Tapering - hours or mgs?

[Pembroke]

Hello hello,

I've primarily posted in OD, but this seems to be the beat place for this question:

Because of medication change, a shit month, and an issue with a caregiver helping themselves to some meds, I am at risk to run out of my much needed pain meds two days before I can refill, and my replacement medication still has not arrived for the med change. I have successfully gone from 8 doses a day to 4, though I'm in a lot of pain and it generally sucks. I have 3.56 doses available per day to sustain me, so if I use 4 doses I will be out entirely, but have not been successful at going to dosing at 8 hour intervals instead of six. It has occurred to me, though, that perhaps I don't need to keep trying to get to TID dosing if I could reduce from 8mg to 6mg every 6 hours. What I don't want to do is to end up in more pain and end up taking extra doses, rendering this attempt less than useless. So, when y'all have tapered as far as you could, was it more effective to try to go more hours between meds *or* to reduce your dose? I'm reading through some of the tapering threads and will continue to do so. The drug is hydromorphone for pain management and the goal is not to come off of it entirely, but rather to make it to my next appointment.

thanks!
Louise

 

[w0w0mg]

Hydromorphone has a pretty short half life. I would suggest trying to go down your mg dose for a couple of days so you have enough to last you until your next refill.

 

[Pembroke]

Hydromorphone has a pretty short half life. I would suggest trying to go down your mg dose for a couple of days so you have enough to last you until your next refill.

Thank you. I thought this would be the better option, I just wish I'd realized a week ago. I've titrated doses before, but I've not had to live in a tapering body. Turns out it sucks! Who'd have thought? I'm trying that today, and if I can reduce by those 2mgs it will save me a full dose each day. Here's hoping it works!

 

[Moreaux]

Totally agree with w0w0mg- taper by mg and not time. Sorry to hear your are in this situation!

 

[Pembroke]

Thank you both for the input. I made it to my appointment, just barely and in full withdrawals. Most humiliating experience of my life... my doctor pegged me as dope sick within a minute of walking in and halted the appointment to give me IV meds before we could proceed. So embarrassing. The only saving grace was that I wasn't the only one by a long shot - the medication change I'm undergoing is a bureaucratic one (as opposed to a therapeutic change), and it turns out I was one of only a few anesthesiology patients who didn't end up in the ER or calling the clinic begging for an earlier appointment. I got scolded for not coming in and telling them what was going on, but I guess I was so focused on the doses my caregiver lifted that I didn't really understand the added impact of the med changes and reductions I was dealing with. I dropped over 200 morphine equivalents per day in less than a month by coming off methadone and going to Dilaudid HP injections, which is a big drop after nearly a decade! The good news is that my tolerance has dropped. I took my 12 mg dose and was ptfo for 11 hours, which means this awful experience did help me drop my equivalency even further. Good times.

Anyway, I just wanted to thank you guys. I'm really glad I finally joined BL, y'all are a fabulous resource. I cannot thank you enough!

Louise