Aa
help
I was taking for two wks percocet (oxycocone-acetaminophen 5-325) 2 every 3 hours(5
doses daily) vs opana ER 5mg 1dose 2tms dly which is generally stronger? And how do most people out there like opana?
doses daily) vs opana ER 5mg 1dose 2tms dly which is generally stronger? And how do most people out there like opana?
Sounds like you have a very neurotic doctor. I talk about treatment options with my doc all the time. In fact, we just rotated my medication from hydromorphone to oxycodone, because after three years, I have become incredibly tolerant to hydromorphone. It was a decision we made together, as was titration of the new dose to an effective level. Smart docs know that every patient responds differently to treatment.
How in the world can your doctor monitor the effectiveness of your opiate therapy if you can't discuss it -- perhaps there's an Ouija board in his exam room?
Yes, some docs chose not to prescribe controlled medications. Personally, I think their patients are being under served, but staying with a doc like this is a choice each patient has to make.
How in the world can your doctor monitor the effectiveness of your opiate therapy if you can't discuss it -- perhaps there's an Ouija board in his exam room?
Yes, some docs chose not to prescribe controlled medications. Personally, I think their patients are being under served, but staying with a doc like this is a choice each patient has to make.
I wouldn't dare speak to my Pain Mgmt Dr about what I'm taking, if I might need lower or higher! Even using the med name triggers him ibto a panic that I must be a druggie if I'm knowledgeable about them! And I have the "contract" and all! Better always say pain is unchanged or suspicion goes off the chart! Lot of druggies in my area-I hate them for the trouble they've caused real patients! (Dr remark upon seeing mri & xrays of my arthritic degenating spine, now w/scoliosis & vertebrae bone on bone was "what a mess!) yet still under suspicion of possible "drug seeking." A tick bit me last fall, went to a Doc closer to home(he treated hubs aunt) than my PCP to check it,not saying that it hurt-it didn't! I was immediately told loudly "I don't prescribe narcotics" What?!? I left, embarrassed, made appt w/PCP, he checked it & prescribed the appropriate antibiotic for anyone w/tick bite. What is wrong with some of these doctors? It's crazy here in healthcare heaven, lol!
Hi there Dee,
This community is for everyone! You don't have to answer every question on your home page just the ones that you have experience with or are knowledgeable in. Everyone gets all of the questions that have not received responses on their home page.
With this kind of question, if answered incorrectly this person may go on and think that their new medication is indeed more effective than their old medication simply because the new medication is stronger mg to mg than their old medication without understanding that the dosage of the stronger medication is equivalent to a lower dosage of their previous medication. They may not talk to their doctor about adequate pain control. They may just think that this is the way it is and think that over time the effectiveness will improve when indeed it will not.
I spent years suffering in pain because I was misinformed about pain management. Now, I have excellent pain control and room for dosage increases should I need them down the road. The excellent pain management I have now is due to me becoming more informed about how pain management works and understanding the options available to me. I hope to help other chronic pain patients understand the leverage that they themselves have when it comes to their healthcare.
I strive to provide other MedHelp members with accurate information so that they have the knowledge to advocate better pain management for themselves. I couldn't imagine the pain that this person must be going through with this underdosage he received from his doctor. I want to empower people to do something about their situations to make it better. There are many that won't be assertive with their doctors without motivation to do so. Providing facts to their doctor about their medications, pushes the doctor to respond and act on behalf of the patient. If a patient goes in misinformed about his/her medications, the doctor is in control; when in reality, the doctor and patient should be working as a team.
No hard feelings. I have spent 3 years researching pain management as it pertains to the doctor, pharmacist, and the patient. I didn't learn these conversions overnight. I found them interesting and researched and studied them until I was proficient. You can do the same if you desire to learn. And in fact, I encourage all chronic pain patients to understand opioid conversions as it can be a useful tool when negotiating medications and/or dosage changes with their physician. Instead of it being a conversation with mostly one way communication with the doctor dominating...it can become a two way communicative discussion involving both the doctor and the patient.
femmy :)
This community is for everyone! You don't have to answer every question on your home page just the ones that you have experience with or are knowledgeable in. Everyone gets all of the questions that have not received responses on their home page.
