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HELP! Urgent Response Needed Before Tomorrow Morning! I don't want to die!

Hi All:

I have found a new primary care physician under my new insurance today and he made some changes to the meds I take that I am very concerned about.  He titrated my opioid medications up by 60 mg morphine equivalent.  I was taking 60 mg of morphine sulfate ER plus 35 mg of percocet a day.  He switched me to 30 mg of Opana ER every 12 hours with up to 25 mg of percocet a day for breakthrough pain.  My old medications equaled 120 mg of morphine equivalent a day and my new medications equal 180 mg of morphine equivalent a day from just the Opana ER!!!  That is a 60 mg increase!!!  The Opana (oxymorphone) is a much stronger medication than morphine and percocet.

I talked to my pharmacist and he thought the titration was very high and suggested that I call the ER to get a more definitive answer.  He said in opioid resistant patients (like myself), I would probably be okay.  He asked if I would have family members around to monitor me tomorrow when I take my first dose and I do.  My husband and son will be here tomorrow.  I am waiting to take it in the morning tomorrow around 7-8 am so that I can be awake to monitor the effects.  I plan to take 30 mg of morphine sulfate ER in an hour and a half, a little earlier than usual to make sure the morphine is completely out of my system before I start the Opana ER tomorrow morning.  I don't think I will need ANY breakthrough meds at all with this new dose.  

I am very concerned because it isn't a 60 mg increase in morphine, but a 60 mg increase of Opana ER in morphine equivalency.  Usually, when a person is switched to a different opioid, the doctor titrates DOWN not UP.

Please let me know what you think about this and whether or not you think I will be okay tomorrow.  Also, please tell me what is the highest increase in mg of opioid medication you have received at one time.  Thanks in advance for the responses.

femmy
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Avatar_f_tn
I think whatever is best for your pain and pocketbook!:)

I definitely had to work with my PM Dr. when the generic patent ran out on Oxycontin as I don't have insurance....So the brand is just so expensive it would bankrupt me!..LOL

So...I moved to MSContin generic as my long term medication and OxyIR as my breakthrough medicine when needed...(as the Acetaminophen was upsetting my stomach when using Percocet)...

I also like having flexibility with my medicines so I have prescriptions for both the 30mg and the 15mg MSContins....

So I take a 30mg at 5am...and then add one or two 15mg pills at 1pm depending on my day...then the last 30mg at 9pm...

And my prescription for OxyIR 5mg is 'up to 8 a day' as needed....I usually don't take that much at all but he writes it for flexibility as my days are very different with pain depending on the level of activity...

So....it sounds like a good plan to ask him about the 15 and the 30mg to have that choice yourself depending on your pain level...

The key is having a great PM Dr. working with you and helps you with both your pain levels as well as understands the finacial aspect of this as well..

Good luck and let us know how it goes:)
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I'm guessing here, but I think your doctor changed your meds so that you hopefully won't even need the percocet.  Opana (oxymorphone) is a slightly different molecule than morphine so you can't compare potency on a mg-by-mg basis.  Trust your doctor.  He doesn't want you to overdose any more than you do.  Since you're opiate tolerant I think you'll be fine - and hopefully better than fine!
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1331804_tn?1336870958
Thank you Jaybay so very much for your quick response.  My husband has been telling me the same thing you are saying...that I'll be okay.  This type of titration is what I have hoped for for many many months now.  I wanted to only have to take the percocet once a week, maybe once a month and have to only take one pill every 12 hours that covered EVERYTHING.  And this change seems to have granted my wish.  I will trust my doctor.  Thanks again!  :)

femmy
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547368_tn?1332173665
Sorry I wasn't on last night.... Please let us know how you are doing.

If you trust your physician (any you do)... you have to trust that he won't do anything to hurt you. Sounds like you have a wonderfully supportive husband. I assume he will be by your side.

I know you've had some nasty uncontrolled pain. Your PMP is most likely attempting to treat it and make you more comfortable. Hang in and please post an update!

