Oxycontin questions

[mmglobal]

I used Oxycontin from 2000 to 2002 when I had my severe lumbar problems. My largest regular dosing was 60mg/day (20mg 3x). After my 2002 surgery, I tapered to zero and only took occasional hydrocodone; never on a regular basis until my neck went south in 2008. When things get bad, I'll creep back up to 60mg/day and when they get better I snap back down to 30. I'm now 2 years in and I'm never close to pain free. I rarely have more than a couple of good days in a row, so I've pretty much given up on any ideas about not being a chronic pain patient. I'm thankful that I can manage on what I consider to be relatively small doses. (Especially compared to most of my clients.)

Back in 2001, I learned that 3/day dosing worked much better for me than 2x dosing. I am highly motivated to take less when possible, so I'd rather take 10x4 or 10x5 if it covers me, instead of jumping up from 30mg to 60mg/day. I was pleased to see that the new formulations of oxy include 15 and 30mg tabs.

My questions are:

1. Is there a difference in the new formulation? I got the new tabs for the first time a few weeks ago. I've not been doing as well and I don't know if it's because of the med change or my situation, activities, etc... are different. (I don't expect to know.)

2. What do the blood level graphs look like with 2x dosing, vs 3x, 4x, 5x. Is it reasonable to go to more than 3/day if that gives a more targeted dose?

I understand that it's impossible to provide any information that can be applied to a specific case... we all must only make medication decisions with our doctors.

Mark

[Pharmacist.steve]

I have not heard anything good about the new formulation.. in regards to be equally effective.

While the Pharma's promote their long acting meds to last 12 hrs.. which may be true in treating acute pain and/or minor chronic pain.. For mod-sev chronic pain..the "12 hr" meds tend to start falling off at about 10.5 hrs and the next dose will take 60-120 min to "kick in".

Personally, I would rather see a patient divide their total daily mgs over every 8 hrs as opposed to every 12 hrs... I would rather have the patient with a 60-90 min overlap of med rather than be at a sub-therapeutic blood level and having to regain pain control.. and having this happen twice every 24 hrs.

IMO.. a viable option is Morphine SR... ideally 1mg of Oxycodone will be equal to 1.5mg of Morphine SR.... again dosed every 8 hrs.

Morphine is a GENERIC ... so a patient's copays should be lower and it cost the insurance company <50% of Oxycontin.. so the insurance company should be more ready to pay for it... fewer prior approvals to deal with.

ideally... a base drug - long acting drug is used every 8 hrs... because the typical chronic pain patient's pain intensity will vary from hour to hour ... day to day ... they will need a break thru - short acting med.

As a rule of thumb... you shoot for a "good day" to be <5 on the pain scale and no break thru meds... a "so-so day" would need 1-2 doses a day... a "not so good day" would need 3-4 doses and a "really bad day" would need 5-6 doses..