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Opiate conversion - changing meds

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Posted 10/18/2013 3:30 PM (GMT 0)
Hi, I've been taking sustained release morphine for chronic pain in my left knee. I would take 200mg in the morning when I got up, 100mg around 1pm, 100mg around 8pm and then 60mg at bedtime. Also I would take 10mg fast acting for breakthrough pain. Total of 490mg per day.

The doc is changing me to dillaudid. She gave me 4mg pills and 2mg pills.

Take 6mg every 4 to six hours and use the 2mg for breakthrough.

The problem is that 6mg has almost no effect on my pain which leaves me using the 2mg pills in quantity to just get some initial relief.

I know the doc is using some kind of conversion chart but it just doesn't seem to be applying to my situation.

Any help with this would be appreciated. Has anyone done a conversion like this before and how was theirs done?

Thanks
Posted 10/18/2013 3:48 PM (GMT 0)
Here are a couple of sources. I personally tend to refer to the first listed.

http://www.pharmer.org/forum/discussion-prescription-and-otc-meds/opioid-comparison

http://opioidcalculator.practicalpainmanagement.com/conversion.php
Posted 10/18/2013 5:24 PM (GMT 0)
I'm confused.... Is the doctor changing just your BT med... Or is transitioning all of your meds from morphine to dilaudid??
Posted 10/18/2013 5:29 PM (GMT 0)
Ok reread... Yes that's WAY under in terms of conversion.

Also the oral bioavailability of dilaudid us terrible. I don't have time to look up the correct percentage... But I think it's around 30%.

What was the reason for the switch??
Posted 10/18/2013 9:22 PM (GMT 0)
Yes, the bioavailability of oral dilaudid is only about 30%. So factoring that in....I have absolutely NO idea what your doc was thinking in calculating the conversion...unless the goal is to get you off pain meds.

Even if the bioavailability was better...that seems like a huge change. So you're supposed to stop both the BT and LA meds at the same time and switch to the dilaudid instead? All at once? Or is it a planned taper and then the switch?

I'm just having trouble with the logic behind it...

Posted 10/19/2013 5:23 AM (GMT 0)
I was on my phone earlier -- so it was hard to post all my thoughts.... but I was thinking everything that LexiRae posted, lol.... I don't see the logic behind this either.

I looked up your meds on a couple of different conversion charts... and even reduced it some for the cross tolerance.... (I also used to be on about 600+ mg of morphine a day, so I have lots of experience switching meds).... and it's still way under what a normal conversion would be?

So does the doctor want you to be on lower meds?

Also -- as LexiRae pointed out -- unless you are coming off the morphine for a reason (like bad side effects etc)... usually you would add in the Dilaudid as a BT and then slowly taper off the morphine over.

To completely go from almost 500mg of morphine to Dilaudid -- at a much lower conversion -- and then adding in what we've shared about the bioavailibility... there's no wonder it's not working for you :( :(

Are you having withdrawal symptoms? If you share some more info - we might be able to further help you.

Hang in there.... --Tina
Posted 10/19/2013 10:43 AM (GMT 0)
Here's another point, your now a chronic pain patient on 2 short acting meds and that's a fast track to No meds. Its becoming a point of contention among the "powers " that rule that Drs cannot prescribe long-term short acting meds only.

Did they give you any indication as to why they've done this? That's my big question because that amount isn't going to come close to an equal conversion, they make it in a sustained release and 8 mg IR.

Just not going to be a comfortable ride either way for you between pain control and withdrawal symptoms.

Like the others said maybe with a little more information we can help more.
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