When to Take Break through Meds?

[Nysff]

I was on Oxycodone 10mg for a few months now and it worked well for me. I seen this new Pain Doc and she had no clue on my history and switch me to Kadian 20mg CR once a day when I begged her not to because A.) 10mg's worked well with me. I was taking a Oxy at 9am, A loritab at 2pm then another Oxy at 9pm again, It Worked well"  B.) I started on 20mg's of Oxy and it gave me the same issues I'm having now on this new med. "Anxiaty, sleepy, confused, cant think straight". But anyways. I took it at 9am today for the very first time "The Kadian that is". I don't like the feeling im getting on these and it's now 4:20pm and no-one has told me when to take my break through meds "Loritab 10/500". Anyone know when I should take this because I am in pain.

And why would a doctor put someone that has been taking Loritabs for almost 10 years now at 10/325 dosage, bump it up to 10/500? Thats like Sucide for your liver. I think I wont take this Kadian again, that or try taking out 25 pellets and make it into a 10mg dose rather than 20mg "Pharm said I could do that being 20mg's of Kadian has about 50 pellets in it, Just dump out 25 pellets and take the remaining 25 in the tablet"


Thanks in Advanced for your help

[marycarmel]

I'm glad you found the forum.  It can be a great resource.  I just want to point out that the post your commenting on is very old and the people who posted and commented are no longer active.  I hope you'll be involved here.  It is sometimes can be slow, especially on holiday weekends.

[cplsmokie]

I'm new to this forum, and glad I finally found it. I've been on pain meds for many years and have tried many different types and Brands. The reason so many Pmp will not write OxyContin is because it is so widely abused. There was a point yrs ago when they even had several TV shows about housewives and normal everyday folk getting addicted due to abusing and not following directions as prescribed. I personally was om Opana for many years because it was the ONLY drug that didn't make me feel high when I was taking it! Unfortunately, after about 6 or 7 yrs, it just quit working. Anytime I'm put on something new, it takes a couple weeks before I start feeling normal. I agree with what everyone else is trying to say....don't do anything wo talking to your Pmp first. Thy are forced to stay politically correct and right now, the powers that be, do not like OxyContin and a few others as first choice for long term pain.

[Tuckamore]

Thank you for clarifying your concerns. Everyone responds differently to medications. Morphine did not make me anxious but iti is a possible side effect.

Sorry but I don't know if you have any choice with this PMP. If she told you straight up she will not prescribe OxyContin I highly doubt she will change her practice. My physician told me that some years ago and I have always respected her personal feelings. If I feel there are no other choices I will have to change physicians. That's the rules and I understand them and respect the fact that she told me right up front.

That does not mean that you have to do the same. This particular PMP may not be the right one for you. Sorry but that may be  a fact.

I suggest that you search for another PMP regardless of what that might mean. Asking her to go against her practice is like asking you to take a medication that you are not comfortable with and that's exactly what has occured. Again I am so sorry that this looks as though it may not be a good fit. I wish you the best in your search for a new physician.

Please let us know how this turns out for you. I wish you the very best.

Peace,
~Tuck

[Nysff]

Not sure if you guy's are following me here. I have Anxiaty and Panic Disorder. The VERY first thing on the side affects of Kadian are Anxiaty. Why would she put something in me that im am trying to battling with by taking Klonopin? Second, Without even looking at my records she tells me is ALL Muscular pain I have when I know 100% that i have problems from my cervical spine ALL THE WAY to my Lumbar spine. Why Would I have a fused back & DDD if it was "Just" Muscular? I told her that I was given 20mg's before and my body does not handle it well PERIOD. She told me that she does not write Oxyconton in her practice and that the Kadian was my Only option. It just dont make sense to me medically on whats going on here. My Surgen even said that taking the Oxyconton and loritabs was the best thing for me currently because it works and i dont take alot of it. and also when she does her exams with you, She is VERY aggresive. i'm not happy at all period. And even though I live in a 54 sq mile city, PMP Are VERY hard to get and my insurance dont even cover many doctors that or they are not taking new Pt's. So right now it's save myself by just making the dose by 10mg's so I can think straight, still work part time and be as much of a father and husband to my family, Or take these strong meds that are messing me up. I shouldnt even be working but because my wife is sick and just had surgery, I have no choice but to man up and suck it up.    I Don't Know what to do......

