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Opinion please.....oxycodone ir vs. dilaudid for breakthrough

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Posted 9/12/2012 5:23 AM (GMT 0)
Of those who have used both which has worked better. I am in the process of weaning off of methadone and am at the point that I am having a pain increase . I see my PM on thurs and instead of an oxy increase am thinking of asking about dilaudid and would value some opinions.
Posted 9/12/2012 5:49 AM (GMT 0)
Hi MtnGrlNC -

These medications are such an individual thing that it's hard to comment on what your experience will be like. I've used both.... and both are good as breakthrough meds. Have you ever used oral dilaudid?

What are you reasons for asking for the change, if you don't mind me asking? (I remember that you are getting off the methadone after being on it for a really long time right? and are you just using IR meds?)....

Like I said.... I've used both.... didn't have side effects w/ either - but I don't get side effects from most narcotics.

Wishing you luck - Tina
Posted 9/12/2012 6:09 AM (GMT 0)
I've used both many times over the last 6yr's and for me the oxycodone IR is the best for me for my breakthru pain at home. I am using 8mg dilaudid presently and I am not happy at the moment with the pain relief.. The only time I've had a better result is when I used the dilaudid with a PCA pump after all of my surgeries but I guess anything going thru an I.V. will produce better results...Hope this helps..Take care Beck
Posted 9/13/2012 12:54 PM (GMT 0)
Our plan is to first wean me off the methadone for many reasons and first use short acting meds until entirely off the methadone. Once I am off the methadone I am going to try to wean off the short acting as well for a drug holiday to see level of pain is there. If I still have significant pain we will start one of the other long acting at that time. I was just curious about others experience with something other than oxycodone or hydrocone. PM appt this morning.

Sorry it took awhile to explain....bad, bad night. It is my allergy season and since my pain stems from my sinuses it increases my pain. Antihistamines and things like sudafed are useless, I just flush and flush hoping to flush the pollen out of my nose.

I hope everyone has a good day.
Posted 9/13/2012 1:14 PM (GMT 0)
Hi, not a whole lot of experience here, as I was only on the delauded for a week, but I think it was far superior to the oxycodone. Since methadone is said to be so difficult to weene off of, is it possible to set up a short trial on each, then to see your PM again after a week, so you can get checked over, and make up your mind about each med's efficiency in yourself at that point? I think even then, it would not be a good test for future use, but it would give you a real idea on what will work while you're weening down. Keep us posted on your progress. Take care, and God bless.
Posted 9/13/2012 1:56 PM (GMT 0)

      I have used the percocet for over 10yrs now, and for short term it works well. After a high blood pressure check on my last visit, my Dr changed over to the Oxycodone IR at double the dose than I was getting with the Percocets, and it has given me some much needed comfort and short term relief.

    To wean off Methadone though, I would think a ER med might be a better choice, than an IR med, as the IR med can have a very quick short life and throw you in a tailspin, unless he is providing enough to keep you comfortable. (just my opinion)

     Even if the ER med was scripted at a lower dose it may bridge the gap, as long as the BT med is scripted correctly too. Withdrawals are not fun at all, especially if you are in great pain as well.

     All in all, I agree with Tina though. We are all different and any med will act different from patient to patient.

     Good luck to you as you try to wean off the Methadone. Not an easy thing to do.

     SE wink    


Posted 9/13/2012 2:59 PM (GMT 0)
As others have noted, meds have different effects on different people.

However, I recall that dilaudid does not have any effect on some people since something like 10% of the population lack a needed enzyme. I suspect I am one of those people, for when I tried dilaudid, it did absolutely nothing -- no reduction in pain or any change in mental state.
Posted 9/13/2012 4:36 PM (GMT 0)
I can't see the logic in continuing to go up and up in dosage of the Oxycodone as I think you are already on 60mg (Oxycodone 15mg) or more of it a day trying to wean off the Methadone if your goal is to be off of all medication for this "med holiday" you are doing.

As mentioned...that will only have you chasing both your pain and your withdrawal symptoms all day long.

May I ask where you are in dosage with the Methadone now? I was reading your last posts where you had originally gone down too quickly so that you all went back up again...

If your Dr. is open to switching your medication from the Oxycodone to the Dilaudid could certainly be an option to hit a different receptor....but I still think it seems strange to be trying to replace a med that has one of the longest half lives (Methadone) with a short acting medication...

