Hi all, Dr's appointment today and I'm wondering if there's such thing as extended release hydrocodone? I have rls 24/7, getting worse, have tried everything else (long list) but the opiates are the only thing that work. I'm currently taking 5, 10/500 per day and while they're great and make the RLS go away I'm only geting about 2 hours of relief (sometimes less) from each pill, it's been 2.5 years. I don't want more pills but would rather have something that I could take once or twice a day. I really don't want to go on Oxycontin. Any ideas?
Thanks!
Ray
Extended release hydrocodone?
Hi ray-
I've often wished someone would make a longer-acting hydrocodone withOUT the tylenol. Unfortunately- there is no such product on the markert. And, I haven't heard of anything coming down the pipeline either. If someone else has-- let us know!
As an aside- you didn't say why you didn't want to take oxycontin-- but I've been on it for some time now and am much better then when I took vicodin. Vicodin made me feel "gorked". I also found that the vicodin only lasted 2-4 hrs which necessitated constant pill-popping. I also hesitated with oxycontin for some time and was extremely worried about the stigma attached to it but the fact that it lasts a long time and doesn't make me so wacked out is well worth whatever issues I was having. Your dose of vicodin would be equal to 10-20 mg twice daily of oxycontin.
The only other long-acting options I am aware of would be MS Contin or methadone.
I've often wished someone would make a longer-acting hydrocodone withOUT the tylenol. Unfortunately- there is no such product on the markert. And, I haven't heard of anything coming down the pipeline either. If someone else has-- let us know!
As an aside- you didn't say why you didn't want to take oxycontin-- but I've been on it for some time now and am much better then when I took vicodin. Vicodin made me feel "gorked". I also found that the vicodin only lasted 2-4 hrs which necessitated constant pill-popping. I also hesitated with oxycontin for some time and was extremely worried about the stigma attached to it but the fact that it lasts a long time and doesn't make me so wacked out is well worth whatever issues I was having. Your dose of vicodin would be equal to 10-20 mg twice daily of oxycontin.
The only other long-acting options I am aware of would be MS Contin or methadone.
Josh
Hi Josh, Thank you for the reply. To be honest, the original reasons you listed are the reasons I didn't want to go on Oxycontin. Maybe I'm just not informed. The vicodin DOES make me a bit "gorked" lol and I just figured the Oxycontin would make it more so. So are you saying you were able to feel more "normal" taking the Oxycontin than the Hyrocodone? I'd really be interested if that's the case, I thought it was the opposite.
Thanks!
Ray
Thanks!
Ray
They both have different effects on different people. It's just the way pharmocology is I suppose.
Hydrocodone was the Jesus of drugs for me. Nothing I've taken could replicate the level of relief and the buzz it gave me, not even Oxycodone. Codeine is a close second but with stomach cramps galore.
I said once I wouldn't dare drive down the street after taking hydrocodone, but I was practically normal to the point where I could definitely drive anywhere I wanted on Oxycodone. It was just a totally different experience.
Right now I take Tramadol, since it's really my only option at the moment that I seem to be in control of. However I don't always find it's relief to be on par with the Vicodin either. That's not to say it couldn't work for you, but unless you have insurance it would be expensive to try Ultram ER, the extended release form of Tramadol. It also comes with it's own risks as well as medication interactions, which I've experienced first hand.
That's the only other extended release drug I know of besides what was listed already.
Hydrocodone was the Jesus of drugs for me. Nothing I've taken could replicate the level of relief and the buzz it gave me, not even Oxycodone. Codeine is a close second but with stomach cramps galore.
I said once I wouldn't dare drive down the street after taking hydrocodone, but I was practically normal to the point where I could definitely drive anywhere I wanted on Oxycodone. It was just a totally different experience.
Right now I take Tramadol, since it's really my only option at the moment that I seem to be in control of. However I don't always find it's relief to be on par with the Vicodin either. That's not to say it couldn't work for you, but unless you have insurance it would be expensive to try Ultram ER, the extended release form of Tramadol. It also comes with it's own risks as well as medication interactions, which I've experienced first hand.
That's the only other extended release drug I know of besides what was listed already.
