Duragesic to HydromorphContin: Finding the equivilant dose?

Hi all,

I'm back again looking for feedback. I've always appreciated the amount of knowledge and primarily first hand experience many users of this forum have and therefore the advice they can give to others in similar situations.

I've been on Duragesic 50mcg/hr for about six months now. I live in Canada so the Duragesic brand name is the matrix patch format like the Mylan kind in the USA. I've been having some occasional adverse effects and I think it's primarily due to the so many different factors that can affect the flow of fentanyl through your skin such as heat sources and whatnot. I've found that strenuous exercise, warm baths, and similar things that can raise your body temperature have resulted in an increased rate of fentanyl entering the bloodstream and I've on occasions like these shortly after become very nauseous, sometimes vomiting out of control, and been unable to carry a conversation. Yet the majority of the time I am completely fine.

Nonetheless I told my doctor that this makes me uncomfortable and I'd like to consider switching to a different pain medication. He agreed and said that due to sometimes unpredictable conversions we will start moderately low and increase as necessary. He has prescribed me HydromorphContin, which I'm not sure if it exists in the US but is manufactured here by Purdue Pharma Canada, and is controlled-release Dilaudid in capsule form (filled with the tiny hydromorphone beads). The starting dose is 12mg capsules, 1 cap every 12 hours and he said that if I don't notice it helping the pain comparably to the fentanyl or notice my body withdrawaling after discontinuing the fentanyl that it is not the right dose and to try two caps (24mg) every 12 hours.

The initial dose was terrible - not only was I in pain but I was also experiencing significant withdrawal symptoms within about 8 hours after removing my last Duragesic patch - so I did as instructed and began 24mg every 12 hours. It has been helping however the pain control is not nearly as effective as the Duragesic was so I have an appointment to discuss either raising the strength or switching to another medication.

Does anyone else have experience with HydromorphContin for their pain - or similar CR Hydromorphone in other countries? I've been doing research and it looks like in Purdue Pharma's own product monograph it says that at least 50% with potential for up to 70% of the drug is lost in first pass metabolism. This seems very high, does it not? Would there be any better option out there that doesn't have such a low bioavailability (I think that's what it is called?) that has been effective for others long term? Or, is the dose I am on simply not the right conversion from 50mcg/hr Duragesic? Note that for breakthrough I also take 2-4mg of IR Dilaudid per day as well. I really want to avoid going back to Duragesic if possible.

Thanks for any feedback, tips, and advice that I can try and/or suggestions to ask/share with my doctor.

Cheers

-KP

Hi KP,

I can't give any advice on the specific conversion but I can say that I have been on the Fentanyl patch 50 mcg's for 4 years now. My BT meds have changed going from Vicodin Oxycontin to Dilauded which I use now. I have not found any other long term med that keeped my pain in check except for the Fentanyl, it does an excellent job with consistant relief, however, I change my patch every 48 hrs because after that I go into withdrawals. For whatever reason my body is not maintaining the level after 48 so my PM doc kept me at that. Because of the "body heat" issue, I have just learned to know what my limitations are with the exposure outside on sunny/hot days, Jacuzzi, baths, etc. There have been times that I have gotten a "bump" because I was not able to control the issue for a very short period of time however, the nausea was very short lasting only a couple of minutes. This has not happened a lot with me, only a handful or so that I can remember. It is very hot and humid where I live so I am forced to be very careful.

I would definitely talk to your pharm. and then again with your PM doc. to help you along with this.

Not much help to you, but wanted to share my insight on my experience with the patch. I so do hope you find the right med for you, it is very difficult because all of these potent meds have some side effect or drawback, to me it can be a personal choice as far as what you are willing to tolerate to get good pain relief.

Hoping you have less pain.

Hugs from Texas,

Pam

I'm in Canada also and was initially put on ms contin pfft did nothing, then the fentanyl patch and again no pain relief. Finally my doctor put me on hydromorph contin and then hydromorphone for breakthrough. This is the only combination that has ever worked for me. I know my highest was 15 mg every twelve hours and that was after a few months so for you to be started out at 12 mg is incredible.

I'm sorry that you aren't having the pain relief that you need. Hopefully they will figure it out soon. Give it a little time because those meds take a few days to start working really well. I don't take anything now except for T1s once in a while but sometimes I sure wish I still had them :)

Good luck to you,
Lynn