Morphine ER - can u take other drug between dosages for breakthrough pain?

[Toreadores]

Hi guys, 1st I want to apologise for the long post, but I want to give you as much information for you as possible if somebody can help me with my issue and question. If you don't want to read all of it and go straight my question just skip to the last paragraph, thank you in advance!

I was recently prescribed morphine extended release 100mg (light blue M 100) every 12 hours for chronic pain - I was hit by a car (as a pedestrian) 2 years ago resulting to broken pelvis (into 18 pieces), broken femur and damaged sciatic nerve. After my discharging and general recocery, me and my doc experimented with almost every possible narcotic painkiller during the last 10 months and of all, the morphine ER helps me the most in long term so my doc fixed on that.

During the weekends I have no problems at all, the morphine last very long and works great. The problem is during workdays, my work is in pretty stressful field and when I finish work at 4pm I am feel smashed, my pain comes way earlier than usually does and I can't take it anymore, my next doc app. is in 3 weeks and I want to find a way out untill then.

So here is what concerns me and want to ask - is it safe to take something in between the morphine dosages? I have relatively high tolerance, but I want to stay safe. I have some dilaudid 4mg IR pills left from few months ago and was wondering if there are any bad interactions between the morphine ER and dilaudid? Can I take the dilaudid for breakthrough pain?
- If I can, how long after taking the morphine is safe to take dilaudid (or in general any IR pill)? I take the morphine at 8am and 8pm.
- Or 2nd option - can I break the morphine pill in half (50mg), take it around 4pm (that's 8 hrs after the initial 100mg) and skip taking another pill until next morning?
- is there any general safe time to take IR pill after OR before an extended release drug?

Thank you for reading my story, I really hope somebody will be able to help me, everybody who went thru somekind of accident knows how devastating is to live in constant pain and how it changes you.

 

[Jekyl Anhydride]

Hi Toreadores I'm sorry that you had such a terrible accident.

First off have you spoken with your doctor about the current problems you are having with the MS not being sufficient at controlling your pain? I think that a severe case such as yours would warrant a sooner appointment to rectify this problem without you having to experiment on your own with Dilaudid. If you were not taking the 200mg a day of MS when the Dilaudid was prescribed, I wouldn't suggest taking it without at least clearing with a medical professional, as they would have a lot more relevant information about your health status, current condition, a list of other meds and any thing else that might lead to complications.

If this is something you are going to do regardless than I would highly recommend that you have someone join you that can keep an eye on your breathing and can call for help if things go awry. Unfortunately there's no real safe time to take it while on ER morphine every 12 hours. If you were to take it instead of the MS at the end of a 12 hour dose that would probably be the best scenario, if taking it is a foregone conclusion. Dilaudid is a hydrogenated ketone of Morphine and while it is absorbed poorly through the GI tract it is powerful.

Another route might be reducing your duties or taking time off work till this can be sorted out properly. Or maybe going to an urgent care facility and sorting things out there till your doctor can fit you in the schedule. While 4mg of Dilaudid equals roughly 20mg of MS, it difficult to estimate on top of Morphine already in your system. I do wish you the best of Luck, Stay Safe TA.

 

[Keif' Richards]

Hey there Toreadores!

No need to apologize for the long post. It's often greatly beneficial to the original poster to include as much detail as possible, no matter how innocuous the information may seem.

In short, there shouldn't be anything wrong with using the Hydromorphone (Dilaudid), in terms of your safety. I doubt highly that a small, additional dosage of an Opioid agonist would harm you given the fact that you are already taking a moderately large dosage of Morphine. You still must be safe tough, work your way up to the dosage that is most appropriate for your pain.

The main issue here is that I'm concerned about you developing a tolerance to other Opioids outside of your relationship with your prescriber. Even though these pills were at one point legitimately prescribed to you, your prescriber is not going to like the fact that you're medicating outside of his or her approved guidelines. It's a shitty thing to develop a larger tolerance, which you can't feasibly tell your prescriber about. You don't want to stretch yourself to thin and end up having to deal with a larger issue down the road.

Is it possible to contact your prescriber or perhaps another physician at the practice that you're attending?