you didn't know, Percocet contains tylenol and oxycodone in immediate release form similar to the norco you take but much stronger. And Oxycontin is oxycodone in extended release form. There are also other long acting meds beside Oxycontin that you could look into such as Oxymorphone (Opana), Hydromorphone (Dilaudid), and Fentanyl which all have a potency that is greater than morphine.
My appointment is Jan 3rd, I will let you know how it goes.
hey buddy you should look up a drug named Nucynta (both instant relief and Extended relief). This really helps my back throughout the day. Nucynta (Tapentadol) is really usefull for chronic pain as ive been using for a good amount of time.
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