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How to switch to extended release painkillers?

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Posted 6/12/2015 5:25 PM (GMT 0)
I currently take hydrocodone which i get compounded because it would be too much tylenol otherwise. We recently found out that Zohydro is now covered by our insurance and although the price wont be much better it will save me a lot of driving and insurance hassles.

I have 2 main related questions: how does the dosing work and the dreaded constipation.

The Zohydro is typically taken just twice a day. Would that normally be the same dose 12 hrs. apart? The problem I see is that now during the day I have taken 80% of the meds by 7:00PM and then one more dose. So If I take half of the Zohydro in the morning and half 12 hours later It would be quite a bit less then what i have during the day. Then I would be taking the second dose late in the day which I assume would work all night and I may end up with bad constipation.

Is that how it usually works or is the daytime dose larger than the later one?
Posted 6/13/2015 12:24 AM (GMT 0)
Hey T-9.I can only tell you my experience.At present I take MSContin ER 30 mg x 2 and Morphine IR 15 mg x 4.

My last PMD prescribed me OxyContin 30 mg x 2 with nothing for breakthrough pain.I could really tell when the medication was wearing off.

Having the IR med with the ER seems to be the key to me.My PMD told me to take the IR med right when I get up.Then take the ER med about 45 minutes later.

I usually take my ER meds at 6 am and at 5 pm.So it's probably wearing off about 4 am.

She's got my pain covered.

I've had some minor constipation taking Oxycodone but the Morphine doesn't seem to cause any problems for me.

I've never heard anyone's experience with Zohydro.I asked my Pharmacy and they said they haven't filled any yet because of the cost.

I think an ER med is definitely the way to go.It's much easier to maintain a steady level of pain control.No peaks and valleys,or at least not near as many.

Take care and keep us posted.

Rick
Posted 6/13/2015 1:31 AM (GMT 0)
T9 it also depends on how your dr writes the script whether its to be taken every 12 or 8 hours. Some people find they need their ER every 8 hours instead of 12 & the dr may let them have it every 8. It just depends on the dr.. For folks dealing with constipation issues they generally take a stool softner. Overall, people tend to have better pain control with an ER & something for BT when having pain spikes. Some people think their BT meds should be taken on a schedule like their ER & that is not true because when its done that way their body will need that level all the time & then you start having tolerance issues. You don't have to watch the clock so much & constantly be chasing the pain.

Good luck.
Posted 6/13/2015 3:49 AM (GMT 0)
T9 I agree with Susie, also I might add, the extended release medication is much much stronger than the normal short term pain medication even if it is the same dosage. As an example say your taking a 20mg oxycodone tablet every four hours. ( this is just written as an example) and then your doctor changes you to 20mg Oxycontin every eight hours, the 20mg Oxycontin is actually much much stronger than your normal 20mg Oxycodone tablet. The Oxycontin is supplying you with 20mg of pain relief constantly over that whole eight hour period. Where as your oxycodone tablet is giving you a 20mg of pain relief one time and it might last for the 4 hours but it is just that one dose, and that is it! That is why you have to keep taking it to control your pain!

The extended release does just that, it releases the medication constantly as the pill passes through your body. In fact allot of people sometimes notice the pill passes out through their stool looking whole, but it is only the pill matrix all the medication has been depleted from it and absorbed into your body over the eight or twelve hour period! That is why they tell you to swallow the extended release tablet whole and not to crush or chew or other wise bite into it! Before they reformulated this medication it was often misused and was abused and often this caused massive over doses and even death. So they changed them and now if you crush them, you just render them useless and there is no mass release of medication. But with this change many people found that the new tablets did not last the whole twelve hours and thus allot of doctors started prescribing them on an every eight hour basis.

Over time if your doctor gets your dosing right hopefully you will not need to use any break through pain medication. May I ask considering your condition, is a pain pump a possible viable alternative for you? And have you ever looked into it? Just a thought!

Good Luck to you!

White Beard
Posted 6/13/2015 9:47 AM (GMT 0)
You should find the ER to be a smoother more consistent pain reliever and not the up and down as with IR meds only. You also are not tied to the pill bottle and after four hours panicking trying to get home before the ir med wears off. Er meds maintain a level of meds as WB said and will stay longer with you.

As for transition? None needed with the same med just fill ZO an when it's time for your next hydro ir take it instead. Constipation the key is stay ahead of the game and assume you are going to need help and take something then if you find you don't or it's too much or not enough adjust it. Miralax is a good one, theres several prescription ones your Dr can give you or otc pericolace, its cheap and taken daily should prevent issues but strong for some.
Posted 6/18/2015 4:07 AM (GMT 0)
My doctor and I tried so hard to get me on zohydro, because honestly hydrocodone is the best working med for me but, I can't stand all that acetometiphin. The director of the clinic even tried, the insurance company said "no way" . So I am currently taking oxymorphone ER 30mg x3 and morphine IR 30mg x3. This has been the best combo other than with the Norco. I might ask if we can switch back and forth(3months Norco, then 3 months morphine). She listens very well and is usually on board because I do my research and write her a pain journal. I feel very blessed to have a doctor who really listens and cares. Man, I read some of these other stories about people who's doctors are suspicious or not willing to prescribe pain meds....it just makes me sad..I think everyone should be able to have access to meds if in pain. I am 34 with 4 children...6yrs,4yrs,3yrs, and 1yr olds. I couldn't do anything as a parent, not even sit without hurting. I hope you find your combination that works for u. Fyi...i have been through..norco,fentanyl, methadone,tramodal, nucynta, and oxycodone. Oxymorphone is great...but u have to ask for the genaric,because name brand-opana- with the new plastic coating is garbage. And also morphine doesn't constipate me. Good luck.
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