Back from the Dr. We talked about Methadone and Oxycontin but I really wanted to try Ultram. The problem I have with the first two is that they are Schedule II which I really don't want to start taking because I would have to go to the Dr's every month to get a refill. I like to travel and feel it would really limit me. I'm really (really really) hoping I have success with the Ultram. That would be a godsend as I could space out doctors visits and more than likely not have a problem finding it while traveling. I also like the fact that there's little to no "high" from it, at least that's what I think? It would be great to get back to feeling "normal" again!
Ray
Ray
Well no matter what you take, the "high" eventually dissapears with all forms of medication.
Tramadol is slightly different however. It does act on the same receptors as narcotics, but is not directly related to them, so that's why it is so far, unscheduled.
It does give a very nice relaxing buzz, depending on how much you take it could be very light, mood augmenting, pleasant social experience; or it could be a little more heavy "alone time" chill out kind of deal too.
If you're taking the ER I wouldnt worry much though, as it's slowly released over time and shouldn't affect you in the same way normal release pills do. I know that I can stop taking them for a day or two and then when I start up again it takes a lot less to get the same amount of relief as I had before. So in that regards it can be pretty easy to deal with and last you a while.
The only thing I would watch out for is that it lowers the seizure threshold. Also I wouldn't take anti-depressants with it, as that caused an interaction which gave me a seizure a couple months ago. As far as other interactions I don't know much, just watch what you are taking and stay away from anything that potentially lowers the seizure threshold.
Don't want to scare you or anything, but that's what happened to me. I've since stopped taking the anti-depressants but I do have a side-effect I never experienced before, which sucks. I will randomly twitch/jerk almost uncontrollably for a brief second every once in a while. It happens the most often and severe when I am seriously tired and should go to bed, but don't want to, however it's a side effect I'm willing to live with, as I get NO sleep when I have no medicine at all.
Tramadol is slightly different however. It does act on the same receptors as narcotics, but is not directly related to them, so that's why it is so far, unscheduled.
It does give a very nice relaxing buzz, depending on how much you take it could be very light, mood augmenting, pleasant social experience; or it could be a little more heavy "alone time" chill out kind of deal too.
If you're taking the ER I wouldnt worry much though, as it's slowly released over time and shouldn't affect you in the same way normal release pills do. I know that I can stop taking them for a day or two and then when I start up again it takes a lot less to get the same amount of relief as I had before. So in that regards it can be pretty easy to deal with and last you a while.
The only thing I would watch out for is that it lowers the seizure threshold. Also I wouldn't take anti-depressants with it, as that caused an interaction which gave me a seizure a couple months ago. As far as other interactions I don't know much, just watch what you are taking and stay away from anything that potentially lowers the seizure threshold.
Don't want to scare you or anything, but that's what happened to me. I've since stopped taking the anti-depressants but I do have a side-effect I never experienced before, which sucks. I will randomly twitch/jerk almost uncontrollably for a brief second every once in a while. It happens the most often and severe when I am seriously tired and should go to bed, but don't want to, however it's a side effect I'm willing to live with, as I get NO sleep when I have no medicine at all.
Ray- In answer to your question, yes- I felt much more gorked with vicodin then oxycodone. While everyone is different-- my years of prescribing both products and watching people react has let me see these drugs up close and personal. If I had to line up all the narcotics in order of "gorkiness" it would be: hydrocodone/codeine>oxycodone/dilaudid>methadone>tramadol. However, there are exceptions to every rule and some folks just react "backwards" or in a way you cannot predict.
Oh btw, I did a quick conversion of hydrocodone to tramadol and found that 120 mg tramadol= 30 mg hydrocodone. So if you're taking 50 mg of hydrocodone a day... you'd need approximately 200 mg per day of ultram. I think the ER Ultram tabs come in 200 mg so that would be perfect.
Oh btw, I did a quick conversion of hydrocodone to tramadol and found that 120 mg tramadol= 30 mg hydrocodone. So if you're taking 50 mg of hydrocodone a day... you'd need approximately 200 mg per day of ultram. I think the ER Ultram tabs come in 200 mg so that would be perfect.
