Opioids oxycodone ir vs Opana ir

[Supeudol]

Yes, most doctors are aware that it has a 10% oral bioavailability. Bring it up in case though.

Actually, most doctors do NOT have a fucking clue when it comes to Bioavailability. I have brought it up with a few, and tried to explain it telling them that prescribing some shitty Morphine for 'Oral', you are only going to get ~25% of that in your bloodstream. Whereas Oxycodone is around ~87%. And these doctors are still like, yeah so, whats your point? Like DUH... I wonder how some doctors get their medical license really. IMO < a lot or most Pharmacists know a hell of a lot more than any doctor when it comes to medications.

Anyways, sorry to go off topic there.. back to the Opana discussion. I have no say because we don't even have OxyMorphone out in Canada yet.

 

[tricomb]

Maybe I've been lucky but all my doctors are very gung-ho on opiates, bioavailablity etc. I have the best pain management clinic though, such a great staff and support from patients.

 

[macd610]

Tricomb..what do you think? Is it possible I may go through withdrawals if I switch??

 

[tricomb]

You should ask your doctor to factor in the low 10% oral bioavailability when he's deciding upon the dose.
The thing about the instant release opanas is if (god forbid) you do start to withdraw, you can snort them and that raises the BA up to around 40%, and I'm sure you wouldn't withdraw as long as you could get enough oxymorphone metabolized.

You're staying on the fentanyl right? Be very careful, I know you're a veteran with opiates and you know what you're doing but opana is sooooo strong it's just like fentanyl. Combined WITH fentanyl, I just want to be sure you're taking all the extra precautions.

 

[macd610]

You should ask your doctor to factor in the low 10% oral bioavailability when he's deciding upon the dose.
The thing about the instant release opanas is if (god forbid) you do start to withdraw, you can snort them and that raises the BA up to around 40%, and I'm sure you wouldn't withdraw as long as you could get enough oxymorphone metabolized.

You're staying on the fentanyl right? Be very careful, I know you're a veteran with opiates and you know what you're doing but opana is sooooo strong it's just like fentanyl. Combined WITH fentanyl, I just want to be sure you're taking all the extra precautions.

Thanks, Tricomb...

Yes, my fentanyl patch will continue. It's just a matter of finding something strong enough to compare to my current Oxy ir...but lasts longer. MD says he would not want me on 2my extended release things (like Opana er + fentanyl patch )
I actually was unaware of the fact that opana is in the same league as fentanyl. So THANKS!

 

[tricomb]

yep! fentanyl is more potent but opana is very strong and can surprise you, the only opiate I can compare it to that does the same thing is fent

 

[macd610]

Thanks for all of your input, guys and girls. As always, I appreciate the support and advice

 

[tricomb]

All fentanyl transdermal patches are designed to release the medication over 72 hours, but it doesn't last this long for everyone. Dead skin and just about any little thing messes with the adhesive and can screw up the stream of fentanyl, patches are notoriously flimsy. Some have to change it every 48 hours or even daily, as directed by their physician.

 

[macd610]

I thought the fentanyl 100ug transdermal patches were all 72hr release... regardless i hope that the switch works out for you.

ive been dealing with serious pain for 2 years now and i cant even get a dr to prescribe me vicodin let alone anything that will actually work, so ive been trying different opiate pain relievers that ive been able to get my hands on from other sources. so far Ive found oxycodone to be my favorite... if the switch to opana doesnt go well, you may want to consider having your doc prescribe a supplement of Oxycontin because its time release... Possibly an oxycodone 40-60ir (for initial relief) followed by an OP60 (for sustained relief) every 8 hours could do the trick.

i hope the best for you, i know it sucks living in pain

Thanks for the kind words I'm sorry you're having trouble finding a physician who will adequately address your pain. I went through that for some time, and understand. I wish you the best.
Tricomb is absolutely correct; the patches are designed for 72 hour relief, but many patients need to change it more often. The literature that comes with the patches acknowledge this.
What my physician wants to avoid is having me on 2 extended release medications (for example, fentanyl patch along with Opana extended release ). At the same time, some short-acting opiates actually by nature last a bit longer than others...That's my issue. Just to be clear, I am taking immediate release oxycodone, not extended release (Oxycontin). I asked my doctor about switching to Oxycontin, and that's when he told me about his concern regarding 2 ER meds at once.
Sorry if I am rambling, I'm super tired. I feel like I may have skipped over a couple of things, so as always, comments are welcome
Good luck on finding pain relief, again!