Peace,
~Tuck
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1855076_tn?1337118903
I think you'll be fine.  Hope you post soon and give us an update.  i always get very anxious when changing medications.  But I'm sure your doctor knows what's best for you.
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I finally called my doctor's office and requested for them to double check the dosage.  They ended up calling my doctor on his day off because the dosage conversion did seem high to them too.  My doctor told them to tell me NOT to take it!!!  He said continue taking my morphine with breakthrough Percocet until Monday.  I have an appointment at 3pm on Monday.  He said at my appointment he will give me a prescription for 15 mg Opana ER to take every 12 hours versus 30 mg every 12 hours.  

I am resistant to medications.  After my surgery a couple of weeks ago, they told me that they had to use A LOT of medication to anesthesize me as my body was doing weird things signaling it was in pain after they started the surgery.  I was long gone from the propofol and woke with no memory of the surgery or any pain.  They said next time I have surgery, I need to tell the anesthesiologist this...like I knew I wouldn't respond to normal doses of anesthesia medications...LOL!

Despite this mishap, my new doctor is GREAT!!! I know if the 15 mg doesn't work, he will titrate up until my pain is controlled.  He said if the Opana doesn't work he will switch me to Oxycontin.  I am so happy to finally have a physician that LISTENS to me!!!  :)  I am already day dreaming of how much more I could do given the better pain control I am about to have...I'm excited.

So no worries, I'm alive and in pain...LOL!  But alive!  And that feels really good today.  

I don't know if you all have converted opioid medications before but it is a good skill to have.  I never thought I would catch a mistake but I did.  I even checked my answer using the opioid conversion calculator on the Opana website and we matched.  But I really wanted to trust my doctor but I still had that gut feeling something wasn't right.  Who knows? Maybe 30 mg is optimal for me but I would rather step to 30 mg than start of on 30 mg right away especially since it is a totally different opioid formulation than I am taking now.

femmy
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Avatar_f_tn
Take a deep breath here....no one's going to die....And obviously if you had any type of reaction you would go the ER and not on the internet for help...

I don't see any issues with his change....You are actually on less medication overall...as you are dropping 15mg of Oxycodone...and the Percocet is 'as needed' anyway....

So if your pain is controlled with 30mg every 12 hours...you don't have to take a single breakthrough med..

That's the part that was confusing me why you were so frantic about this....

You are only taking the Opana every 12 hours....that is plenty of time after the 30mg dose to see how you are doing....without taking a single Percocet....

Now going down to only 30mg per day...I'm going to bet that your pain won't be contolled as much at all as you were used to 60mg of Morphine a day plus 35mg...

The goal of PM is to only need breakthrough medicines once in awhile...not even every day....

So that was his obvious thinking....that you wouldn't just take the 60mg total of the Opana and automatically taking the 25mg of Percocet on top of this if your pain is controlled...He is giving you the Percocet to take UP TO 25mg per day IF NEEDED.....

I don't see any mistake he made actually.....I am thinking that within a week or so ONLY taking the Opana ER 15mg every 12 hours....that alone will not control your pain....

I guess I don't see why you didn't try just the 30mg twice a day...no Percocet and see how it went? There was no risk in overdose as they take your total amount of opiate intake per day which was 95mg....So.....that would have been just 60mg per day to start.....

Well...whatever you all decide....that's the best as I'm certainly not a Dr. but I've been at this over 10 years and my best friend is a PM Dr....

Good luck...
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Correction...you were dropping 10mg instead of 15 with his original prescription...

Used to take...60mg Morphine plus 35mg of Percocet is 95mg of opiate.
New prescription...60mg of OpanaER and (up to) 25mg of Percocet is 85mg of opiate.
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1331804_tn?1336870958
Hi Weathergirl,

I know you meant well by the information you provided in your post.  And I do very much appreciate the response.  However, the calculations you posted are not correct.

The conversion to Opana ER from percocet or morphine is not a 1:1 ratio.  It is slightly more complicated than that.  Opana ER is oxymorphone in extended release form.  Oxymorphone is an extremely potent opioid.  It is up there in similar strength as Fentanyl.  There are only 3 opiates: codeine, morphine, and thebaine.  Opioids are derived from these opiates (e.g., semi-synthetic, synthetic) that come directly from the poppy plant.  

The 30 mg dose of Opana ER taken twice a day as prescribed by my physician equals a total of 180 mg of morphine in 24 hours.  Here is how it works:

40 mg of oxycodone per day for breakthrough pain is 1.5 times stronger than morphine; hence, 40 mg of oxycodone = 40*1.5 mg of morphine per day (i.e., 60 mg) for breakthrough pain.  

