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difference between hydrocodone and hydromorphyn

Ok I know that hydrocodone has acetaminophen in it and hydromorphyn doesn't.   My question  really is when is it more beneficial for hydromorphyn to be  used for chronic pain over hydrocodone?
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7721494 tn?1431627964
I went through the same transition. On methadone for 11 years, and then came off going to hydromorphone. It took about a year to go from 160mg down to 40mg/day, and then I needed a doctor to help me make the transition to hydromorphone.

Today I'm using morphine. It covers the pain, but I haven't slept well since I came off the methadone 5 years ago. Of course, on methadone, I could sleep all day, wake up and still feel tired.

I don't know if the hydrocodone will be strong enough for you. I can't use oxycodone anymore -- tolerance is too high. If you're like me you may be better off with morphine or hydromorphone.

Ask your doc.

Good luck.
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Avatar universal
Thank u both  philnoir and jerry _oll19 for a wealth of info on the two medications i adked about.
Back ground info: i have been on opiate pain medication for chronic pain for 10+ years
  About 2yrs ago i made the jump off of methadone, after being tapered off of 10 mg x8 dayly & 5yrs of use. I was very nieve about pain medication and was put on heavy dose for chronic back pain,bulging disk in C6&7 and L2&3?. After that Dr was no longer in practice. Another  primary care Dr took his place and the chang was made to tramadol and norco10/325. After i was able to manage on that for a few months  that PC sent me to a pain management Dr to continue treatment.  I have neen going for about 3 months.  A couple of months ago while talking to the RN she spoke to me about making aove to hydrocodone 10/325 & fentanyl patch 12mcs.(see other post,scared I'm going to be kicked out of pain management ) I discussed with her my fear of fentanyl patch and in the end we made a choice to start it.  I was only on it for a month  and a half and got sick with  upper respiratory infection and took my patch off due to the fear of respiratory distress while sick. Feeling that if any withdrawal happened it would be manageable with my norco. Non the less withdrawal got VERY bad and i made the choice to goto the ER with server withdrawal symptoms. I could of put the patch back on but choose not to due to the withdrawal symptoms and wanted to  get them over with now.  I was  not going to go back to the fentanyl patch after becoming well or after the ER visit.  Went to see my pain management Dr the following Monday and decided to just stick with tramadol er 100mg x3 and norco10/325 x3 dayly. We talked about hydrocodone verse hydromorphyn and decided to think about it this month befote making a decision.
Was not sure if hydromorphyn was the were i wanted  to be  after the fentanyl patch situation i was in.  Methadone was hard to get off of bit fentanyl patch was worse to withdraw from than methadone, to me that is.
So hince the inquiry about the two meds. With what i am taking now i still have pain but yes can manage with a 3/4 pain level. Just not sure how the hydromorphyn would do any better. Knowing  also that my tolerance would probably increase on it.
So thank u for the extended information thathaf a wealthof knowledge in it. I have alot of information to think  about.
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7721494 tn?1431627964
I just realized that I didn't answer your question -- which medication is right for you?

The answer requires a knowledge of your pain condition and medical history, so let me answer in general. But before I start, remember this:

the decision to enter into chronic opioid therapy (COT) is not to be taken lightly. While opioid analgesics can be effective for some chronic pain, for certain pain syndromes, it does not relieve much pain. Also, entering into COT means that you will become dependent on the drug, and opioid tolerance will eventually lower the effectiveness of your medication. There is also risk of addiction in 5%-10% of people who begin COT.

Ten years ago it was easier to choose the right pain medicine -- chronic pain that was mild or moderate was treated with CIII medications -- codeine, propoxyphene, and hydrocodone. Pain that was moderate to severe was treated with the CII medications -- oxycodone, morphine, hydromorphone, and methadone.

It was then a matter of trying different medications on a patient, depending on their pain syndrome, and see what worked best.

Today, that's changed. Propoxyphene is no longer available, and hydrocodone has been elevated to CII -- here's a few stories on that.



Codeine is the only  CIII opioid analgesic left, and it is not well tolerated in many patients.

Also, doctors are reluctant to prescribe CII medications because that class of opioids has a much higher level of oversight than any other. Prescribers are under a great deal of pressure to write for less opioids overall, and in lower doses to individual patients. Some prescribers will not write for opioids in any situation where pain lasts more than 90 days.

Every pain patient needs to understand to use the lowest strength opioid at the lowest dose possible to reduce pain to a comfortable level. This helps in delaying opioid tolerance and dependence.

People with chronic pain do better by seeking other means of therapy and learn behavioral chances to help manage that pain. So, with pain, whatever works is a good strategy. Those therapies and behaviors can include exercise, physiotherapy, CBT, TENS, and many other therapeutic techniques.

If you can discover a half-dozen ways to  reduce pain by a point or two, you're able to manage your pain. The trick is to put two or three together to reduce pain by 50% or more and you've reduced pain to a tolerable level.

Never depend solely on opioid medications to reduce all of your pain. It won't work and you'll find yourself in trouble, taking too many pills a day, running out early, and creating a bad reputation.

Still haven't answered your question, have I? Well, knowing nothing about your pain makes suggesting treatments difficult.

For example, if you have a pain syndrome similar to mine,  and therefore had moderate intractable pain from degenerative spine disease, and if I were part of your pain treatment teatm, I'd suggest either an extended release hydrocodone or oxycodone like OxyContin or Zohydro ER. Both these medications are on the low end of the pain medicine spectrum as far as strength, and they come in many doses which makes them easy to titrate.

You can still get in trouble with opioid pain medications if you don't follow your doctors orders and that rule of thumb about using the lowest amound of opioids to do the job.

Best wishes
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7721494 tn?1431627964
Purrm3, yes that is correct.

Indeed,  the liver enzyme CYP2D6 is responsible for the metabolism of hydrocodone, codeine, and dihydrocodeine to their active metabolites; hydromorphone, morphine, and dihydromorphine.

If a metabolite is "active" it too occupies an opioid receptor and helps reduce pain.

All of these active metabolites occur in fractions, some less than 10% of the total amount of hydrocodone. I don't have the specific numbers for hydrocodone, but they probably can be found with a google search if you're interested.

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Avatar universal
Philnoir u are right about the hydrocodone not having the  acetaminophen in it.  My mistake i was thinking of the norco or vicodin and miss spoke.  Thank u for correcting that for other  readers.  
I also understand that when hydrocodone is broken down in the body some of it is converted to hydromorphyn. Just not clear on when it would be more beneficial for a person with chronic pain to use one over another.
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7721494 tn?1431627964
Hydromorphone and hydrocodone are both semi-synthetic opioids, but hydromorphone is a much stronger pain reliever -- about 10 times stronger than hydrocodone.

btw, hydrocodone does not contain acetaminophen. Medications like Vicodin and Norco contain both hydrocodone and acetaminophen, but hydrocodone is itself a semi-synthetic opioid, similar to oxycodone.

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