 

[tricomb]

Well your doctor was probably right, OxyContin will be no good to replace your instant release oxycodone. You shouldn't replace IR with ER and be on two ERs, doesn't really make sense unless you REALLY need two ER's, and people who require multiple ERs certainly still have breakthru meds.

 

[macd610]

Well your doctor was probably right, OxyContin will be no good to replace your instant release oxycodone. You shouldn't replace IR with ER and be on two ERs, doesn't really make sense unless you REALLY need two ER's, and people who require multiple ERs certainly still have breakthru meds.

EXACTLY what my MD said lol. Go, Tricomb!
Yeah, after I asked him about it, I also considered the fact that oxy ER would probably give me the same trouble its IR partner is now...which would be an even BIGGER pain in the ass.
The more I think about it, the closer I'm getting to the decision to just go ahead and change meds.

 

[DooMMooD]

They actually say that IR opanas can last upwards of 8 hours already, and that ER opanas can stay in the blood theoretically for a day. So opana actually has the lengthy profile of another ER drug while being considered IR, so your doc might have less of a problem with you on that since it has the letters IR in it.

Although anyone with the knowledge would realize that being hesitant to have you on 2 ER meds would be just the same as being on 1 ER med and Opana IR, since as I said Opana IR has a profile akin to other ER drugs (ie it might as well be considered ER because of its long lasting effect)

So yes, you will be doing a lot less clock watching with the opana. Just be careful, they are unlike any other opiate in terms of strength/addictiveness/painful withdrawals. Just because someone has a handle on their OC usage or what have you doesn't mean the same will apply with the opana. Just be careful mang.

 

[macd610]

DooMMooD, thank you for your useful post, and for the warning. I will be careful, this is the 2'nd or 3'd time I have heard something like that.
It sounds as though you have experience with both of these drugs...Would you mind sharing more of your experience? I would be especially interested in hearing anything regarding switching from one med to another.

 

[macd610]

Hi guys,

I probably should have asked about this when I started this thread originally, but it that point I wasn't even sure whether or not I was going to make the switch. I have made the decision to switch to Opana. I called today to make an appointment, thinking it would probably be at least a week before I could get in... but my appointment is just a few hours away(1:00).
if I looked hard enough I could probably find the answer to my question, but right now I'm sort of in a state of panic.
SO, my question is- given the fact that oxycodone has (around 85 ) percent bioavailability orally, and Opana ir has something like 10% (if I remember correctly) what would be a good dose of Opana to switch over to, considering I was taking 60mg Oxycodone ir every 4 hours?
I realize this sounds stupid, but I'm not sure how to do the math for this... don't know if it's as simple as finding out the difference between 85 percent and 10 percent, and/or what other factors there are to consider.
Not that Im gonna saunter into the office & tell him what dose to give me lol! He DOES appreciate that I sort of "investigate" meds before I take them...so he would take it under consideration as a part of his decision on dose.
I apologize for the super long post. I am just really nervous about this switch (mostly because I'm afraid of getting too low a dose) but I know it's the right thing to do
So I'm hoping maybe Tricomb & some of you other knowledgeable bluelighters out there can help me out in time! Just so you know, it's 8:45 here now, and I will be leaving for my appt. at 12:45.
THANKS again for reading this rambling post.

 

[Paulington]

Hi there.

From your post saying you take 60mg Oxycodone IR daily, assuming eight hours sleep and perfect schedule that is 240mg of Oxycodone daily.

Now, you have to remember, bioavailability is not the be all and end all when it comes to trying to calculate doses of one opiate that is equianalgesic to another dose on a different opiate.

Now, correct dosage...

As you are taking a total of 240mg of oxycodone a day, I would expect your Doctor to put you on somewhere between 40-60mg Opana (oxymorphone) daily in the form of 1x10mg pill every four hours or 1x10mg + 1x5mg pill every four hours. This is assuming an average incomplete cross-tolerance of roughly 50%. If this doesn't quite hit your pain hard enough then your Doctor will titrate the dose upwards until a comfortable balance is found between pain relief and side effects.

Now, personally, I would suggest to your Doctor that you try Opana ER. The reason for this is taking instant relief medication is VERY bad for chronic pain which is what I assume afflicts you. The reason for this is when you take IR medication, about an hour later the blood serum level spikes and then tapers off very quickly meaning a couple hours after taking it you want more to get the same pain relief.