Josh
Josh, I am interested but confused by your tramadol/hydocodone conversions. If I understand the conversion, if I am taking 100mg of tramadol (50 mg X 2) that would equal approximately 5 of the 5/500 mg hydrodcodone or about 5 tabs. That seems an extremely high conversion. If I understand correctly and that a 5/500 tab of hydrocodone contains 5 mg of hydrocodone and 500 mg of acetametophin then someone taking 50 mg of hydrocodone is taking 10 tabs of the 5/500 daily. Wow! 10 tabs of the 5/500 vicodin (50mg) to equal 4 of the 50 mg of ultram (200mg)---I don't know. That seems like an awful lot but maybe is what is called for in some cases. Still...... 10 vicodin daily? I have used both and have never considered taking 5 vicodin in place of the 2 (50 mg) ultram which I take in one dose prior to bedtime.
I'm sure I am missing something in the conversion that is staring me right in the face and would be happy if you could steer me in the right direction. Thanks.
I'm sure I am missing something in the conversion that is staring me right in the face and would be happy if you could steer me in the right direction. Thanks.
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Hi Mark-- ltns! I thought it was a high conversion too but alas, it is the only conversion available in the literature and via Google. I even pulled the package insert and it was extremely vague... something to the effect of: "tramadol 50 mg is stronger then codeine 60mg". 
With opioid naive patients-- I've used a conversion of 50 mg of tramadol=4-5 mg of oxycodone (7.5 mg hydrocod) and have had a little bit of success . Unfortunately there really isn't any good data to show that any of the conversions we use is appropriate. The other thing is-- the general rule when converting from one narc to another is to drop your dose by 30%. This is especially true when converting to stronger narcotics. So even if I wanted to use the conversion for your dose-- 100mg tramadol = 5 vicodin which then would have to be "knocked" down to ~3 tabs. This would put you over the 1000mg tylenol rule and you would have to back down to 2 tabs anyway. Unfortunately, this conversion nightmare is why we don't use tramadol more often and I often end up recommending oxycodone/oxycontin.
With opioid naive patients-- I've used a conversion of 50 mg of tramadol=4-5 mg of oxycodone (7.5 mg hydrocod) and have had a little bit of success . Unfortunately there really isn't any good data to show that any of the conversions we use is appropriate. The other thing is-- the general rule when converting from one narc to another is to drop your dose by 30%. This is especially true when converting to stronger narcotics. So even if I wanted to use the conversion for your dose-- 100mg tramadol = 5 vicodin which then would have to be "knocked" down to ~3 tabs. This would put you over the 1000mg tylenol rule and you would have to back down to 2 tabs anyway. Unfortunately, this conversion nightmare is why we don't use tramadol more often and I often end up recommending oxycodone/oxycontin.
Josh
Josh, Thanks for the additional rationale. I tried checking Dr. B's book but could not seem to find anything on point. Maybe a good question to pose on the Southern Cal site.
Anyway, fortunately or "un," I am one that seems not to have a dramatic response to either hydrocodone or tramadol. That is, while they seem to have relatively good pain relieving properties for me, I have very little psychological response to them such as feeling, euphoric, groggy, etc. Both improve my general feeling of well being primaily because the pain is diminished. That being said, for me, one 5/500 hydrocodone (vicodin) seems to have a more beneficial effect than 100 or even 150 mg of tramadol (ultram). So, for me, my perception is that tramadol is the weaker of the two. I think that is why the conversion struck me as odd. Again the addage that we are all different is quite applicable. But, at least now I better understand your post and truly appreciate your feedback. Thanks.
Anyway, fortunately or "un," I am one that seems not to have a dramatic response to either hydrocodone or tramadol. That is, while they seem to have relatively good pain relieving properties for me, I have very little psychological response to them such as feeling, euphoric, groggy, etc. Both improve my general feeling of well being primaily because the pain is diminished. That being said, for me, one 5/500 hydrocodone (vicodin) seems to have a more beneficial effect than 100 or even 150 mg of tramadol (ultram). So, for me, my perception is that tramadol is the weaker of the two. I think that is why the conversion struck me as odd. Again the addage that we are all different is quite applicable. But, at least now I better understand your post and truly appreciate your feedback. Thanks.
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Mark, i don't get a high off of any thing like that either. Except for the pain relief. As a matter of fact, when I had my 2 kidney stones the dr gave me a shot (I think 2mg of Dilauid)sp? the pain stopped but my pulse was still up and skipping beats. He then gave me a shot of tramadol in the drip. My heart stopped the PVC action. I was still awake and lucid. Go figure...Pat
Pat, I remember several years ago when I had an "ambulance came to the house" level migraine. Anyway, in the emergency room after giving me one pain shot (not sure what it was) the doc said I should start to "feel better" in about 15 minutes. Well two more shots later I did start to "feel better" along with the much needed pain relief. Actually think I could have driven home. It was the perverbial "enough medication to knock out a horse" scenario. On another occassion, I actually woke up during my carpal tunnel surgery. That was no fun. Funny, how some meds faze you and others don't. Lots of support for that concept on this board. Best wishes.
