Oxycontin / Oxynorm / oxycodone
Discussion
A bit specialised I know, but can I get some advice please as to what level of dose I'm taking? This kind of drug scares me, I need it, but I spose some assurance I'm not taking a dose such has never been taken by anyone else would appease some of my worries!
Currently on 45mg SR night and morning, with full paracetamol and ibuprofen as routine, and between 10 and 15 mg of oxynorm as breakthrough - not needed for 3 days now but end of last week about twice a day.
Using heat as main 'comfort' which masks pain and so helps me keep sane - but I'm not very at moment.
Treatment is for secondary breast cancer in my bones, mainly lower back and pelvis, but with pain spreading to hips thighs and knees for my added enjoyment.
All anyone says is morphine is s drug which you take what you need and there is no max -having trouble getting my head around this - probably not helped by head and concentration shot to death by pain and morphine!
Woe is me!
Nina
Currently on 45mg SR night and morning, with full paracetamol and ibuprofen as routine, and between 10 and 15 mg of oxynorm as breakthrough - not needed for 3 days now but end of last week about twice a day.
Using heat as main 'comfort' which masks pain and so helps me keep sane - but I'm not very at moment.
Treatment is for secondary breast cancer in my bones, mainly lower back and pelvis, but with pain spreading to hips thighs and knees for my added enjoyment.
All anyone says is morphine is s drug which you take what you need and there is no max -having trouble getting my head around this - probably not helped by head and concentration shot to death by pain and morphine!
Woe is me!
Nina
Hi Nina
Firstly, morphine and oxycodone are two different drugs. The rapid release capsules for breakthrough pain are branded as Oxynorm and the longer release 12hr tablets are branded as Oxycontin.
The maximum daily dose of Oxycodone is 400mg, you are currently taking 100-105mg daily(40mg,5mg,40mg,5mg,10mg/15mg)-i presume you take a 40mg tablet plus a 5mg tablet to get the 45mg you mentioned?
Going forward;
Have you got access to a palliative care nurse/team?
Have you been in contact with a pain clinic?
Has your GP/consultant mentioned Bisphosphonates namely Ibandronic acid 50mg daily which may help reduce the pain associated with bone metastases?
Keep taking the Paracetamol, Ibuprofen and using heat as required to keep it bearable.
I hope the information on the dose has settled some of your worries about the maximum dose and i hope you look further into the other info with regard to going forward.
Keith
Firstly, morphine and oxycodone are two different drugs. The rapid release capsules for breakthrough pain are branded as Oxynorm and the longer release 12hr tablets are branded as Oxycontin.
The maximum daily dose of Oxycodone is 400mg, you are currently taking 100-105mg daily(40mg,5mg,40mg,5mg,10mg/15mg)-i presume you take a 40mg tablet plus a 5mg tablet to get the 45mg you mentioned?
Going forward;
Have you got access to a palliative care nurse/team?
Have you been in contact with a pain clinic?
Has your GP/consultant mentioned Bisphosphonates namely Ibandronic acid 50mg daily which may help reduce the pain associated with bone metastases?
Keep taking the Paracetamol, Ibuprofen and using heat as required to keep it bearable.
I hope the information on the dose has settled some of your worries about the maximum dose and i hope you look further into the other info with regard to going forward.
Keith
Thanks guys - yes I take my pain in the derriere bone pill daily - it gets fun when you wake in agony, want pain relief but can't take it due to the fast / nothing else for 30 minutes restrictions! It's the MacMillan nurse who has been the best help with pain relief - the GP prescribes what she says, and the oncologist agrees, but when I started it was 5mg oxynorm as breakthrough and 5 mg oxycont - no-one told me the breakthrough was proportionate to the slow release for example. No pain clinic or palliative care yet.
It seems to be one of these if you know what to ask you get answers areas, but if you don't you've had it!!
Myu understanding was oxycodone was an artificial morphine - they went with that due to hallucinogenic effects diohydrocodeine has had in the past when I tried that due to septicemia on primary dx.
The 400 figure helps - deos anyone take that much?
From what you have said the McMillan nurse is doing a great job (as normal), she is effectively the pain clinic and palliative care team rolled into one person as she will deal with patients like yourself day in day out so knows exactly who to tell to do what. Unfortunately there are many questions you will have do not get answered or quite often there is an information overload which leaves the patient bewildered. I suggest you keep a pen and notepad handy and list the questions you have throughout the day's so you won't forget when you see the nurse/pharmacist/GP/consultant.