With this kind of question, if answered incorrectly this person may go on and think that their new medication is indeed more effective than their old medication simply because the new medication is stronger mg to mg than their old medication without understanding that the dosage of the stronger medication is equivalent to a lower dosage of their previous medication. They may not talk to their doctor about adequate pain control. They may just think that this is the way it is and think that over time the effectiveness will improve when indeed it will not.
I spent years suffering in pain because I was misinformed about pain management. Now, I have excellent pain control and room for dosage increases should I need them down the road. The excellent pain management I have now is due to me becoming more informed about how pain management works and understanding the options available to me. I hope to help other chronic pain patients understand the leverage that they themselves have when it comes to their healthcare.
I strive to provide other MedHelp members with accurate information so that they have the knowledge to advocate better pain management for themselves. I couldn't imagine the pain that this person must be going through with this underdosage he received from his doctor. I want to empower people to do something about their situations to make it better. There are many that won't be assertive with their doctors without motivation to do so. Providing facts to their doctor about their medications, pushes the doctor to respond and act on behalf of the patient. If a patient goes in misinformed about his/her medications, the doctor is in control; when in reality, the doctor and patient should be working as a team.
No hard feelings. I have spent 3 years researching pain management as it pertains to the doctor, pharmacist, and the patient. I didn't learn these conversions overnight. I found them interesting and researched and studied them until I was proficient. You can do the same if you desire to learn. And in fact, I encourage all chronic pain patients to understand opioid conversions as it can be a useful tool when negotiating medications and/or dosage changes with their physician. Instead of it being a conversation with mostly one way communication with the doctor dominating...it can become a two way communicative discussion involving both the doctor and the patient.
femmy :)
I received these questions in my home/profile page, I thought I was supposed
to help answer. Thank you so much for setting me straight :)
Holey Moley crackerjack! Just re-read your post. You are taking TWO 5/325 percocet 5 times a day!! That equals 50 mg of oxycodone per day, which is twice the amount used in my conversion information above. You are severely UNDERDOSED. I'm not going to go through all the math again as it just brings people to sleep. So to cut to the chase, taking 20-30 mg of Opana ER per day is equivalent to 40-60 mg of oxycodone a day. Per the guidelines put out by Endo pharmaceuticals, 20-30 mg daily of Opana ER is typically dosed at 10-15 mg twice a day. My apologies, just noticed that you wrote that you were taking 10 mg of oxycodone 5 times per day versus 5 mg of oxycodone 5 times per day. So instead of being slightly underdosed, you are severely underdosed. You need to make an appointment ASAP to talk with your physician about your pain control on the Opana ER.
To All: This is a GREAT example that shows why learning opioid conversions are so very helpful as understanding them can help you make sure your doctor isn't pulling a fast one over on you. Doctors sometimes switch patients to a different opioid that they are not familiar with and reduce the dosing to lower than therapeutic levels without the patient being aware that this is happening. The patient is confused for awhile trying to figure out why their pain isn't controlled and the doctor is able to prescribe less of an controlled substance in the process.
femmy
To All: This is a GREAT example that shows why learning opioid conversions are so very helpful as understanding them can help you make sure your doctor isn't pulling a fast one over on you. Doctors sometimes switch patients to a different opioid that they are not familiar with and reduce the dosing to lower than therapeutic levels without the patient being aware that this is happening. The patient is confused for awhile trying to figure out why their pain isn't controlled and the doctor is able to prescribe less of an controlled substance in the process.
femmy
Hi Dee,
Thanks for the sweet note this morning. :)
I understand your statement that, "none of us are doctors" (you would be surprised if you knew how many doctors and nurses both retired and active respond in this community). Really his question more lies in the realm of pharmacology. What he really wants to know is, overall which medication based on the total daily dosage amount he is prescribed is supposed to provide him more pain relief. He is asking this question as he probably noticed that his pain is not as controlled on the Opana ER as it was on the percocet.