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wigglypain
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Opana Newest Released Long acting
Back again family, pain has been an incredible. My MS contin just stopped working like someone turned a light switch off. Happened during work. Woke up ok, got to work, did a few cases in the non-invasive room. ( Iam an RN to catch some up). Then whamo from 0 to 60 there it was. My manager almost did not let me go home. I could not believe a person in my own profession told I should just suck it up, handle it and finish the day. Here I am a man at 42 in so much pain tears streaming down my face and she tells me this. What a friggin 
B---H 
.
Anyway, had to take the week off in order to get my pain under control and find the right thing. My doc could not see me till Thursday and this was Monday. Stopped by and he gave me some Percocet 10/325 till I could see him on Thursday. Rather than increase the morphine he suggested an new drug just released a few weeks prior. Man my higher power was looking out for Ed in this case. Opana-oxymorphone. It is a time released similar to Dilaudid. Started at 10mg three times daily. Now this can be taken two times daily, however, my liver just eats it up before then. Within three weeks needed to go up to 20 mg three times daily and so far so good. This was 2 May and reluctanly gave me 10 more Percocet for breakthrough. My only issue is added SinemetCR 25-100 to the mix on 15 May, not happy, cause not pain increase has come again. Called him today and I have to double the Sinemet
, but he was willing to give me more breakthrough meds. I know augmentation is here. I am going to try to convince him of this or I am going to have to just stop the Sinemet on my own. I really hate the thought of that, but you know what I am talking about. It is no fun.
Oh, by the way Opana comes in instant release 5mg and 10mg and long acting 10mg, 20mg, 30mg, and 40mg.
I am still going for the spinal cord stimulator and need to have a lead in my lower back and in my neck for the arms. My tolerance to meds has topped out.
Hope this can be of help to anyone.
Ed
This is a scheduled II drug so it means picking up a script each month or seeing the doc every month to pick it up.
B---H .
Anyway, had to take the week off in order to get my pain under control and find the right thing. My doc could not see me till Thursday and this was Monday. Stopped by and he gave me some Percocet 10/325 till I could see him on Thursday. Rather than increase the morphine he suggested an new drug just released a few weeks prior. Man my higher power was looking out for Ed in this case. Opana-oxymorphone. It is a time released similar to Dilaudid. Started at 10mg three times daily. Now this can be taken two times daily, however, my liver just eats it up before then. Within three weeks needed to go up to 20 mg three times daily and so far so good. This was 2 May and reluctanly gave me 10 more Percocet for breakthrough. My only issue is added SinemetCR 25-100 to the mix on 15 May, not happy, cause not pain increase has come again. Called him today and I have to double the Sinemet
, but he was willing to give me more breakthrough meds. I know augmentation is here. I am going to try to convince him of this or I am going to have to just stop the Sinemet on my own. I really hate the thought of that, but you know what I am talking about. It is no fun.
Oh, by the way Opana comes in instant release 5mg and 10mg and long acting 10mg, 20mg, 30mg, and 40mg.
I am still going for the spinal cord stimulator and need to have a lead in my lower back and in my neck for the arms. My tolerance to meds has topped out.
Hope this can be of help to anyone.
Ed
This is a scheduled II drug so it means picking up a script each month or seeing the doc every month to pick it up.
Wiggly Pain
ems2rn@gmail.com
ems2rn@gmail.com
Hang in there man, that really sucks.. If you think it's the sinement and are pretty sure, get off that crap right away.. It's considered useless by most people these days because of it's high failure rate is my understanding.
I know it drove me nuts when I was on it. I had to keep taking more and more before I finally got the hint, I guess I'm lucky I don't have painful symptoms too, I don't know how I would have coped with that. Hopefully if it is the cause things will go back to normal after you stop it.
I know it drove me nuts when I was on it. I had to keep taking more and more before I finally got the hint, I guess I'm lucky I don't have painful symptoms too, I don't know how I would have coped with that. Hopefully if it is the cause things will go back to normal after you stop it.