Aa
In search of anwsers
I was hoping that all you kind peps would give me your input about Opana ER. I am on fentanyl 175/48 hrs. right now. not what I want it to be. I really need to find a solution. Thanks.
Welcome and Thank for sharing your information.
I'm sorry to tell you that many - indeed most won't see your post. It's on an old thread that belongs to another member. - and these old threads are just not reviewed very often.
I encourage you to copy and past your post onto a new thread "Post A Question". You can find that choice at the top right hand side of this page, just outside this thread. It's in a green box. I'll look forward to reading it.
Take Care,
~Tuck
I'm sorry to tell you that many - indeed most won't see your post. It's on an old thread that belongs to another member. - and these old threads are just not reviewed very often.
I encourage you to copy and past your post onto a new thread "Post A Question". You can find that choice at the top right hand side of this page, just outside this thread. It's in a green box. I'll look forward to reading it.
Take Care,
~Tuck
I think they are developing an Oxymorphone nasal spray, which has a BA of~40%. I've always had the best results with Opana/Oxymorphone (vs Oxycodone) because it lasts longer, it is more "targeted" and hits the right receptor(s) that helps my pain without the "rush" or euphoria Oxycodone seems to produce for me. Oxycodone gives me energy (part of the euphoria, I suppose) and it makes it tougher to sleep. I have a great doctor, and he has no reservations prescribing Opana IR - many doctors don't like prescribing Opana IR because it's very easy to abuse - the BA increases dramatically if you crush and snort it (~40%) or IV/IM it ~(90%). Many pharmacies won't carry it because it is highly sought-after for diversion/abuse... and as someone pointed out earlier in this thread, the withdrawals from Opana are the worse I've ever experienced. MDs and Pharmacists simply don't want to deal with the risk.
Opana is very subtle, and doesn't leave me feeling like a space cadet. Since it is subtle, I don't feel the "urge" to misuse it like I do with the Oxycodone. So, after trying just about everything (except exotics like Levorphanol), 25 mg patch of Fentanyl (also very subtle to me) and up to 4x10mg Opana IR for breakthrough is the right cocktail for me.
But everyone is different. I hope you all find a competent pain specialist who you can trust, and build a good rapport with him/her. It's also important to find at least one ER and one IR "fallback" medication in case a shortage arises, a formulation is changed (eg. plastic Opana ERs), and make sure your primary care provider knows what you're taking in case something happens to your PM doc.
Be well, and God bless poppies!
Opana is very subtle, and doesn't leave me feeling like a space cadet. Since it is subtle, I don't feel the "urge" to misuse it like I do with the Oxycodone. So, after trying just about everything (except exotics like Levorphanol), 25 mg patch of Fentanyl (also very subtle to me) and up to 4x10mg Opana IR for breakthrough is the right cocktail for me.
But everyone is different. I hope you all find a competent pain specialist who you can trust, and build a good rapport with him/her. It's also important to find at least one ER and one IR "fallback" medication in case a shortage arises, a formulation is changed (eg. plastic Opana ERs), and make sure your primary care provider knows what you're taking in case something happens to your PM doc.
Be well, and God bless poppies!
If having major surgery soon after having stopped taking meds like exalgo, fentanyl, oxycotin, opana, etc. (Last 60 days or so) be sure the hospital workers know. In case of car accident, keep a list easily located, even on a card around your neck, etc. Along with allergies. I stopped oxycontin 40 x 2 / day, + 600 mcg fentanyl IR, but while still taking opana 10s IR 2x / day 30 days before my 2nd major neck surgery. I didn't tell the Drs or hospital staff since it was 30+ days ago. Tolerance was still there though. I awoke in severe uncontrolled pain after surgery, they assumed I was faking for more meds, until my BP went sky high, nearly coded, and they consulted my wife. She informed them of my prior meds. They then quickly brought meds IV dose after dose after dose eventually putting me back under to get control then start over with reawakening me. I didn't tell them originally bc I was worried they would assume I was still taking it all and OD me. Please make sure they know how much of x, last use, etc., even if it's illegal use. Mine wasn't illegal but I had no choice but to go cold turkey 30 days before my surgery since damn DEA arrested my pain mgmt doc for conspiracy, not even actually committing a crime. He was as really helping me, legit med reasons, military injuries that VA denies military connection. VA no help, DEA stopped the help I finally needed and left 4000 others, many vets, cold turkey. Off point though. All above, just my experience, lesson learned, maybe it will help others too.
