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Changing ER Pain Medication from Hydromorph Contin?

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Posted 8/5/2015 1:08 AM (GMT 0)
Good evening all,

I was on Duragesic matrix patches (Canada no longer has the reservoir version) for quite some time for my long acting medicine however after discussing some increasingly obstructive side-effects like frequent nausea, random dose overloads from hot baths and exercise in hot weather, etc. my doctor and I decided it would be beneficial to switch pain medications and see if it helped.

For about six months or so I have been on Hydromorph Contin (Purdue Pharma Canada's long acting hydromorphone bead-filled capsules, not marketed globally anymore from what I've seen in my searches) 24mg x2 daily. My breakthrough medication is Dilaudid 8mg up to 4x daily as needed, which is the same drug, hydromorphone. I'm not sure if that contributes to my problem or not here.

What I've noticed, however, is that both versions are almost entirely ineffective now. I understand that over time opiates lose effectiveness and the dose will need to be increased to achieve the same effect, but I have not experienced such a drastic difference over six months with previous medications that I have been on. I want to avoid increasing my doses further so I asked about perhaps trying an equivalent dose of a different medication just to see if there is any improvement before we prescribe a higher strength. I read somewhere online that hydromorphone is not as effective as morphine, oxycodone, etc when taken orally on an equivalent dose basis due to loss of medicine through metabolism processes, so figured it may be worth trying. My doctor was hesitant to do so, saying that an equivalent dose of another opiate would likely not produce any improvement, and wrote a new script doubling my current dose, so x2 24mg capsules twice daily, Dilaudid 8mg 2 tabs up to 4x daily. Obviously there has been some improvement, but I'm concerned that side effects like constipation will now also worsen and I really wanted to avoid a dose increase because I've already has to deal with multiple episodes of fecal impact ion due to opiates and it is a terribly unpleasant experience.

I'm looking for opinions. Has anyone else found hydromorphone to be substantially less effective over time than a morphine-equivalent dose of another opiate? Is he right, is that hydromorphone metabolism theory just a myth? I couldn't find any "official" looking reports to back it up, just personal experience articles from other patients.

Thanks for any suggestions or advice that anyone can offer me. I'm planning to give this a shot for a couple weeks but if I notice any negative side effects from the dose increase I will go back in and request to switch again.

Peace and love, and pain free days ahead to all.

-KP
Posted 8/5/2015 1:25 AM (GMT 0)
KP dilaudid actually is one of the highest abused medications in the US for several reasons,one it's easily broken down to be injected and two the degree of high it carries. However it's also one of the most addictive and fastest tolerance building medications as well. It contributes to hundreds of od and accidental deaths among IV drug users. The biggest reason for that is the tolerance issue,it doesn't take long for the addict to require what virtually is a lethal dose to maintain the same high. The problem occurs because the med has almost no half life and is metabolized and excreted within hours meaning someone addicted will display withdrawal symptoms very quickly and require more med. Viscious cycle until accidentally overdosed. Now I used this as a reference and not to say your any such thing as this but when it comes to medication experience and studys they do more in the drug wars here against them then they do for normal use in CP.

In saying all that I personally don't think using the same ER and rescue med produces as good results as using two entirely different meds do. I've always been of the mind that tolerance builds much faster with higher doses and when you add up base plus rescue that's a pretty good amount.
Posted 8/5/2015 1:39 AM (GMT 0)
Thanks for the feedback. Note that I did specifically ask my doctor to be switched off of this medicine and he then voluntarily doubled the dose, more or less against my wishes, saying this would probably be the 'best solution' for now. I also take this medication exactly as prescribed, and orally, not via IV, and have monthly doctor visits.

I've read similar reports about having different ER and IR meds being more effective than both the exact same. As I mentioned, the new dose is working again but I share your concern with the total daily dose being quite high and I wanted to avoid such an increase myself.

I will give it a shot for a week or two but if I notice an increase in side effects I am going to demand that he switch medications.

Is there anyone else who has been in a similar situation or had such an experience with ER/IR hydromorphone before?

Cheers

-KP
Posted 8/5/2015 8:33 AM (GMT 0)
I was in no way suggesting you did any of the above and using the information only because of the lack of it for CPers,most pertains to the addict as usual. I'm not sure how many folks here use hydromorph since it's difficult to find and fill here,more use oxy and morphine but I am sure we have a few who currently use it and more who did at one time and hopefully they can shed some light on their experiences for you.

Good luck and I hope you find the answers and better pain management.
Posted 8/5/2015 10:33 PM (GMT 0)
Hey KillerPain.I've only taken 2 mg Dilaudid for breakthrough pain.That was only for a few months so I wasn't on it long enough for any tolerance issues.

I take Morphine ER and IR.So far I'm pretty satisfied with both the effectiveness and longevity of it.I'm prescribed 180 mg a day at present.

To me the Dilaudid didn't last as long as Morphine.

I'm not sure about the conversion between Morphine and Dilaudid.I think Oxycodone is 1 1/2 x Morphine.

Glad to have you aboard.

Rick
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