I also take 60 mg of morphine sulfate ER total per day split in 30 mg doses every 12 hours.  If you add the morphine equivalent dose of oxycodone (i.e., 60 mg) with the 60 mg of morphine sulfate ER you get 120 mg per day.

Now, converting that to Opana ER.  Opana ER is 3x stronger than morphine; hence, 120 mg of morphine = 120/3 mg of Opana ER per day (i.e., 40 mg).  Therefore I should be taking 20 mg of Opana ER every 12 hours NOT 30 mg of Opan ER every 12 hours.  The 40 mg Opana ER includes all of the breakthrough percocet I take per day and the total in morphine sulfate ER I take per day.  With this lower dose, I still should not need breakthrough meds.

I consulted with two pharmacists about my conversions at Medco (my prescription provider), one pharmacist last night and one in the morning today (I also went to the opana website and used their conversion calculator and got the same results).  The pharmacist last night did the same hand calcs I did and we matched and he said that is a very high titration dose (i.e., additional 60 mg of morphine per day) and suggested I contact a ER.  I did that this morning and some snappy lady said that there are no nurses or doctors that can talk to me.  So I called Medco and asked to speak with a pharmacist again this morning.  The second pharmacist said that the effects of the dose highly depends on the patient and recommended I call my doctor.  Luckily my doctor's office was open on Sat. morning and the nurse called my doctor at home and he said for her to tell me to not take the 30 mg Opana ER tablet.  About an hour after that, my phone rung 2x when I wasn't near it, no one left a message and then the phone rung a third time and it was the 2nd pharmacist I talked to earlier and she was very concerned and worried that I took the Opana ER tablet.  Asked how I was doing and I told her my doctor told me to not take it and she was so relieved!  She then said that she talked with the 1st pharmacist that I spoke to last night and they both agreed the dose increase was "way too high".  So I am 100% certain I made the right decision to not take it.

There is a chance I would have been OK just really out of it.  But, why would I want to start taking too high of a dose and hit tolerance on that if I don't need it to control the pain.  Now what I just wrote in the previous sentence may not be true.  It could turn out that I really need the 30 mg of Opana.  But I would rather start a new opioid at a safe dose and be able to titrate up to the optimal level rather than start high and titrate down.

I'm thinking the 20 mg Opana ER is optimal not the 15 mg Opana ER tablet but he may be applying a cross tolerance to make sure the transition to Opana ER goes smooth with minimization of side effects.  I plan to talk to him about my conversion results on Monday and see what he says.  

To All:

Opana ER I've heard is a great medication and that it works really well for many chronic pain patients so I am very happy to be able to try it and see if it gives me a few more pieces of my life back.  So if any of you have uncontrolled pain and are trying different medications to find the right fit, Opana ER might be a great medication to ask your doctor for.

I plan to post next weekend how my pain levels have been over the week an the dosage my doctor and I settled on.  

femmy
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You did the EXACT right thing by contacting your physician. You were very lucky to find him on a Saturday!!

In my experience it depends on the individual state and physician as to the use of short release opiates with the long acting opiates. Most physician's will also take their patients wishes into consideration. So respectfully not every pain management goal is to eliminate the use of short acting meds (break-through) as stated by weathergirl.  

I am so glad to hear that all things are good!!!

Peace,
~Tuck
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I also agree that this is all best discussed with your DR. so all of us, including myself are just giving our suggestions and thoughts based on our own knowledge which doesn't come close to a Drs...LOL..

Femmy...It's because you have been on 95mg of opiates for quite awhile that the conversions don't work the way that you are stating them...

If OpanaER was given to someone straight of the bat as their very first opiate...then yes...the conversion would be higher as there is no cross tolerance...

You can certainly let us know....but I am betting that if you don't take any of the Percocet...I can guarantee that the 30mg of Opana ER every 12 hours will not be too much at all...In fact it may not even cover your pain like before...

That is why he was giving you UP to 25mg of Percocet 'as needed' per day to supplement the pain spikes...

Again...you are taking all those numbers based on an opiate intolerant person....

And some people who are switching over like yourself, even find that Opana is way LESS than Morphine Sulfate ER and doesn't work for their pain...So it's really all relative..