Sorry, but that's not correct.
When oxycodone metabolizes, it leaves 15% as oxymorphone. Because oxymorphone has a longer half life than oxycodone, it is often present in the urine after oxycodone falls below the detection threshold.
See PPM for more info:
http://www.practicalpainmanagement.com/treatments/pharmacological/opioids/oxycodone-oxymorphone-metabolism
When oxycodone metabolizes, it leaves 15% as oxymorphone. Because oxymorphone has a longer half life than oxycodone, it is often present in the urine after oxycodone falls below the detection threshold.
See PPM for more info:
http://www.practicalpainmanagement.com/treatments/pharmacological/opioids/oxycodone-oxymorphone-metabolism
I'm a multiple sclerosis patient (for the last 8 years) and I have had every single pain med known to man, in that time... All boils down to this - for the last six or so years, I have been on either OxyContin 40mg ER or Opana 40mg ER - every 12 hours & never at the same time; I complained the other day that the Opana wasn't doing its job right (it wasn't truly "bad" - I was just ready to try a different opiate due to tolerance of the OxyContin & the Opana... Long story short, my neurologist put me on Fentanyl 100 mcg every three days, and for the last 2 days that I've had it on, my actual pain levels are non-existent; I would think that 3 100 mcg patches would be harmful, but what do I know - I don't have cancer, just MS - maybe I'm wrong, but 300 is a HUGE dose!!! Oh, and I wanted to point out that you had the metabolites backwards: the Opana metabolizes into oxycodone, not the other way around - but it's all good - honest
Istake...
Istake...
1 Comments
You are actually only on 100 MICROgrams of fentanyl. It realeases that amount into your system every hour. You are to change the patch every 3 days. You should only be wearing one patch at a time, thus making it 100 micrograms. Not 300. Relax it's okay lol I'm on the same thing and agree completely! My pain went from being unbearable to practically non-existent
Hi, I'm having gastric bypass have been on Opana 30mg er 3 x a day for 2 years. Percocet 10/325 for break thru. Let's not forget I also have a spinal cord stimulator . I'm am trying the fentanyl patch 50 x72 hours. I started to get sick the first day, took off the patch went back to opana. I have to make this work, I'm told with gastric it will pass right thru . So this morning I have the patch on the opana hasn't worked well in the last year, lots of break thru, I have rods in my back so I cannot vomit, very very painful, so trying to keep out if withdrawals . Any help or direction I have the best pain clinic dr.she really listens
1 Comments
I have a lap band and experienced the same problem with the patch. The patch is contraindicated with any kind of gastric restriction (technically, all er (extended release) medications have the same contraindincation. I am now trying opana....I'll update this when I know the answer to it. My doctor believes I am wrong but it is in writing so I am not making it up. I showed him the paper (from Rite Aid, the patient handout on fentanyl patches!) and now he believes! You have to try the med and see how you react!
It MIGHT be okay, and it MIGHT NOT. IMMEDIATELY contact your doctor. Today is Saturday -- THAT'S FINE -- CALL the weekend emergency phone number NOW. Turn off your computer, CALL NOW.
Too high = too much = possible overdose!
It's not like 5 percent more or 10 percent more. No, you have FIFTY percent more. That's a big jump. From what I read about the recent version of Opana, it may not be the best idea to use "how you feel" from the Opana to judge future opiate conversions.
Again, it MAY be okay, but hey, at the price of a quick phone call (uh, like FREE), it's worth it to call and make sure.
NOW (why are you still reading....)
Too high = too much = possible overdose!
It's not like 5 percent more or 10 percent more. No, you have FIFTY percent more. That's a big jump. From what I read about the recent version of Opana, it may not be the best idea to use "how you feel" from the Opana to judge future opiate conversions.
Again, it MAY be okay, but hey, at the price of a quick phone call (uh, like FREE), it's worth it to call and make sure.
