PharmacistSteve...Question

[Kathi49]

My PM still wants me to try the Duragesic patch. I re-read the insert again today and am a little confused. The way that insert reads it SEEMS like you have to be VERY opiate dependent and it addresses Methadone and Morphine and things of that nature. Soooo...what would be the equivalency of ONE 5/500 Vicodin a day and/or in relation to 12mg of the patch? Not sure if I am asking this right. But it just seems so powerful. And, I am wondering...would it work as well for neuropathic pain (burning) or would Lyrica as an example still be the better one? My PM just said that since I can't tolerate Neurontin at all and have difficulty with Lyrica, that I should just go ahead and try the patch. Still leery though. :eek:

[Pharmacist.steve]

My PM still wants me to try the Duragesic patch. I re-read the insert again today and am a little confused. The way that insert reads it SEEMS like you have to be VERY opiate dependent and it addresses Methadone and Morphine and things of that nature. Soooo...what would be the equivalency of ONE 5/500 Vicodin a day and/or in relation to 12mg of the patch? Not sure if I am asking this right. But it just seems so powerful. And, I am wondering...would it work as well for neuropathic pain (burning) or would Lyrica as an example still be the better one? My PM just said that since I can't tolerate Neurontin at all and have difficulty with Lyrica, that I should just go ahead and try the patch. Still leery though. :eek:

DURAGESIC® should ONLY be used in patients who are already receiving opioid therapy,who have demonstrated opioid tolerance, and who require a total daily dose at least equivalent to DURAGESIC® 25 mcg/h. Patients who are considered opioid-tolerant are those who have been taking, for a week or longer, at least 60 mg of morphine daily, or at least 30 mg of oral oxycodone daily, or at least 8 mg of oral hydromorphone daily or an equianalgesic dose of another opioid.

This is a quote from the prescribing info.. Hydrocodone is suppose to be mg to mg equal to morphine... so if you are taking 5mg of Hydrocodone/day.. and you are getting adequate pain management .. according to the literature .. you should not be prescribed Duragesic patches. The 12.5mcg patch would be equal to 22mg - 70mg of morphine/day.. so in your case ... it could be like upping your dose by up to FOURTEEN TIMES... I would suggest that you talk to the doc about starting with 15mg SR Morphine 2-3x daily to see where it would get you. BUT since Vicodin only last 4-6 hrs ... I don't see where you may need ATC therapy.

[Kathi49]

Thanks Steve,

That is what I thought. It just seems way to potent for what I really need. Fourteen times? No thanks LOL! And when I read about the potential for severe constipation...again, no thanks! I just want to get this burning down...it is so much worse in the summer. So, maybe I should try the Lyrica AGAIN.

[BrokenBladder]

Kathi great job on picking up on the huge difference in the doseage.

steve thanks for always being here for all of us to answer our questions, it means the world to so many of us!!:)

[Kathi49]

Lisa,

Thanks! But it was Steve who figured it out! :) His help means a lot to me too!