Either way...it's going to be up to you and your Dr. to figure all this out...I just didn't want you worrying about this being so much medication that you were in any danger...

I certainly hope that whatever you all come with, it helps with your pain and you are able to take less to none breakthough medications during the day to get smoother and more steady control...

That's the best goal:) I do wish you luck..

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1331804_tn?1336870958
Hi All:

I thought about this a little bit more this morning.  And while I still think taking two 30 mg Opana ER tabs twice a day is too much, taking one 30 mg Opana ER tablet during the day makes sense to me now.  I take 75% of my total meds during the day when I am awake and I take the other 25% at night before bedtime.  So, I plan to discuss this with my doctor tomorrow afternoon.  Perhaps taking one 30 mg Opana ER tablet during the day and one 10 or 15 mg Opana ER tablet at night before bedtime is the right way to go.

Weathergirl, while the calcs weren't exactly right, I agree with you that the 15 mg Opana ER tablet during the day probably won't be enough and I will still have to take breakthrough meds that will probably end up equaling the equivalent of one 30 mg Opana ER tablet.  So, I may end up going with the 30 mg Opana ER tablets after all and just requesting thirty 10 or 15 mg Opana ER tablets to take at night only.  They have a generic in the 15 mg strength but not in the 10 mg strength so I need to price the 10 mg strength to see how much more it is going to cost me.  The sixty 30 mg tablets cost me $242 on Friday as they don't have a generic in that strength yet...not until Jan 2013.  I did receive a copay card that gives me $25 off on 12 refills but it is still a pricey med.  The retail price is $670 for a 30 day supply and my insurance only pays 1/2 because it is a non-preferred brand name drug.  Oxycontin is actually a preferred brand name drug so it is much cheaper than the Opana ER.  But, I could take two 15 mg Opana tablets in the morning and one 15 mg Opana ER tablet at night and that would cost a $10 copay for a 30 supply.  I think if we both decide to stick with the 30 mg during the day, I will keep and use the 30 mg brand tablets for this month and then switch next month over to the generics.

What do you all think?

femmy :)
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Avatar_f_tn
I think whatever is best for your pain and pocketbook!:)

I definitely had to work with my PM Dr. when the generic patent ran out on Oxycontin as I don't have insurance....So the brand is just so expensive it would bankrupt me!..LOL

So...I moved to MSContin generic as my long term medication and OxyIR as my breakthrough medicine when needed...(as the Acetaminophen was upsetting my stomach when using Percocet)...

I also like having flexibility with my medicines so I have prescriptions for both the 30mg and the 15mg MSContins....

So I take a 30mg at 5am...and then add one or two 15mg pills at 1pm depending on my day...then the last 30mg at 9pm...

And my prescription for OxyIR 5mg is 'up to 8 a day' as needed....I usually don't take that much at all but he writes it for flexibility as my days are very different with pain depending on the level of activity...

So....it sounds like a good plan to ask him about the 15 and the 30mg to have that choice yourself depending on your pain level...

The key is having a great PM Dr. working with you and helps you with both your pain levels as well as understands the finacial aspect of this as well..

Good luck and let us know how it goes:)
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1331804_tn?1336870958
Hi All,

I know you all are surprised that I am online on a weeknight but I had to get some paperwork faxed over for FSA reinbursement.  While I was on the computer, I thought I would drop in and let you know how my appointment today.

He really did want me to try the 30 mg of Opana ER both during the day and night.  And I told him that I realized a 15 mg Opana ER tablet isn't going to be strong enough during the day so we agreed that I would take the 30 mg Opana ER in the morning and a 15 mg Opana ER tablet at night.  I have enough brand tablets to last 2 months since they were originally prescribed for twice a day.  I picked up the 15 mg generic Opana ER this afternoon.  My doctor agreed to switch to taking two generic 15 mg Opana ER tablets during the day versus one 30 mg tablet once the brand tablets run out.  Made sure I ate early enough to be able to take it @ 9 pm as you have to wait 2 hours after eating or take it 1 hour before eating as food releases more of the medication into your system (weird, usually it is opposite).  

