My experience with my new pain meds Exalgo ER and Dilaudid IR

From my experience, you may want to spread out the Exalgo somewhat to improve absorption.....say, two in the morning and two at night, both at times when you haven't eaten in a long time and don't anticipate eating for at least another hour or two (ergo, between meals).

Also, you may want to get your doctor's permission to try taking the Dilaudid IR sublingually (under the tongue) and/or bucally (between your cheek and gums). This may also improve absorption, as the oral bioavailability of Hydromorphone varies widely from person to person. Obviously you don't want to change your route of administration (although sublingual, in this case, is really not a huge difference since you will generally be swallowing the dissolved pill matter once you can't hold it in your mouth any more) without talking to your doctor first, but in my experience most are fine with this.

You may find that this, plus time, improves your results.

Two weeks after switching from methadone -- particularly if it was a sudden switch and not a cross-taper -- is not NEARLY enough time to adjust. It takes 30-45 days to adjust after stopping methadone, in my experience and this is backed up by many other reports. So I would *expect* not to feel my best after only 2 weeks.....it's not at all necessarily the hydromorphone, but rather the dosages involved and the sheer nature of methadone. I'd talk to my doctor if I were you, but two weeks isn't nearly enough time to adjust from a methadone switch IME.

i was put on a one week experiement with dilaluid, and found it totally useless for my level and type of pain, my oncologist quickly switched me back to Loratab once he found out. when i have been on dilaluid in IV form, as in the hospital, I thought it was a godsend. however, it sure doesn't seem to have the same effect in pill form.

hope you find the right mix and solution for you.

david in sc

Hey RJ, I was just wondering how you were doing with the change?
I too have been on methadone for many many years for PM, I have thru the course of those years been put on other meds to see if they worked better,or every now and then a new Doc would be on the not liking methadone band wagon. For whatever reason I never made the change stick. I have not had alot of luck finding anything that works as well as the methadone for me.

Just switching was a nightmare in itself for me as I didnt do well with any of them as far as not suffering w/d's and at times I know due to that I couldnt get a good read on the pain relieving property of said meds. I understand that methadone is a very hard to switch drug as it take far more of something else to equal out to prevent w/d symptoms.

If I wasnt miserable from the w/ds on other meds I simply was sleeping my life away from the higher doses to make me comfortable. I think now after 10 years on the methadone I most likely will never be on anything different. I really have no problems with building tolerance and thru the years have been on very high doses to very low doses depending on whats going in my CP life at that point. Post op of course I always increase but as soon as possible I lower myself down again.

I use only the methadone and currently am not using a rescue med but have used them thru the years if needed. I dont take the methadone on a prn bases and take the entire dose at one time a day and it lasts me for the entire 24 hr period as long as I have not missed a dose for any reason. Dont ever have to run home to make sure I dont get slammed with pain because I didnt have meds with me when I went out that morning.

I dont have to clock watch ever anymore the way I did on hydro and oxy way back when! My Neuro has no problems with writing it and like you said it is cheap cheap cheap. My medicare part D pays for it now but before it kicked in I was paying out of pocket so it was never a hardship to get.

The lethargy at higher doses is the only real problem I have ever had,except of course the bathroom one but thats pretty much a opiate problem no matter what your on. If I have lethargy or the famous nodding out ppl complain about on methadone I lower my dose some and see if that helps or at times I have taken meds to counteract that.

So I completely see your concerns with not wanting to change and especially the prices of those meds I couldnt do that not even with my part D as the higher the meds are at the pharm the higher the tier and the more my co-pay and that is after a huge run around between me and the carrier and the pharm and the Dr to make sure he has tried all the cheaper ones and this is a have to case! Then they still most likely will refuse to cover it.

Didnt mean to go into this long post was simply just wondering how you were doing with it.

It seems a bit strange that your Dr. wanted to change things around when you were getting such good relief from the Methadone....

I can see if you were not getting that relief and needing to go higher and higher on dosages that he wants to rotate meds....my Dr. has done this with me but we do every 3 years or so.

If things are going great....we don't rock the boat.

Hopefully your Dr. will have absolutely no problem going back to what you were on.

That's the thing about medications....it's never a one size fits all as one medication will be great for one person but not work at all for another. We just have to give them a 100% try which it seems like you have (many Drs. say about a month or so).

Hope you are having a good Sunday!