However, if you have MR/ER medication, after 2/3 hours the blood serum level is at it's peak and continues to stay at this peak for another six hours before it begins to taper off. This gives you a CONSTANT level of pain relief which is what a patient with true chronic pain should be after. You should ONLY take instant release pain medication, especially of the opiate type, as a LAST RESORT. For example, you fall over or something and your pain spikes MASSIVELY, then you should take it. Otherwise, avoid it at all costs and stick to your PRESCRIBED DOSAGE of Extended/Time/Modified release medication as it will provide much better pain management taking 1x 12 hour MR pill twice a day than it will taking 4x 4 hour IR pill four times a day.

If you do decide to try ER/MR medication of the Opana (Oxymorphone) type, then I'd expect your Doctor to prescribe you 2x30mg Opana ER per day, taken at 12 hour intervals and 5mg Opana IR capsules, a maximum of three per day to be used ONLY IN PAIN EMERGENCIES. You shouldn't be taking them at all unless they are ABSOLUTELY REQUIRED.

As I have said, 240mg Oxycodone --> 60mg Opana with an average incomplete cross tolerance, you may require less, you may require more, but I believe that this is a good 'starting point' when it comes to dosages and then you and your Doctor can talk to each other and figure out if you need more or less.

Also, you only waited 14 minutes before you basically reposted this. I guess you know the rules? Listen to the Moderators and don't double post, especially when you have a nice big thread with lots of good advice already in here. I also ask that you TRUST YOUR DOCTOR. As I am currently in Medical training it annoys me when people distrust physicians. Do you know how much training we go through before you can be GPs/PCPs? We study, we do our homework and we know what we're talking about. If you have concerns, voice them, but at the end of the day he is the person with decades of medical experience.

Cheers!

 

[macd610]

Thanks, Paulington. That helps alot.
I want to apologize to everyone again for freaking out and double posting. I think that in the frame of mind I was in, I felt the need to let you guys know the time crunch I was under, via the title of the stupid new thread I created. I feel SO silly and embarrassed. You guys have always been there for me and I fear I may have ruined the rapport I feel I have with many of you, even though I've only been a member for a short time .
Thanks for your time, hope you all have a great day.

 

[Doug2113]

It's honestly not that big of a deal...don't fret about it...and while he makes a point about the ER medications...I'm in chronic pain and I take 400mg IR tramadol for 1, because it's 1/4 the price of the ER formulation...and 2...While I do ride the pain rollercoaster all day every day...the IR formulation of tramadol has a higher peak plasma concentrations...I tried the 300mg (the biggest they had) ER Ultram for a month and HATED IT...I couldn't do anything if I was in more pain...I had nothing for breakthrough pain...AND it didn't last the full 24 hours (probably something to do with my tolerance) so I would wake up in pain and wouldn't see any relief for a good 4 hours...

to prove my point...if you look at the graphs on page 3, it will show you 200mg IR vs. 200mg ER in terms of blood concentrations, and if you'll notice that while the M1 concentrations are about the same at the beginning of the day (when the ER does finally hit), it's much higher near the end of the day with the IR meds...Also...that's comparing 200mg to 200mg...the max ER dose is 300mg/day, and with the IR I can take up to 400/day...so really it all depends...

Don't get me wrong...I wish I had a nice ER medication that way I would only need about 2-4 pills a day for rescue, but I haven't gotten all the proper diagnostics done (which will be occurring next month) and once I get those, I shall ask for a referral to a PM clinic...Just had to wait for the insurance new year before getting my shit done...but I'm sure doctors will be a bit more willing to help once I have MRI's of my c-, t-, and l-spine and X-rays of my c-, t-, and l-spine...(as opposed to the really out of date single MRI of my l-spine, which is where the least of my problems is at)...

 

[Harryjerry]

Opana IR 10mg is pretty awesome! I used to be prescribed Opana IR and ER and it was fantastic! Too bad I can't afford both anymore Make sure you snort them to get the most out of the ir's.

 

[macd610]

Hello Everyone!

My appointment went just fine. I was switched to IR Opana (which was a bitch to find at local pharmacies, btw), and will continue my 100mcg Fentanyl patch. The patch is the reason I cannot have extended release Opana...at least, my Dr. isn't comfortable doing so. He is starting me off on 10mg for the first day to be sure I tolerate it alright, but he feels pretty sure I will need 20mg. It feels MUCH different from Oxy ir to me. It'll take a little getting used to, but I had my first dose at 3, and still doing well! Good sign
When I was talking dosage, I forgot to mention it's every 4-6 hours.

 

[Doug2113]

good to hear it's doing you well though...all medication switches are a bitch...especially when it comes to pain meds...