As of right now, I am very comfortable.  However, I do feel "weird"...kinda like I am up in a cloud somewhere...LOL!  It sure beats the pain!  I can only imagine what the 30 mg tablet is going to do tomorrow morning as I took a 15 mg tablet tonight...gulp!  But it isn't too bad, no respiratory depression or severe side effects but I feel like I am in a fog.  So I am certain I won't die from the 30 mg tablet tomorrow (as weathergirl assured me wouldn't happen :), should have listened).

Anyways, heading to bed...got meetings galore tomorrow.  I hope no one knows I am in outer space except me LOL!

femmy  :)
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PS: will provide more updates/comments this weekend.  :)
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1855076_tn?1337118903
Glad you're feeling good!!!
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547368_tn?1332173665
I'm glad to hear your pain has imnproved. The "fog" should ease up as your system adjusts to the medication.

Again you did the right thing. Don't take the word of ppl on the internet, even this site. Always follow your physician's orders and contact him/her when in doubt or you have a question. Obviously we are always here to support you and offer our suggestions.

Have a great week!
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Avatar_f_tn
Glad to hear everything is going well, but I absolutely agree with Tuck....it was ALWAYS best that this was all discussed with your Dr. and not my word at all!!!....(Just wanted to emphasize this...lol)...

We are patients just like you and only have suggestions or thoughts....never medical advice...

I was just putting my thoughts based on how you are an opiate tolerant patient...

Another good suggestion is that while you are getting used to any new medication...(this should be something your Dr. and Pharmacy tell you and listed on the medication information)....that you don't drive until you know how you are going to react...

Many new medicines take a few weeks to work out those fuzzy type of feelings...

So just be careful:)

I'm glad it is helping with your pain...that is the main goal...we look forward to more updates...
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1331804_tn?1336870958
Hi All:

I am home early from work today so I thought I would drop in again and say hello and let you know how I am doing and respond to the comments from all of your posts.  :)

All of you were spot on regarding the dosing.  I just freaked myself out reading stuff on the internet LOL! But I do appreciate all of you backing up my decision to seek further clarification from my doctor.

My body quickly adapted to the medication within 24 hours.  The 30 mg tablet was a lot stronger, but again, no respiratory depression just a stronger fog came over me.  I waited in the car outside of my office building to let the medicine peak at the hour mark before going inside to make sure I wouldn't have issues that I wouldn't want my coworkers to see.  Nothing bad happened and in fact I had pretty good pain control until about 2 pm yesterday.  I had to take one 5mg percocet at the time and also at 6 pm.  The breakthrough pain was a lot worse as with the old medications I knew the precise times pain would breakthrough so I took the percocet around those times every day.  So I think waiting on the breakthrough pain to hit made it stronger.  It was bad...shooting pain down my legs all the way to the ankles and through the gluts (I haven't felt that in months, it usually just shoots down my mid thigh and through the gluts...rarely down my entire leg).  

My doctor told me to call him on Friday and let him know how things were going.  He said at my appointment on Monday that I shouldn't need any breakthrough meds but that is so not true.  I needed 2 percocet yesterday and 3 percocet today (could have probably used 4) but it is better than the 7-8 percocets that I was taking.

Weird thing is that the 15 mg Opana is supposed to be stronger than the 30 mg morphine tablets I used to take at bedtime (Opana is supposed to be about a 15 mg morphine equivalent increase) and it feels that way initially and through to the point of falling asleep but I wake up in WITHDRAWAL and I am extremely tired.  I don't know how I made it through today without falling asleep!!  So I really feel like I do need to take the 30 mg of Opana at bedtime as well but I am worried about how much more tired I might feel in the mornings.  Granted I haven't slept as long as my body needed as I usually only get 6-7 hours of sleep on the weekdays but on the morphine I don't wake up barely able to keep my eyes open.  When I first started the morphine, I would wake up more tired than usual but it would wear off rather quickly and right before I switched to Opana, I was waking up feeling normal so I hope that with time the Opana will not make me feel so beat to the ground in the morning.  I am on here tonight trying to stay awake at least for another 2 hours so that I can eat dinner (I'm starving but I have to wait another 30 mins before I can take the Opana and then eat an hour after that...if I eat now, I will have to wait 2 hours!).  