Opana ER is oxymorphone in extended release form. Oxymorphone is the STRONGEST opioid medication in pill form available in the United States soley for pain management. Therefore, short answer is yes...Opana ER is stronger than oxycodone mg to mg. For example, 1 mg of oxymorphone is stronger than 1 mg of oxycodone...to be precise, oxymorphone is approx. 2 times stronger than oxycodone. Therefore, to get equivalent strength of oxymorphone through oxycodone, one has to take their oxymorphone dosage and multiply it by 2 to yield equivalent oxycodone dosing in mgs.
Here is another example, if a patient is taking 10 mg of oxymorphone per day and wants to switch from oxymorphone to oxycodone, the patient would need to be dosed twice the amount of his oxymorphone dosage as mgs of oxycodone (10 mg of oxymorphone = 20 mg of oxycodone). If he is dosed more than 20 mg of oxycodone per day, his new dose in oxycodone is STRONGER than his old dosage in oxymorphone.
Opioid conversions are not straight-forward and most who are not in the medical field do not understand how to do the conversions correctly to determine whether the dosage in the new opioid is as effective as the dosage in the old opioid. Add variable cross tolerances to the mix and the conversions are more trickier. Cross tolerance factors are a % of total daily dosage reduction after the unit conversion from one opioid to another opioid is complete. For many, a different opioid never tried before can be stronger even when the dosage equivalent is less than the amount received in the old opioid because of incomplete cross tolerance. Most often, doctors reduce the dosage in the new opioid down by 20-25% after the unit conversion to minimize adverse side effects from the new opioid. When this is done, most patients need to be titrated up from the initial dosage for effective pain relief.
It seems that you are very devoted to helping people on MedHelp but to truly help them you need to provide accurate information. If you don't know then don't guess. It's that simple.
I believe we should all be empowered patients. Doctors and pharmacists are human and humans make mistakes from time to time. Whenever I am dosed a new opioid medication, I make sure that the dosing in the new opioid medication is comparable to what I was receiving from the old opioid. I amaze my doctor by how well I know how to do opioid conversions and we do them together during my appointments when I am being switched to a new opioid medication.
Earlier this year when I switched from morphine to Opana ER, I noticed that the conversion added 60 mg of morphine to my current dosage and I discussed this with my doctor to make sure that he wanted to increase my dosage by that much when switching me from morphine to Opana ER and he confirmed that he did. I called several pharmacists and bounced my conversion numbers off them to get their thoughts, and not only did our conversions match, but they thought the conversion was on the high side as the majority of the time, patients are dose downward not upward when switching from one opioid to another opioid. But my doctor said the conversion factors that Endo pharmaceuticals provides for converting different opioids to Opana ER are very conservative (in other words, the conversion factors have some amount of cross tolerance factored into them). I used these same conservative conversion factors when converting oxycodone to Opana ER in this post. So in truth, the dosage of Opana ER at 5 mg bid is most likely a significant reduction in medication from what was taken daily in oxycodone due to approx. a 50% cross tolerance factor applied - which is a lot. But his doctor may not be aware that the conversion factors supplied by Endo pharmaceuticals are conservative already and therefore tacked on an additional 25% reduction due to cross tolerance.
Given a daily dosage of 25 mg of oxycodone a day, Opana ER would be better dosed at 10 mg twice a day versus 5 mg twice a day. This would result in 20 mg of oxymorphone daily, which is approx. 40 mg of oxycodone daily and therefore 10 mg of Opana ER twice a day results in a 15 mg increase in oxycodone per day from the 25 mg dosage taken before the switch to Opana ER...this is a modest dose increase. There is generic Opana ER in 7.5 mg and 15 mg strengths manufactured by Actavis pharmaceuticals. Taking generic oxymorphone ER at 7.5 mg bid yields a 5 mg increase in oxycodone vs. a 15 mg increase. The 7.5 mg oxymorphone ER dose bid would be the closest in terms of equivalent oxycodone dosing.
