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Opioids EXALGO---Is There a Maximum Dose?

Eva 33

Bluelighter
Joined
Mar 19, 2009
Messages
75
I'm a pain management patient. I've been taking about 500 mg. morphine per day for several years. The conversion chart says that 500 mg. morphine E.R. (Avinza) is roughly equivalent to 100 mg. Exalgo E.R.

I'm trying to switch to Exalgo due to excessive sweating from Avinza.

My pain doc prescribed me 16 mg. Exalgo, 6 pills per day. So that's 96 mg. But my insurance is trying to LIMIT it to no more than 4 pills per day (64 mg).

I've been hassling with my insurance for 3 WEEKS, probably because Exalgo is a VERY expensive med.

I can't seem to get a clear answer from insurance. One person from insurance told me that there is an FDA MAXIMUM DOSE of 64 mg. I have no idea if this is the truth or if insurance just doesn't want to pay for 6 pills a day. I just wish they'd be HONEST and give me an answer!

IF insurance will only pay for a MAX of 4 16 mg. pills per day, then I'd only be getting the equivalent of about 320 mg. morphine per day, probably LESS than what I need. 64 mg. really isn't that high for severe pain in an opioid tolerant individual.

I just thought I'd ask if anyone knows if 64 mg. really IS the "FDA MAXIMUM DOSE" for Exalgo?

If true, I'd think my pain doc would have known about this. He's been in practice for many years. He did warn me that insurance may try to limit my dose.

Also, I just wondered if anyone could recommend a long-acting pain med that is likely to NOT cause profuse sweating?

I've heard that morphine is the worst for sweating, and that's what I'm on. Maybe Oxycontin or Opana would be better? I had severe dry mouth from the Fentanyl patch, so that's not an option for me. Maybe methadone?

Thanks for any advice or answers!

Eva
 
I'm a pain management patient. I've been taking about 500 mg. morphine per day for several years. The conversion chart says that 500 mg. morphine E.R. (Avinza) is roughly equivalent to 100 mg. Exalgo E.R.

I'm trying to switch to Exalgo due to excessive sweating from Avinza.

My pain doc prescribed me 16 mg. Exalgo, 6 pills per day. So that's 96 mg. But my insurance is trying to LIMIT it to no more than 4 pills per day (64 mg).

I've been hassling with my insurance for 3 WEEKS, probably because Exalgo is a VERY expensive med.

I can't seem to get a clear answer from insurance. One person from insurance told me that there is an FDA MAXIMUM DOSE of 64 mg. I have no idea if this is the truth or if insurance just doesn't want to pay for 6 pills a day. I just wish they'd be HONEST and give me an answer!

IF insurance will only pay for a MAX of 4 16 mg. pills per day, then I'd only be getting the equivalent of about 320 mg. morphine per day, probably LESS than what I need. 64 mg. really isn't that high for severe pain in an opioid tolerant individual.

I just thought I'd ask if anyone knows if 64 mg. really IS the "FDA MAXIMUM DOSE" for Exalgo?

If true, I'd think my pain doc would have known about this. He's been in practice for many years. He did warn me that insurance may try to limit my dose.

Also, I just wondered if anyone could recommend a long-acting pain med that is likely to NOT cause profuse sweating?

I've heard that morphine is the worst for sweating, and that's what I'm on. Maybe Oxycontin or Opana would be better? I had severe dry mouth from the Fentanyl patch, so that's not an option for me. Maybe methadone?

Thanks for any advice or answers!

Eva


The largest dose of Hydromorph Contin is 30mg, and people take multiple doses a day of that one heh. There is also Jurnista 64mg over 24 hour pills.... Someone with a huge pain problem and tolerance will be able to eat hundreds of milligrams of hydromorphone. What's the largest dosage of Exalgo, 16mg ? lol your extended release hydromorph sucks in the usa.
 
Thanks for your reply. I believe that the largest dose of Exalgo ER is 16 mg. (24 hour med).

My pain level is very high, so that's why my doc thought I'd need around 100 mg. Exalgo ER. I'm afraid that being limited to only 64 mg. per day will put me in a world of pain.

Does anyone have any experience with Exalgo ER? Is 64 mg. a relatively low dose for a person with a huge pain problem? Thanks.
 
I tried Exalgo before being put on Opana ER.. I didn't like it at all.. I would stick with the MS Contin if I were you.
 
Maybe you should get this 64mg and morphine pills till the equivalence of 500mg morphine...Just an option, i'm not sure. I'm in a lot of fuckin pain too, i take a 100mcgr/h every 48hrs, it helps, but it's obvious i need more (or a strong breakthrough med), pain is such a fucked up thing...I wish you to find the solution to your problem..

MartinFn
 
Thanks for your reply. I believe that the largest dose of Exalgo ER is 16 mg. (24 hour med).

My pain level is very high, so that's why my doc thought I'd need around 100 mg. Exalgo ER. I'm afraid that being limited to only 64 mg. per day will put me in a world of pain.

Does anyone have any experience with Exalgo ER? Is 64 mg. a relatively low dose for a person with a huge pain problem? Thanks.

Exalgo is already time-released, i don't get what the hell you're talking about . The highest dose of Jurnista (same thing as hm contin, well not really, Jurnistas are more like exalgo and that push pull creepiness) is 64mg. My ex dealer who eats 4 30 hydromorph contins huge red gelcaps a day. + from 8 to 20 dilaudid 4/8mg.

Let's say Jurnista is not a big success here. Hydromorph Contins may be abusable, but from many's experience especialy legit pain patients, almost all ER concoctions are never ever as good it it spread over way too long, with H M contins you can just take some out to taper yourself in case. I'm sad for you americans, Palladone SR was basically the same thing as Hydromorph contins. i've drank 3 beers over a very small dosage of hydromorph (the pink 6mg ones, there's loads of dosages but the kings are the 30's) and you know what i didnt feel any different i felt like I had wasted 3-4 snorting sessions or 2 for IV"

Well i'm rambling a bunch I'm gonna go to bed nao.

Oh yeah forgot to say, the tiny beads inside HMContin make them last 12 hours, unlike jurnista and this exalgo silliness.
 
Hydromorphone is a crappy opiate orally and when taken that way doesn't do much for pain but ruins your tolerance

Maybe try a different opiate/opioid altogether
 
Has your p.m. doc ever tried you on nucynta er?I went from opana to exalgo er to nucynta er and have found that at least for me the nucynta works miracles!
 
I'd try oxycontin.

Is sweating the only issue? If so is it really worth messing with your meds and possibly ending up in pain just to prevent sweating. Also maybe there is something you can take to limit the sweating, a diuretic perhaps? edit: Diuretic might actually might make it worse. Figured if you increased production of urine it would limit sweating, guess not though. Diuretic also might also cause the morphine and M6G to excrete quicker than desired.
 
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