I have been pushing through the withdrawal these past two mornings (i.e., haven't taken a percocet until an hour after taking the Opana in the morning).  I guess I was expecting much better control from the Opana than I was getting from the morphine but it is not turning out that way).  My pain levels are okay right now.  And I guess another factor is that I am way past due on a epidural injection as I had to skip the one scheduled last month due to surgery and my new spine doctor wants to wait until the MRI films come in before considering injections...my next appt. with him isn't until Feb. 14th.  :(

I think I may end up on Oxycontin.  But, I did read that it takes 4 days or so for Opana to reach a steady state level in the bloodstream so I am hoping things will iron themselves out by next week.  When I call my doctor on Friday, I am going to ask for permission to revert the night time dose back to 30 mg from 15 mg.  to see if that helps with the withdrawal symptoms in the morning.  

To weathergirl: I agree with you that I need to talk to my doctor about more flexibility.  I don't think the Opana is lasting 12 hours despite the new "TimerX" technology that Endo pharmaceuticals brags about.  I just think my body is different.  I really think taking the Opana on an every 8 hour schedule should fix things so I plan to bring that up at our next appointment on the 3rd.  I would like to maybe not have the every 8 hour schedule set in stone but to have the flexibility to switch to that schedule if I need it.  And not necessarily another 30 mg tablet at the 8 hour mark but a 15 mg tablet instead similar to how weathergirl is setup.

Whew! rough day ya'll.  Hoping to wake up a little more alert tomorrow.  

femmy

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1331804_tn?1336870958
Hi All:

I wanted to let you all know that I am doing MUCH BETTER on the Opana ER now!!  I am not sure why it took 4 to 5 days to really gain momentum but it is working quite well now since I went back to the original dose that I freaked out about, 30 mg every 12 hours.  

The 30 mg Opana I take at night is MUCH stronger than the 30 mg Opana I take in the morning...probably because there is a lot more medication in my system from all of the other meds I take during the day.  But taking 30 mg Opana at night lets me sleep through the night and I don't wake up in withdrawal.  I was able to sleep a little bit longer this morning as my hips didn't start hurting at 7 am like they did every weekend morning when I was on the morphine.

My low back stills have some moderate pain throughout the day but it is tolerable.  My PT supposedly "fixed" my sacrum a couple of weeks ago by doing some crazy stretch of my upper body in one direction and then she lifted one of my legs up and stretched it in the other direction.  I felt a weird stretch like sensation that I have never felt before and all I initially had was pain from the weird muscle she stretched BUT I took 7 percocets that day along with the morphine so something could have been injured but just didn't know it until I went into withdrawals earlier this week from the lower dose of Opana.  I hope the disc touching the S1 nerve root didn't push out more.  The Opana is helping a lot more with this additional severity of low back pain and the pain that radiates up into my upper back and shoulders is completely gone for most of the day.  Sometimes it breaks through during the day but it is only for about 15 mins versus just lingering on and on.  Upper back pain was a frequent complaint when I was on the morphine.

Earlier in the week before the Opana really started to kick in the pain in my lower back was the worst it has been in months!  The pain was running through my butt and shooting down to my ankles!  Every step I took was excruciating!  My doctor said that I could take 45 mg of Opana during the day if I needed it since I also have generic 15 mg tabs on hand.  I instead decided to step up to originally prescribed nighttime dose of 30 mg of Opana and the next day I could get around a lot more easier.  But when I go in next month for an appointment, I am going to ask him if I could take the 15 mg Opana either together with the 30 mg Opana in the morning or 8 hours after taking the morning dose of 30 mg similar to how weathergirl has her dosing schedule set up.  This would give me more flexibility from the long acting medicine for days when I have really bad pain flares and would further reduce the IR breakthrough meds that I would need to take.

But I am AMAZED at the change in the results!  Yesterday I took 2 percocets at 7:45 am and 30 mg of Opana at 9:00 am.  I had pretty consistent pain relief until 5:30 pm!!!  I have never been able to go that long without taking an IR med for breakthrough pain since I started opioids.  So when the dose is therapeutic, the Opana does last pretty much the full 12 hours!  The only other test is its effectiveness when cleaning the house or during some other high activity level task.  The extreme fatigue that I had earlier in the week has disappeared but it is still very sedating and I can actually feel when additional medicine is being released as a wave a tiredness (and sometimes dizziness) overcomes me for about 15 mins and then it is gone but repeats itself several times throughout the day.