Obviously I am not a medical professional...but it seems that it would have been better to go to Oxycontin then wean down from that, then to Perocet or OxyIR 5mg, then off for good if your goal is to be off all opiates.

So...it really has nothing to do with what what works "better" as your goal is to be weaning down off all medications....

Hopefully your appt. today goes well and you have said that your Dr. is completely on board with you weaning off these meds so I hope you all came up with a good plan today...

Keep us posted..
Posted 9/13/2012 6:12 PM (GMT 0)
 

       ...one more thing!...I have heard it said that methadone will cancel out the effect of all other pain meds...with maybe the exception of oxycodone. Maybe someone can provide some experience about it  here, as I'm not sure. It may be one of the reasons that methadone is so hard to get off of.

   ...and oxycodone may be the only med that methadone will tolerate working together at the same time? Another suggestion, may be Suboxen? ...if indeed you are trying to get off all pain meds. Just suggestions...I don't have experience with any  of them. Hopefully another member can shed more light on this.

  SE wink

    

Posted 9/14/2012 3:17 AM (GMT 0)
wow, Im new to this forum lots of good topics n really don't know where to start. I have been on hydrocodone for like 12 yrs. I just recently got into pain manigment n he is giving me perk 5 n I really cant tell the difference, other than being hollered at for taking say 6 a day at times instead of 4.He did offer to put me on morphine n i freaked out. I told him that thats what they give patience thats fixing to die. I have several things wrong with me n I don;t see how ppl on here can get some of the meds that i would try but yet the dr's wanna like keep me on the same stuff. Had I of took the morphine im sure it would of been a low dose ,not sure but i do know he would only give me 60 he said 1 for morning and 1 for night. sorry if i posted in wrong thread or topic.
Posted 9/14/2012 6:36 AM (GMT 0)
I am new to the pm aspect of all this. I do know I do not like pain! Not at all and when my levels get up in the 9/10's it is horrible I am a puker and with neck issues that doesn't help and I swear nothing gets me outta of the pain cycle except for quiet, a trip to the er, a coctail of morphine, toradol, anti-nasuea and something else I forget but they know me by name...lol I go at least every other month just because when your levels get that high the meds just dont work for me and it is hard to get the pain back under control. I will sit on the couch in tears for 10 days straight and then give in and make the trip to the ER. Just wanted you to know I realize where u are coming from and I am sorry for your pain.

I am two years post op cervical fusion, lumbar laminectomy/discectomy, l5/s1 fusion, several tears, bone spurs and herniations throughout spine, thoratic lessions, and stenosis. Lets not for get the knees and the feet they in there too.

I have been on 6 10/325 percs per day and 2 350soma perday for pain and spasms, gaba for nerve pain, clonazapam for anxiety same meds two years no change. I have to say it isn't working. So, I like the idea of mixing it up, flopping back and forth and to have realistic expextations. If your everyday, unactive is an 8 the dont think you can take a pill, clean the house and have no pain. I was told to decrease the pain enough to give you a reasonable quality of life. Just my two cents!lol

Post Edited (XxSandyxx) : 9/14/2012 12:41:19 AM (GMT-6)

Posted 9/14/2012 2:26 PM (GMT 0)
I was given 1mg of Dilaudid once and it knocked me out, so it *seems* to be way, way stronger. That was just my experience though.

Oxycodone 5mg doesn't do anything for me really.
Posted 9/14/2012 2:38 PM (GMT 0)
Just FYI.

Most people's experience with dilaudid is in the hospital by IV form and this is a lot stronger than what you get when it's prescribed in oral form.

Same goes with morphine. Many people fear how "strong" this is but in oral form it isn't the same.
Posted 9/14/2012 2:45 PM (GMT 0)
As an oral med, oxy is better than dilaudid in my opinion. The only time dilaudid works well, at least for me, is via IV at the hospital. Orally, it did nothing for me.
Posted 9/14/2012 2:45 PM (GMT 0)
Yeah, morphine in oral form is nearly useless by comparison. It barely absorbs into your system apparently.
Posted 9/14/2012 2:49 PM (GMT 0)
I don't think it's useless at all as I've been on it for more than 3 years. It is one of the more smooth medications and after a few weeks when I first started taking it, I don't have any side effects.