In my experience as a community pharmacist i have not seen total daily doses of more than 150mg-200mg, although pharmacists in hospital will see higher doses.
The Ibandronic acid "bone pill" that you take each morning is not pain relief in the same sense as the oxycodone/paracetamol/ibuprofen but will slow the bone damage and thus hopefully reduce the pain due to further bone damage. If you find that pain wakes you in the early mornings then your evening dose of oxycodone may need altering to last longer, this is something to discuss with your nurse/GP. Likewise if you have constant pain that is above what is tolerable then your medication will need altering, only you know the pain level you can tolerate.
Also remember, although your situation is daunting you are one of many in a similar position.
In my experience as a community pharmacist i have not seen total daily doses of more than 150mg-200mg, although pharmacists in hospital will see higher doses.
The Ibandronic acid "bone pill" that you take each morning is not pain relief in the same sense as the oxycodone/paracetamol/ibuprofen but will slow the bone damage and thus hopefully reduce the pain due to further bone damage. If you find that pain wakes you in the early mornings then your evening dose of oxycodone may need altering to last longer, this is something to discuss with your nurse/GP. Likewise if you have constant pain that is above what is tolerable then your medication will need altering, only you know the pain level you can tolerate.
Also remember, although your situation is daunting you are one of many in a similar position.
hiya Nina,
This might be a good time to give you a gentle nudge about comfier beds and mattresses to augment your options for pain control... I remember from last time we talked about it that there are a few not insignificant downsides, but given that you can, for example, hire them from all the main companies for not too much cash, it might be worth borrowing one to try so you can weigh up your options a bit more directly. You can of course get adjustable double beds, especially if you're able to hire/buy privately, so don't let the prospect of having to go into single beds put you off if it's something you want to avoid.
Remember too that you *don't* have to wait until things are dire to try, for example, a syringe driver. Because of the association with late-stage palliative care it might not be suggested for ages yet but they're so incredibly useful for managing certain types of very persistant pain when very small, frequent or constant doses of your drug of choice are what you need... definitely worth a shot (pun unintended!) if you're getting fed up with waking in pain. As you'll see from the time I'm writing this, that's exactly what I'm handling just now.
Got my fantastic 'special' armchair tweaked a bit the other day and am astonished all over again at what a difference having it has made to my quality of life. It's basically completely stopped me from having days so bad that I have to stay in bed - in particular I can go in the chair but then lie it flat for a bit if I need to, having electronic controls means that I can adjust the position SO minutely to find what's comfortable that minute - obviously what I'm dealing with is very very different from what you handle, but some particular problems have close similarities.
Hope you're getting a decent night's kip just now.
Becca
This might be a good time to give you a gentle nudge about comfier beds and mattresses to augment your options for pain control... I remember from last time we talked about it that there are a few not insignificant downsides, but given that you can, for example, hire them from all the main companies for not too much cash, it might be worth borrowing one to try so you can weigh up your options a bit more directly. You can of course get adjustable double beds, especially if you're able to hire/buy privately, so don't let the prospect of having to go into single beds put you off if it's something you want to avoid.
Remember too that you *don't* have to wait until things are dire to try, for example, a syringe driver. Because of the association with late-stage palliative care it might not be suggested for ages yet but they're so incredibly useful for managing certain types of very persistant pain when very small, frequent or constant doses of your drug of choice are what you need... definitely worth a shot (pun unintended!) if you're getting fed up with waking in pain. As you'll see from the time I'm writing this, that's exactly what I'm handling just now.
Got my fantastic 'special' armchair tweaked a bit the other day and am astonished all over again at what a difference having it has made to my quality of life. It's basically completely stopped me from having days so bad that I have to stay in bed - in particular I can go in the chair but then lie it flat for a bit if I need to, having electronic controls means that I can adjust the position SO minutely to find what's comfortable that minute - obviously what I'm dealing with is very very different from what you handle, but some particular problems have close similarities.
Hope you're getting a decent night's kip just now.
Becca
I don't know if it's been mentioned but what about fentanyl patches?
I'm on 76ug a day patches and on top of that I'm taking 40-50 mg of oxynorm, my issues is different in that it's complex regional pain but surely patches would make your life easier, you're certainly on enough oxycodone to move to patches, another bonus is you only have to change them every 72 hours.
I'm on 76ug a day patches and on top of that I'm taking 40-50 mg of oxynorm, my issues is different in that it's complex regional pain but surely patches would make your life easier, you're certainly on enough oxycodone to move to patches, another bonus is you only have to change them every 72 hours.
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