I will continue to keep you all posted but I am starting to really like the Opana.  

femmy  :)  
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Avatar_f_tn
Thanks for the update!...Glad to hear things are evening out for you with both pain control and side effects...

When I had to switch from Oxycontin to MSContin....it took about a month to work out the fatigue and bit of nausea that came with it...

Sounds like you have a really good Dr. willing to hear you and work with you on everything...

And that's great that it's giving you good pain control to only have to take the breakthrough when needed....it will keep it working better too...

Hope you have a great weekend!:)
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1331804_tn?1336870958
Hi Weathergirl,

Thanks for responding!  After I posted earlier I ended up getting rather sick.  I got really dizzy and was lying on my bed with my feet propped up for about 2 hours!  But I wanted to move around and made several attempts to do so but every time I got up I became super nauseated!  Finally when I thought it was safe I threw up two times.  :(  And during the dizzy period I had absolutely NO PAIN...it was very strange.  

After I threw up, I called my pharmacist and told her about my entire week's experience with Opana and she asked me to check my pupils and they were fine.  I told her I didn't have any respiratory depression during the dizzy spell.  She told me the medicine take 3 days or so to reach steady state so by tomorrow morning, it will be full strength.  She didn't think I threw up my pill because I got sick 4 1/2 hours after taking it, in which she said the pill had already moved to the small intestine.  It has been about 3 hours since I got sick and I still have good pain control.  Some of the low back pain came back but I think I can make it to 9 pm when I am scheduled to take my nighttime dose.  So it sounds like both MS Contin and Opana come with nausea in the beginning.  When I first started MS Contin, I had heart burn and headaches, both of which went away.  Gotta "love" these adjustment periods!

You have a great weekend too!!  Thanks again for your help and advice.  It is much appreciated!

femmy  :)
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Sorry to hear you got sick...Yea...it took a bit of time to get used to a new medicine...I would have Tums with me at all times...

Also..for me...it turned out that the Acetaminophen in the Percocet that I used to take for my breakthrough pain was causing more of my nausea than even the MSContin....The bad part is I was moved to both of them at the same time...

Literally a week after switching over to OxyIR (generic) which is just plain oxycodone short release...it made a HUGE difference and I never feel nauseaous anymore....(This was done about a month after I started the MSContin....)

So...that may be something your Dr. can discuss with you if that is an option...Again...I have no health insurance so I am all about the cost too...and OxyIR 5mg is really cheap....I get 'up to 8 a day' for my prescription which gives me flexibility if I need to add a 5mg or two at a time to help with the bt pain....

Anyway...I hope that it settles down soon for you and continues to be helpful with your pain control...

Yea...isn't it fun being a human guinea pig! LOL
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Hi Weathergirl,

Yes it hasn't been fun today.  I have only taken one dose of my other meds as I think I took the Gabapentin too close to when i took the Opana.  I took the Gabapentin 1 hour after taking the Opana as that is around the timeframe that I would take it when I was on Morphine.  During the week I take the Gabapentin 3 hours after taking the Opana/Morphine(was).  So this was my first day trying out the Opana on the weekend schedule...LOL.  

My doctor seems a little hesistant about prescribing anything pure oxycodone.  He didn't like how much acetaminophen I was taking via 7 percocets a day but proceeded to say that we need to get your dosing of the Percocet down versus he could have said, let's start you out on oxycodone IR versus Percocet to eliminate the tylenol.  Additionally, the same thing happened when I told him that my old PCP (which is a friend of his) said to ask you about Oxycontin.  He said let's try Opana first.  Perhaps it is because I am new and he wants to see how things go and/or he doesn't want his name on the scripts for oxycodone IR and Oxycontin going to someone new.  I don't know his reasoning behind his choices for me but I am grateful he has done SO MUCH for me already after only one doctor's visit.  I have read all of the internet that many doctors are making their chronic pain patients trade in Oxycontin for Opana.  But Opana I have read is starting to get abused a lot now too so who knows if Opana will become the next Oxycontin or not.  It is just frustrating the hoops compliant chronic pain patients have to jump through for their medications these days.  But what can we do? But just hope for the best in each coming year we live.  But I feel deep inside that if he had to prescribe pure oxycodone for both IR and ER that he would.  