So conversions are not simple and to spare folks of all of this math, I leave it out and provide only what I think is necessary to answer the question.
In summary, unfortunately the daily dosing amount of Opana ER is not equivalent to the oxycodone daily dose taken before the conversion and more specifically, LESS oxycodone is taken now through the adminstration of Opana ER.
Keep in mind that all of the information provided is based solely on the science of pharmacology and it does not tell anyone how to take their medications prescribed by their doctor. Medications should always be taken per the schedule provided by the physician. When in doubt, consult your local pharmacist. Furthermore, this information should be used for education purposes only as it simply explains the difference in potency between two opioids and answers the simple question, "Which is stronger?".
Lastly, 50% of the time conversions from one opioid to another opioid require at least one titration by the physician to achieve adequate analgesia. So if your pain is poorly controlled after being converted to a different opioid, speak to your doctor!
femmy
Thanks for the sweet note this morning. :)
I understand your statement that, "none of us are doctors" (you would be surprised if you knew how many doctors and nurses both retired and active respond in this community). Really his question more lies in the realm of pharmacology. What he really wants to know is, overall which medication based on the total daily dosage amount he is prescribed is supposed to provide him more pain relief. He is asking this question as he probably noticed that his pain is not as controlled on the Opana ER as it was on the percocet.
Opana ER is oxymorphone in extended release form. Oxymorphone is the STRONGEST opioid medication in pill form available in the United States soley for pain management. Therefore, short answer is yes...Opana ER is stronger than oxycodone mg to mg. For example, 1 mg of oxymorphone is stronger than 1 mg of oxycodone...to be precise, oxymorphone is approx. 2 times stronger than oxycodone. Therefore, to get equivalent strength of oxymorphone through oxycodone, one has to take their oxymorphone dosage and multiply it by 2 to yield equivalent oxycodone dosing in mgs.
Here is another example, if a patient is taking 10 mg of oxymorphone per day and wants to switch from oxymorphone to oxycodone, the patient would need to be dosed twice the amount of his oxymorphone dosage as mgs of oxycodone (10 mg of oxymorphone = 20 mg of oxycodone). If he is dosed more than 20 mg of oxycodone per day, his new dose in oxycodone is STRONGER than his old dosage in oxymorphone.
Opioid conversions are not straight-forward and most who are not in the medical field do not understand how to do the conversions correctly to determine whether the dosage in the new opioid is as effective as the dosage in the old opioid. Add variable cross tolerances to the mix and the conversions are more trickier. Cross tolerance factors are a % of total daily dosage reduction after the unit conversion from one opioid to another opioid is complete. For many, a different opioid never tried before can be stronger even when the dosage equivalent is less than the amount received in the old opioid because of incomplete cross tolerance. Most often, doctors reduce the dosage in the new opioid down by 20-25% after the unit conversion to minimize adverse side effects from the new opioid. When this is done, most patients need to be titrated up from the initial dosage for effective pain relief.
It seems that you are very devoted to helping people on MedHelp but to truly help them you need to provide accurate information. If you don't know then don't guess. It's that simple.
I believe we should all be empowered patients. Doctors and pharmacists are human and humans make mistakes from time to time. Whenever I am dosed a new opioid medication, I make sure that the dosing in the new opioid medication is comparable to what I was receiving from the old opioid. I amaze my doctor by how well I know how to do opioid conversions and we do them together during my appointments when I am being switched to a new opioid medication.