I was just comparing strengths of IV meds and oral meds as people tend to "fear" the name of a medication from their experience in the hospital.
Posted 9/14/2012 2:56 PM (GMT 0)
The bioavailability is apparently useless, the majority of it doesn't get into your system orally. Oxycodone is like 80% absorbed and morphine is 40% or something.

It used to work for me too, not anymore. It might as well be advil now.
Posted 9/14/2012 3:38 PM (GMT 0)
We've discussed this on other threads so I don't want to hijack another thread. But you aren't counting the cross tolerance which is anywhere from 25% to 75%.

Medications are not an exact science and everyone is different. Morphine may not work for you and feel like "ibuprophen" but that is not the case for many people. It's all relative based on pain levels, metabolism, cross tolerance, other medications someone takes, etc.

So a blanket statement that "Morphine doesn't work " just isn't true.

I'll just end the back/forth in that hopefully you will speak with your Dr. and find something else that works better for you along with other modalities as I've said numerous times, no one should rely on the opiate for all their pain relief (NOT saying you are doing this, speaking in general for those that read this)

MtnGrlNC....Do you have any updates from yesterday's appt. with your Dr?
Posted 9/14/2012 3:41 PM (GMT 0)
"Yeah, morphine in oral form is nearly useless by comparison. It barely absorbs into your system apparently."

Snowbunny that's not what I said at all, I said oral form is useless by comparison (to IV, etc) I did not say it was useless for those who take it.
Posted 9/15/2012 3:44 AM (GMT 0)

I was diognessed bipolar n the depression state kicked in big time so i was put in a nice mental ward for like 3 wks. They had me on lithium for six months. I will say that that was perfect for me for i felt like i could handle anything that the world throwed my way. Thay also put me on 2 mg xanaxs for major anxiety. After i come home n like my 5th month ppl was telling my husband that i was staying messed up on xanes. It was the lithium. My hair thined out, i started getting the shakes my writting looked like chicken scratch n i was always constipated.So i went back to dr n he  lowered my dose. nothing changed i was always toxic so i just got off of it .I can't remembere what they put me on after that but it was not making me a zombie like lythium was. I,ve had pannick attacks so bad that my daughter called the an ambulance cuz my chest was hurting so bad i was crying and thought i was having a heart attack.when they got here they hooked me up to machines n when all was said n done they said  my body was putting out more oxoygen than taking in.I have other problems too but i guess being that im new here i gotta find the right topic to post everything on.Thanks for the info .This is a great site. smilewinkgrin

Posted 9/16/2012 7:27 AM (GMT 0)
Worked thursday night so I'm posting a couple of days late. Had a good appt and decided to slow the wean even more. My pain stems from repeated sinus surgeries and allergy season (for me ragweed) can send things up a notch, many hot showers with eucalyptus oil and much time spent in the hot tub. We also decided thhat at least right now I am sticking with the oxycodone. As an aside I have been on methadone for many years and it has never "blocked" any other opiate I have taken. I still plan to come off the methadone and am at 1/3 my original dose.

Thanks for all the responses, I know the pharmacology behind all these drugs and that each person's experience is different it is still valuable to get opinions.
Posted 9/16/2012 2:05 PM (GMT 0)
Hi MtnGrlNC, I have regular seasonal allergies, pretty much like any other person who in my part of California, the weeds around here at the end of summer are so bad, it would make anyone get the sniffles. I thought my allergies were pretty bad, I've been battling them since I was a boy, but reading your DX just makes me cringe!!! I just can't imagine how awful that must feel, especially on a cold, dry, winter day with weeds blowing everywhere. I feel so bad for you. I really hope this taper down gets you some answers quickly, it just sounds so painful, like trying to.breath in glass or something. I hope it's not as bad as my imagination thinks that it is. Take care, oh, my nose hurts for you, that just sounds so awful.
Posted 9/16/2012 3:35 PM (GMT 0)
Unfortunately, you hit the nail on the head. I no longer have protective cilia lining my nasal passages or if they are there they no longer work after years of second hand smoke exposure...you can see why I became a respiratory therapist. We all have our crosses to bear and if I have learned one thing on this pain odyssey it is (to paraphrase Scarlett O'Hara) tomorrow is another day.
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