I have only taken two percocets today at 8 am.  And, who knows? The percocet could have played a factor in me getting sick but I seemed fine after Opana hit full strength an hour in and then I took the Gabapentin and an hour later...all hell broke loose.  LOL!  So I have taken 1 of 3 Flexeril, 2 of 4 Gabapentin, 1 of 1 valium (because I was having a panic attack from valium withdrawal as I tapered again from 3 mg to 2 mg because I felt that was best at the beginning with Opana and I had to cut the pill in quarters and take 1/4 because the panic attack happened when I was DIZZY!!  So I knew I could take much given all that was already going on but the measly .5 mg of valium stopped the panic attack and I was very happy for that).

You aren't kidding about feeling like a guinea pig.  I sometimes even feel like I am in observation tank with the doctors looking from above! LOL

femmy  :)
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Sounds like you take a lot of the medicines at night...The Flexeril, Gaba, and valium..on top of the Opana....Is there any way to space those out more during the day or early morning? I could see how the Flex.Gaba, and Valium would cause a huge dizzy spell!....

And I wonder if you were to mention the 5mg OxyIR....he may not be hesitant about that all...Maybe he is more thinking about the Roxicodones which are 15mg.. and 30mg...So...it could be worth mentioning next time around...saying that you are still getting nauseaous...and that having the option to take a 5mg OxyIR when needed for breakthrough might help...

Then he will see you are asking for the lowest ones to be taken throughout the day...

Anyway...just some thoughts...

Keep on trying and tweaking things with him...you'll get to a great place soon and being comfortable without major side effects and decent pain control....I'll be praying for you!!!

Take care..
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1331804_tn?1336870958
Hi Weathergirl,

Thank you so very much for your prayers!  I was able to sleep 10 hours overnight and into this morning but I woke somewhere between a rock and a hard place.  I woke up 1.5 hours before my Opana morning dose and I was in withdrawal and omg the pain!  Took two percocets and 1 flexeril at that time and felt a little better.  Now I am about 30 mins away from the Opana peaking.  I don't plan on taking the Gabapentin until sometime after 3 hours from taking the Opana like I do on the weekdays.  It makes me feel better that you could see why I got dizzy so hopefully spreading things out a bit on the weekends would help.  I might try taking 1/2 the normal dose of Gabapentin today to see how things go.

I typically take 2 gabapentin (600 mg) at 10 ish am or so and the other two at 6 ish pm or so.  The flexeril I typically take 1 upon waking, and then 1 at noon and then 1 at 4pm.  The valium I typically take 1-2 mg at 2 pm and 1 mg at bedtime.  But obviously given what happened yesterday, I am going to have to tweak the schedule.  I plan to brainstorm new times for all of my meds starting at least 3 hours from taking Opana ER.  

You are right that if I brought it up to him, he probably would have considered Oxy IR 5 mg for breakthrough.  He did have a med student yapping in his ear about how the tylenol in percocet is probably providing some additional analgesia.  I will definitely discuss it with him at next month's appointment if the nausea doesn't let up.  

PLEASE let today be a better day!!! PLEASE!!  LOL!  I think I have reached steady state now so it shouldn't get any worse.  I really like how amazing well the Opana works for me such that I hope I can adjust to it as I have a feeling the Oxycontin would just be a different roller coaster ride...not necessarily better.  I really hope I won't need another titration for 5-10 years...I am fed up with the wild side effects after switching to a different med or increasing the dosage of a med.  But my pain is usually the decision maker...lol!  I always say this and then my pain worsens and I find myself buckling up for another ride.

It seems surreal to not need hardly any percocet during the day but I am very happy to be able to loosen "the chain" a bit.  I hope to do some house cleaning today...we'll see how that goes.  

I'll be sure to post an update later on.  Again, I appreciate the continued support.

femmy  :)  
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I take 400 mg subbys  and 20 mg opal with 120mg percucet as needed has any notices that when they take opana it makes them nausea
Precious
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I was on Opana for a short time. It was a high dose, and it didn't help me at all. I'm opiate tolerant(been on them for many years), the pain releief just wasn't even close to my previous medications. I did some research and found out that it has a poor bioavailability-meaning your body doesn't absorb the drug as readily as others might.
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