Earlier this year when I switched from morphine to Opana ER, I noticed that the conversion added 60 mg of morphine to my current dosage and I discussed this with my doctor to make sure that he wanted to increase my dosage by that much when switching me from morphine to Opana ER and he confirmed that he did. I called several pharmacists and bounced my conversion numbers off them to get their thoughts, and not only did our conversions match, but they thought the conversion was on the high side as the majority of the time, patients are dose downward not upward when switching from one opioid to another opioid. But my doctor said the conversion factors that Endo pharmaceuticals provides for converting different opioids to Opana ER are very conservative (in other words, the conversion factors have some amount of cross tolerance factored into them). I used these same conservative conversion factors when converting oxycodone to Opana ER in this post. So in truth, the dosage of Opana ER at 5 mg bid is most likely a significant reduction in medication from what was taken daily in oxycodone due to approx. a 50% cross tolerance factor applied - which is a lot. But his doctor may not be aware that the conversion factors supplied by Endo pharmaceuticals are conservative already and therefore tacked on an additional 25% reduction due to cross tolerance.
Given a daily dosage of 25 mg of oxycodone a day, Opana ER would be better dosed at 10 mg twice a day versus 5 mg twice a day. This would result in 20 mg of oxymorphone daily, which is approx. 40 mg of oxycodone daily and therefore 10 mg of Opana ER twice a day results in a 15 mg increase in oxycodone per day from the 25 mg dosage taken before the switch to Opana ER...this is a modest dose increase. There is generic Opana ER in 7.5 mg and 15 mg strengths manufactured by Actavis pharmaceuticals. Taking generic oxymorphone ER at 7.5 mg bid yields a 5 mg increase in oxycodone vs. a 15 mg increase. The 7.5 mg oxymorphone ER dose bid would be the closest in terms of equivalent oxycodone dosing.
So conversions are not simple and to spare folks of all of this math, I leave it out and provide only what I think is necessary to answer the question.
In summary, unfortunately the daily dosing amount of Opana ER is not equivalent to the oxycodone daily dose taken before the conversion and more specifically, LESS oxycodone is taken now through the adminstration of Opana ER.
Keep in mind that all of the information provided is based solely on the science of pharmacology and it does not tell anyone how to take their medications prescribed by their doctor. Medications should always be taken per the schedule provided by the physician. When in doubt, consult your local pharmacist. Furthermore, this information should be used for education purposes only as it simply explains the difference in potency between two opioids and answers the simple question, "Which is stronger?".
Lastly, 50% of the time conversions from one opioid to another opioid require at least one titration by the physician to achieve adequate analgesia. So if your pain is poorly controlled after being converted to a different opioid, speak to your doctor!
femmy
So sorry, I thought the question was which drug was stronger. I looked it up and provided a site for her to read. I said, I think, it is stronger. I am not a doctor, none of us are.
Dee unfortunately you are incorrect...again. Opana ER is a stronger medication but it has to be given in equivalent dosing to the percocet that the poster was taking 5 times a day.
5 times a day*5 mg of oxycodone = 25 mg of oxycodone
Next, convert oxycodone to equivalent dose of Opana ER = 25 mg/2 = 12.5 mg of Opana ER.
Currently, the Opana ER dosage is 5 mg bid = 10 mg of Opana ER per day
Thus, the new Opana ER dosage is less equivalent opioid medication than the oxycodone taken 5 times a day. This assumes 0% cross tolerance:
10 mg of Opana ER < 12.5 mg of Opana ER (oxycodone equivalent)
Therefore, the 5 mg of oxycodone taken 5 times per day is stronger than the Opana ER as the amount of oxycodone taken per day trumps the Opana ER dosage level per day.
Dee, if you are interested in understanding how opioid conversions work, there are tons of great conversion tables and calculators on the web to help you understand opioid conversions better...Google it. You do have to have a basic understanding of mathematics, specifically "Unit Conversions".
femmy
5 times a day*5 mg of oxycodone = 25 mg of oxycodone
Next, convert oxycodone to equivalent dose of Opana ER = 25 mg/2 = 12.5 mg of Opana ER.