NOW (why are you still reading....)
Hi. I switched from 25 mcg fentanyl which I replaced every 48 hrs as I absorbed the drug more quickly. Due to insurance I switched to opana er I began at 20 went to 30 mg twice daily due to insurance. Didn't help at all with pain. Decision was made to try fentanyl again. This time the usual 3 days. My drugs arrived and it was 75 mcg. I expected 50. Did she do the conversion correctly. I'm concerned about the dosage being too high. Any comments. Please.
whoops! hit the censor...let me rephrase my sentence: The 10% bioavailability of Opana ER is crummy. :)
femmy
femmy
I totally agree with what you have said. The 10% bioavailability of Opana ER *****. Earlier this year, I was at 30 mg twice a day and it worked wonderfully for a month and then things went south. I jumped ship to Fentanyl TD before the new reformulated Opana ER came out and I am glad I did as there are many chronic pain patients across the web saying that it is 50% less effective than the original formula.
I mentioned it only because the OP said that Oxycontin OP (weird sentence lol!) worked very well for her and many chronic pain patients have said the reformulated Oxycontin ***** similar to how Opana ER super ***** now. But the OP seemed to have success with the new Oxycontin so I was thinking she might (and I say, might) have success with Opana ER as some folks are wired differently then the majority.
femmy
I mentioned it only because the OP said that Oxycontin OP (weird sentence lol!) worked very well for her and many chronic pain patients have said the reformulated Oxycontin ***** similar to how Opana ER super ***** now. But the OP seemed to have success with the new Oxycontin so I was thinking she might (and I say, might) have success with Opana ER as some folks are wired differently then the majority.
femmy
I have been on opiates of almost every type for many, many years. the only problem I have with opana is the fact that a relatively low amount of the drug that the body absorbs. this "little detail" made it a poor choice for my pain control. I understand everyone is different, and reacts differently to different drugs, and differing dosages of said medicines ( I'm using the word "different" alot--oops I did it again!). I think opana is a good drug, but given it's bioavailabiliy, one must be on a "higher than average" dosage that most doctors would be very reluctant to prescribe. This is just my 2-cents, nothing more.
Not even close. 120 mg of Oxycontin is equal to 180 mg of MS Contin based on a 0% cross tolerance.
200 mg of Oxycontin is equal to 300 mg of MS Contin.
femmy
200 mg of Oxycontin is equal to 300 mg of MS Contin.
femmy
Hi emmaless,
Am I reading your post correctly that you were taking 80 mg of Oxycontin 3x per day and 40 mg of Oxycontin 3x per day? If yes, keep reading...LOL. I thought you wrote that you were taking 80 mg and 40mg total of Oxycontin per day. That is why my post to your other thread stated that you were on more medicine through Fentanyl than through Oxycontin. That is not the case if you taking the 80 mg and the 40 mg 3x per day. That is 120 mg x 3 or 360 mg of Oxycontin per day vs. 120 mg per day. Let me rerun the conversion calculator...
So if you remember I converted your total daily dose of Fentanyl to Oxycontin and it came out to be 210 mg of Oxycontin. That is 150 mg of Oxycontin less than what you were taking through Fentanyl vs. 90 mg of Oxycontin more than you were taking. It now makes perfect sense to me why you are in so much pain on the Fentanyl. Converting 360 mg of Oxycontin to Fentanyl results in 150 mcg/hr...this is conservative. Converting Fentanyl to equal 360 mg of Oxycontin with the opioid calculator results in 300 mcg/hr. This is the largest dose conversion that is shown in the fentanyl prescription leaflet that comes in the box with the medication. So your doctor's thoughts that you need to keep going up on the Fentanyl patch are CORRECT.
