Breakthrough Meds - Cycle

[Sara1979]

I am currently taking Oxycontin 20mg - twice a day as my main medication and Oxycodone 5mg (every 4-6 hours as needed) for breakthrough pain. The Oxycodone is becoming less and less effective. Is there something I could switch it out with to lower my tolerance?

[debhun]

I Am on Opana ER 10 mg 1 every 12 hours and I can have 1 5/325 mg of perc 2 times aday. And it seem to work very well for me. Unless I over do things and nothing works it seems. It is I just have over done it. I am hoping after the week-end things go back to normal. What ever normal is. But before I wasn't doing much and now that I am she may have to go up on mine. We will see. I hope you fine relief soon. you should call your doc and ask them what you can do.


Deb*sparkle

[gambles]

I've been on MS Contin for years and building up a tolerance is just the nature of the beast. Hopefully your doctor knows this and will give you a slightly higher dose if you can tolerate it and it helps you. Your dose know is pretty low so I wouldn't think it would be much of a problem on his/her end.

It is also common with Oxycontin to need it 3 times a day instead of 2. When I tried it, my PM Doctor knew that and built that into my regiment. Maybe just adding one a day would be enough to get you over the hump for now.

Suzanne

[Kira]

I am in the same boat with you. I use a 50 mcg/hr fentanyl patch (change every 3 days) and take 5 mg oxycodone (up to 4/day). I have gradually gotten more tolerant to the oxycodone. It doesn't really work well for the pain anymore, but if I don't take it I get withdrawal-ish feelings... a weird hot/flushed feeling in my skin, anxiety out of nowhere, watery eyes, and worsened pain.

Every time I have a rhabdomyolysis attack, we temporarily increase the meds until the pain gets better. I have a morphine PCA for a few days in the hospital, then a tapering schedule of oral oxycodone. My last attack was in July and ever since that attack, I haven't been able to taper down below 3-4 oxycodone tablets per day. Whenever I get down to 1 or 2 tablets/day, I feel like crap. So I take 3-4 oxycondone tablets on most days. That leaves me without anything else I can do when the pain gets worse, and I don't think my pain is very well controlled right now on the patches + oxy. I would say that most days, on my scale, my pain is about a 6-7 with a few spikes up to 8. When these meds were working better, I could keep it at a 4-5.

I don't know why I was able to taper down from the higher doses used during & immediately after the attack, but I can't get rid of these last few oxycodones. Maybe because I was on the higher doses for such a relatively short period of time, so my body didn't have time to accomodate to them?

I think that I've gotten to the point where my breakthrough med is just part of my background, "base" med because I take it so often. I really have not wanted to increase the patch dose, but I think that probably is what I need to do. We have talked about increasing the patch dose at the last 3 appointments but I keep saying I don't want to yet... so I know that my pain doc will just switch the patch dose at my visit next week if I want to.

I am wishing I could use less meds, not more... but this is just another aspect of my disease that I need to work on accepting, I guess. I really hate it any time the meds need to be increased. It makes me feel like an addict even though I know the difference between tolerance and addiction.

Maybe we can just increase by another 12.5 instead of going all of the way up to 75 mcg/hr.

I just hate the idea of being on an ever-increasing dose of opiates.

[BrokenBladder]

I also take Oxy, but I use Vicoden for B/T. As Deb said you might want to talk with your doctor about increasing the Oxy to 3 times per day.

I take my Oxy TID and that really helped me. If the doctor is willing to make that change then your normal B/T med will probably work much better.

[Sara1979]

Thanks for all of the suggestions. I am also really worried about getting on the roller coaster of increasing my medication dosages but I know it is the nature of the beast. Did you have any problems getting your insurance to cover Oxy 3 times a day? When I was on extended release Ultram 200mg twice a day they wouldn't pay for the second dose because it was considered "off-label use" which of course is really funny since most of the meds they give us for CP are off-label.

[Mark N]

Sara, I didn't have any problem with my insurance covering taking Oxy TID. It isn't always a case that you become tolerant to the med. Once I established my baseline at MSContin 60mg TID with no breakthrough meds I haven't change the dose for over three years now. I started at 15mg and went up worried that it was my tolerance to the med but after I reached 60mg it has continued to control my pain adequately. I am not saying it will work that way for everyone but it does for me so you may not continue upping the dosage once you reach your therapeutic dosage.

[BrokenBladder]

Sara,

No my insurance company had no problems covering the Oxy TID. I would talk to your doctor right away and try to get the adjustment.

Who knows, once the adjustment is made you may not need to increase for quite some time.

[Sara1979]

Thanks Everyone. I am going to have to do something. I was up till 6am because my neck was bother me so badly. It's been a while for that. I just woke up and know if I move around too much I know I am going to be in that boat again.