Currently, the Opana ER dosage is 5 mg bid = 10 mg of Opana ER per day
Thus, the new Opana ER dosage is less equivalent opioid medication than the oxycodone taken 5 times a day. This assumes 0% cross tolerance:
10 mg of Opana ER < 12.5 mg of Opana ER (oxycodone equivalent)
Therefore, the 5 mg of oxycodone taken 5 times per day is stronger than the Opana ER as the amount of oxycodone taken per day trumps the Opana ER dosage level per day.
Dee, if you are interested in understanding how opioid conversions work, there are tons of great conversion tables and calculators on the web to help you understand opioid conversions better...Google it. You do have to have a basic understanding of mathematics, specifically "Unit Conversions".
femmy
Hi I think, from what I have rea, that Opana is stronger however if I were you I would look it up www.opana.com
Good Luck
Good Luck
Hi and welcome to the pain management community.
I used to take 30 mg of Opana ER twice a day but I switched to the Fentanyl patch last month. 30 mg of Opana ER is roughly 60 mg of oxycodone or 90 mg of morphine.
10 mg of Opana ER is roughly 20 mg of oxycodone or 30 mg of morphine. You are actually getting 5 mg less of oxycodone through the switch from percocet to Opana ER. However, since Opana ER is an entirely different opioid formulation. There is probably some cross tolerance and your doctor applied a 20% cross tolerance factor when converting you from oxycodone to Opana ER. This is to protect you from severe side effects and a potential overdose of the Opana. After switching from one opioid medication to another, most patients require at least one dose titration. Keep in mind that it takes 3 days for the Opana to build up to a steady state level in the bloodstream so it may be a few days before you will know whether or not the Opana is covering your pain.
Mary is right. Most patients that are being treated with an extended release medication require a short-acting opioid like percocet for breakthrough pain.
I switched from Opana ER for two reasons: (1) The new abuse deterrant Opana ER reformulation is getting really bad reviews across the web from chronic pain patients saying that the new Opana ER has been making them sick and that it is isn't controlling their pain very well, and (2) Severe constipation issues (you will probably need to take a laxative with the Opana ER).
I hope that the Opana ER works well for you. It worked well for my pain but the side effects were intolerable. Please keep us updated.
femmy
I used to take 30 mg of Opana ER twice a day but I switched to the Fentanyl patch last month. 30 mg of Opana ER is roughly 60 mg of oxycodone or 90 mg of morphine.
10 mg of Opana ER is roughly 20 mg of oxycodone or 30 mg of morphine. You are actually getting 5 mg less of oxycodone through the switch from percocet to Opana ER. However, since Opana ER is an entirely different opioid formulation. There is probably some cross tolerance and your doctor applied a 20% cross tolerance factor when converting you from oxycodone to Opana ER. This is to protect you from severe side effects and a potential overdose of the Opana. After switching from one opioid medication to another, most patients require at least one dose titration. Keep in mind that it takes 3 days for the Opana to build up to a steady state level in the bloodstream so it may be a few days before you will know whether or not the Opana is covering your pain.
Mary is right. Most patients that are being treated with an extended release medication require a short-acting opioid like percocet for breakthrough pain.
I switched from Opana ER for two reasons: (1) The new abuse deterrant Opana ER reformulation is getting really bad reviews across the web from chronic pain patients saying that the new Opana ER has been making them sick and that it is isn't controlling their pain very well, and (2) Severe constipation issues (you will probably need to take a laxative with the Opana ER).
I hope that the Opana ER works well for you. It worked well for my pain but the side effects were intolerable. Please keep us updated.
femmy
You may need a breakthrough med with the Opana ER. You've gone from taking 25 mg. of oxycodone daily to 10 mg. of Opana, the difference being the Opana is extended release. Different drugs are not equal milligram to milligram so 10 mg. of Opana ER may work fine, or you may need a breakthrough med. If it's been a couple of weeks and you're not getting relief, go back to your doctor to figure out what works best.
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