There is another option for you. Many patients who require large doses of opioid medication daily for the management of chronic pain typically combine two long acting medications together. For example, most are on the Fentanyl patch but also take a smaller dose of Oxycontin, MS Contin, or Opana ER daily along with a short-acting medication for breakthrough pain. If you are uncomfortable with wearing three 100 mcg/hr patches, it is possible that your doctor could prescribe for you to wear two 100 mcg/hr patches and to take Oxycontin 40 mg 3x daily or Opana ER 20 mg 3x daily or MS Contin 60 mg 3x daily. The 200 mcg/hr Fentanyl patch combined with any of these options (Oxycontin, Opana ER, MS Contin) would yield a total daily dose of 360 mg of oxycodone a day. This would be equal to your previous dose of Oxycontin before the switch to the Fentanyl patch. If you prefer less than 200 mcg/hr Fentanyl, your doctor could prescribe more medication in long acting pill form and less in transdermal patches.
Given incomplete cross tolerance, you may need less of the Oxycontin, Opana ER, or MS Contin (Exalgo is a option as well) than the conversion based numbers above.
Problem is that when the opioid dosage gets up to the large amounts above, undesirable side effects increase significantly which can limit the amount you can take comfortably, and most importantly, safely. A slow titration up can help minimize these side effects but most still experience a large amount of undesirable side effects at large dosages. I read your additional post on your other thread explaining the health conditions that are causing your chronic pain so I completely understand your need for high doses of opioid medication. You are not alone. I have run across a patient that is taking 700 mg of morphine a day and another patient that is on 200 mcg/hr Fentanyl plus 10 mg of Opana ER 3x a day.
So given the above conversions, you know approx. where your optimal dosage lies and you just need to work closely with your doctor to titrate up your dosage of long acting medication. I think the Fentanyl should lie somewhere between 200 mcg/hr and 300 mcg/hr with another long acting opioid medication added at bid or tid dosing.
Just wanted to let you know that based on your post above stating that you were taking 120 mg of Oxycontin 3x per day, your doctor's recommendation to keep titrating up is a good recommendation as your current dosage of Fentanyl is suboptimal.
Good luck and keep us posted on how your titration period is going with your doctor and the final dose that you and your doctor decide upon. I now believe that you can get effective pain relief from the Fentanyl but you need to work with your doctor and keep titrating up to get there.
femmy
Am I reading your post correctly that you were taking 80 mg of Oxycontin 3x per day and 40 mg of Oxycontin 3x per day? If yes, keep reading...LOL. I thought you wrote that you were taking 80 mg and 40mg total of Oxycontin per day. That is why my post to your other thread stated that you were on more medicine through Fentanyl than through Oxycontin. That is not the case if you taking the 80 mg and the 40 mg 3x per day. That is 120 mg x 3 or 360 mg of Oxycontin per day vs. 120 mg per day. Let me rerun the conversion calculator...
So if you remember I converted your total daily dose of Fentanyl to Oxycontin and it came out to be 210 mg of Oxycontin. That is 150 mg of Oxycontin less than what you were taking through Fentanyl vs. 90 mg of Oxycontin more than you were taking. It now makes perfect sense to me why you are in so much pain on the Fentanyl. Converting 360 mg of Oxycontin to Fentanyl results in 150 mcg/hr...this is conservative. Converting Fentanyl to equal 360 mg of Oxycontin with the opioid calculator results in 300 mcg/hr. This is the largest dose conversion that is shown in the fentanyl prescription leaflet that comes in the box with the medication. So your doctor's thoughts that you need to keep going up on the Fentanyl patch are CORRECT.
There is another option for you. Many patients who require large doses of opioid medication daily for the management of chronic pain typically combine two long acting medications together. For example, most are on the Fentanyl patch but also take a smaller dose of Oxycontin, MS Contin, or Opana ER daily along with a short-acting medication for breakthrough pain. If you are uncomfortable with wearing three 100 mcg/hr patches, it is possible that your doctor could prescribe for you to wear two 100 mcg/hr patches and to take Oxycontin 40 mg 3x daily or Opana ER 20 mg 3x daily or MS Contin 60 mg 3x daily. The 200 mcg/hr Fentanyl patch combined with any of these options (Oxycontin, Opana ER, MS Contin) would yield a total daily dose of 360 mg of oxycodone a day. This would be equal to your previous dose of Oxycontin before the switch to the Fentanyl patch. If you prefer less than 200 mcg/hr Fentanyl, your doctor could prescribe more medication in long acting pill form and less in transdermal patches.