[Tuckamore]

Hi Nysff,

Welcome to the Pain Mangement Forum. I am so glad that you found us at MedHelp. However I am sorry that you are having issues with what your new PMP prescribed.

For the life of me I cannot understand why PMPs will often change a drug that is working for a new patient. I do know that physicians are concerned with the long term effects of acetaminophen. It makes little sense to me that your PMP increased your dosage of it.

However his/her goal may be to eventually stop the acetaminophen containing tablets in the future. Therefore he may be trying to mange you on a long acting opiate rather than a short term one. I would certainly ask his rational. Now is the time to begin to build a good patient/doctor reationship in my opinion.

Yes Sherry is correct. You take break through (B/T) medication for break through pain which mean pain that your long acting opiate is not controlling. According to my physician even if that mean an hour from your dose of long acting medication. It's called break through because the pain breaks through the barrier that is supposedly created by the long acting medication. Read your label. If it says you may take the B/T medication every four hours as needed for pain then anytime you feel increased pain after four hours from your last dose of the B/T medication you may repeat it. You may want to check with your pharmacist but that is how I understand it.

Please, please do not adjust the dosage of the Kadian, regardless of what your pharmacist tells you. A pharmacist is very knowledgeable and often an over looked source of information but they cannot change your dosage without the consent and agreement of your prescribing physician. Physicians (especially PMP) are very specific about the dosages they have prescribed for you. You must contact your PMP for any adjustments in the dosage.  If you signed a contract you I am concerned that you may be viewed as violating it by changing the prescribed medication dose.

Opening a long acting capsule is not normally advisable. However I am neither a pharmacist or a physician so please check with your PMP.  I just don't want you in violation of your physician's wishes immediately following your first visit. You have enough challenges with your chronic pain.  Please call your PMP and ask for advice. I beleive that in the long run you will be glad that you did.

I hope that you will become an active participant on our pain management community. We are here to support you or just listen if you need to vent. We all do a bit of both from time to time. Please let us know how you are doing. We will look forward to your updates. I wish you the very best.

Take Care,
Tuck

[Sarajmt]

Sherry, as usual, is absolutely correct!  You need to address this with your doctor before you make any adjustments.  You could get booted out of her practice for that!

And what happened to your medical records?  You need to track those down and get them to your new doctor.  I'm really sort of surprised she treated you without them.  My pmp would not do that.

I am on Lortab 10/500.  That and Clonazepam.  Works great for me. And so far, no liver problems.  But I don't drink alcohol.  personal choice.  Don't like the taste.

[namnam46]

Hi Nysff,

When you have a BT  (Break Thru) med you should take it when you feel that the pain is starting up. Don't wait as the pain will get too strong and then it is VERY difficult to get control of it. After you take your first BT then you should wait until your  "8 hrs" are up (IF that is what the instructions on your script are) before taking another of your BT meds. The time that you wait to take a 2nd BT med depends ENTIRELY upon the Script instructions.

PLEASE  DO NOT ALTER YOUR MEDS WITHOUT PERMISSION FROM YOUR DOCTOR. If you do it can get you kicked out of your PM Dr. or Clinic. It can also get you Red Flagged and it will be VERY difficult to get in to another PM Clinic.

I'm not being mean or anything but I'm VERY worried about  you if you alter you meds and your Dr. finds out. I'm VERY surprised that you Pharmacist would recommend that to you.

You need to call your Dr.'s office and tell them your concerns and work something out with them. That way you are protected from being kicked out.

Actually , there are MANY CP Patients taht are taking 10/500 Lortab, I am one of them. I was on either 7.5/500 or 10/500 for 7years before I was put on the Fentanyl Patch and Percocet 10/325  1/2 to 1 tab. every 8 hours for BT Pain. You are correct about needing to be careful because of your Liver. Just do it with the BLESSING of your Dr. so that you are protected.

I hope that you will get back to us and let us know how it goes with your PM Dr.

Best of luck and we look forward to your updates....Sherry