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Pain Management Message Board

Pain Management Board Index

Hey Allan, Although this isn't an absolute or exact way to do it, You can replace the total daily Kadian dose with short acting morphine divided into 6 short acting doses. So 120 mgs of kadian a day woul be comparable to takeing 20 mgs of IR morphine every 4 hours. 20 mgs of IR morphine every 4 hours is les than half of what 30mgs of oxycodone would provide as far as relief in theory if equiananelgesic tables were dead on. Unfortunately they really aren't, Most conversion would have 30 mgs of Oxy equal to 45 mgs of MSIR, Personally I don't get the relief from 60 mgs of MSIR that 30 mgs of Oxy provides, but that' just how I respond.

20 mgs of MSIR every 4 hours really isn't squat when only half your dose of oral morphine crosses the blood brain barrier. I've swithced from kadina to generic MSIR mg for mg. My doc used TID dosing with kafdian and has no problem with TID dosing as long as the doses are taken evenly apart "8 hours" and at the same time evrey day. When I switched from 200mgs of Kadian TID I replaced it with 200 mgs of MSC 3 times a day and really didn't find much differnce othe than the MSC would flat wear off if you were more than an hour late for the dose. The advantage of taking Kadian TID is that as your first dose of the day is wearing off 24 hours later, you still have 2/3 of your daily dose working. So worst case scenario your serum level is only going to drop by 1/3 it it's lowest point.

IF you had to convert all your opiate intake into morphine/Kadian to maintain what takng one 30 mg Roxi on top of the existing 120 mgs of Kadina every 4 hours you first convet the kadian into 6 IR doses taken every 4 hours. 120 mgs of kadian would equate to 20 mgs of IR every 4 hours. Using a 1:1.5 conversion for morphine to oxy which is extremely conservative IMO. You would replace 30mgs of roxi with 45 mgs of MSIR every 4 hours. Plus the 20 mgs of MSIR every 4 hours the Kadian roughly sustains equals 65mgs MSIR every 4 hours.

So now you at 65 mgs of MSIR every 4 hours or 390 mgs of morphine per day. Now you simply convert the IR morphine back into LA morphine mg for mg.
65mgs of MSIR X 6 doses per day equals 390 mgs of sa morphine, which could then be replaced by 400 mgs of Kadian per day or dosed 200 mgs BID.

Kadian's full prescribing info recomends you do all the conversions to come up with your total daily opiate intake, convert it to morphine and start at half for safety reasons. That's really for an opiate naive patient.So the starting dose would be 100mg BID. Someone that can take 30 mgs of Roxi on top of 120 mgs of morphine a day is not opiate naive. IF that's what it requires to manage your pain, I really don't see the logic in relyng so heavily on your BT meds. Have you told him that the kadian only provides 5% of the relief you get from the combined opiates you take, and what does he say to justiify continuing this plan?

From the docs standpoint is taking 180 mgs of oxy plus 120 mgs or morphine a day really that much different than taking 400 mgs of kadian a day and having a limited number of BT meds available to truly use as BT medication. I don' know if your doc provides you 6 doses of roxi a day but if you can handle even one dose a day on top of the kadian, you know how that makes you feel for the 4 hours it lasts and you know it's safe because you have been doing it so frequently, for so long.

Increasing your level to be constanly in that range really is no more dangerous and I would think 4 capsules/doses of kadian a day would bring less attn to his prescribing than 6 roxi a day plus 2 doses of Kadian.

He could reduce the number of pills he needs to prescribe by half and keep you in a range you already know is safe because you do have that high of a serum level every time you take a roxi. If it's safe for those 4 hours the roxi is working, it's safe to do around the clock.

Basicaly when you take a roxi now it more than tripples you opiate serum level that the kadian creates. When it wears off you take a huge nose dive and will have a hard time recovering unles he is giving you 5 or 6 doses of roxi a day. It really doesn't make sense to rely so heavily on the roxi. IF you were actually at 400 mgs of kadian a day the 15 mg roxi would probably be fine for BT and you wouldn't requre it around the clock.

We used the same logic to titrate my pump. I had a day time setting and at night it would increase by 15%. After 2 weeks I have a good idea of how the higher night time setting effected me and how much relief it provided. IF I still wasn't getng relief we would turn my night time dose into my day time dose and increase the night rate another 10-15%. We just kept going based on how the higher rate effected me untill we reached a level I could function in the day time on and one that managed the increased night pain and allowed me to truly use BT meds for BT pain.

Your higher rate is when you take BT meds, if you can function during that 4 hour period and don't feel impaired, there is no reason not to use your BT level as your target for your base level. This way you can limit your BT use and actually use it for BT pain rather than trying to sustain what the kadian could be doing at the right dose.

Every peron I have met that isn't happy with Kadian is usally in the same position as yourself. The dose is simply too low. I started at 200 mgs a day, that didn't touch my pain and there are docs that would have given up on morphine right then. Fortunately over the next 8 weeks we increased to 300 , then 400 and then 600 where I stayed for a year although I did have to switch to the same number of mgs of generic MSC when my insurance changed. If my insurance hadn't coveed the generic MSC we would have converted to the same number of mgs of MSIR per day devided into 6 doses.

Obviously evryone doesn't need to be at that high of a dose, but based on your BT med use, you can obviously handle tripplng your long acting dose safely. If it was done all at once the constpation or UA retention may hit you so hard you couldn't handle the side effects but he could continue to titrate the Kadian untill it's providing 80-90% of your pain control and then BT meds could be used for their intended purpose. It follows no principles of pain management or standards of practice to force a patient to rely on continual use of BT meds when your long acting dose is so proportionally low compared to where you are after taking 30 mgs of roxi on top of your present dose of LA med.

What's the goal here, Is he expecting something else your doing to slowly improve your condition so that you can decrease your BT meds use? Whether you take 400 mgs of Kadian a day or 180 mgs of roxi plus 120 mgs of Kadian, your tolerance level is still the same. If he is presently providing 6 doses of roxi a day, I would ask to trade the roxi for more LA med so you don't have to continue to watch the clock and live your life in 4 hour increments. The whole purpose of LA meds is to prevent the ups and downs and free you from clock watching.

Good luck, Dave

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