Given incomplete cross tolerance, you may need less of the Oxycontin, Opana ER, or MS Contin (Exalgo is a option as well) than the conversion based numbers above.
Problem is that when the opioid dosage gets up to the large amounts above, undesirable side effects increase significantly which can limit the amount you can take comfortably, and most importantly, safely. A slow titration up can help minimize these side effects but most still experience a large amount of undesirable side effects at large dosages. I read your additional post on your other thread explaining the health conditions that are causing your chronic pain so I completely understand your need for high doses of opioid medication. You are not alone. I have run across a patient that is taking 700 mg of morphine a day and another patient that is on 200 mcg/hr Fentanyl plus 10 mg of Opana ER 3x a day.
So given the above conversions, you know approx. where your optimal dosage lies and you just need to work closely with your doctor to titrate up your dosage of long acting medication. I think the Fentanyl should lie somewhere between 200 mcg/hr and 300 mcg/hr with another long acting opioid medication added at bid or tid dosing.
Just wanted to let you know that based on your post above stating that you were taking 120 mg of Oxycontin 3x per day, your doctor's recommendation to keep titrating up is a good recommendation as your current dosage of Fentanyl is suboptimal.
Good luck and keep us posted on how your titration period is going with your doctor and the final dose that you and your doctor decide upon. I now believe that you can get effective pain relief from the Fentanyl but you need to work with your doctor and keep titrating up to get there.
femmy
femmy,
Thanks fot the responce. I have read some reviews, and it doesn't sound like a good option. I have only been on fent a short time. I switched from Oxy 80er & 40er three times daily. Pluse breakthrough. This worked really well for me. I just could not afford it. I talked to my doc about going back and she wants me to at least try a few other things not so on the radar. So..... That is the issue
Thanks fot the responce. I have read some reviews, and it doesn't sound like a good option. I have only been on fent a short time. I switched from Oxy 80er & 40er three times daily. Pluse breakthrough. This worked really well for me. I just could not afford it. I talked to my doc about going back and she wants me to at least try a few other things not so on the radar. So..... That is the issue
Hi emmalee,
I was on Opana Er from Jan through Apr of this year. I switched to Fentanyl because Endo pharmaceuticals reformulated the pills and there are numerous compliants all over the web about how the new pills are making people sick and the potency is about 1/2 the potency of the original formula. Comparing the nonexistant original formula with Fentanyl...Fentanyl works much better on my pain. The pain relief is more consistent. I don't have the up and down roller coaster every 12 hours like I did on extended release pills. Your results may be different but BEWARE...Opana ER is different now and manufactured with plastic polymers (and some other junk) to make them crush resistant so that you can't snort them...similar to Oxycontin OP. Everyone is different when it comes to how the body responds to medications. I recommend that you read some medication reviews on Opana ER at http://www.webmd.com and http://www.drugs.com.
Wishing you the best.
femmy
I was on Opana Er from Jan through Apr of this year. I switched to Fentanyl because Endo pharmaceuticals reformulated the pills and there are numerous compliants all over the web about how the new pills are making people sick and the potency is about 1/2 the potency of the original formula. Comparing the nonexistant original formula with Fentanyl...Fentanyl works much better on my pain. The pain relief is more consistent. I don't have the up and down roller coaster every 12 hours like I did on extended release pills. Your results may be different but BEWARE...Opana ER is different now and manufactured with plastic polymers (and some other junk) to make them crush resistant so that you can't snort them...similar to Oxycontin OP. Everyone is different when it comes to how the body responds to medications. I recommend that you read some medication reviews on Opana ER at http://www.webmd.com and http://www.drugs.com.
Wishing you the best.
femmy
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Another option is Exalgo, it is extended release hydromorphone (dilaudid) that is a pill taken once per day as it works for 24 hours versus 12 hours. It is slightly weaker than Opana ER. With my insurance Exalgo is ungodly expensive!! But that may not be true for you.
I know Opana ER and Exalgo companies offer a copay card and a patient assistance program which is income based. Many are getting these expensive meds for free through the patient assistance programs. So you should go to both websites and call their toll free number to see if you qualify.
femmy :)