Switching from Oxycodone to Hydromorphone ...

[QyX]

Tomorrow or Monday I am switching from Oxycodone to Hydromorphone. I was on Oxycodne for period of 6 months but there have been some problems with these drugs.

The positive aspects about Oxycodone were:

- it 100% killed the urge to move the legs.

- my pain tolerance dramatically increased

but

I still was feeling a lot of pain which totally killed my energy and mood. Man days I was just lying in bed and analyzed the pain in the legs. Moving helped but I was so tired and frustrated and with the urge to move the legs gone and the high pain tolerance I was just accepting the pain but not doing anything else. It consumed all my focus and energy. (Partially I was augmenting again on Pramipexole but that doesn't fully explain it).

Another problem with Oxycodone is that it wasn't really working the full 12 hours as it should. So I had big trouble taking the drug at a fixed time and with all the pain it was hard to say when it was working or not working.

The reason what finally caused the motivation to raise this topic in the discussion with my doctors are my dry eyes. I went to an eye doctor of a university clinic because my eyes were horrible red the hole night and I had a constant feeling of an unpleasant pressure over the day. So it turned out that I have severe red eyes and need to use artificial tears for at least 10 times per day. (It is very likely that the reason is Oxycodone. When I tried higher doses my eyes became even more red)

So in the end there is no way I could go to med school under these circumstances. I suggested Hydromorphone and after some discussion through the week my Doctor agreed.

Hydromorphone has some advantages over other opioids.

a) it doesn't have any active metabolites. Hydromorphone stays Hydromorphone.

b) it doesn't interact with the Cytochrome P450 Enzyme-Complex meaning that other drugs don't change the metabolism of Hydromorphone

As a consequence it is often very well tolerated and preferably used in elderly or when patients need to take a lot of other drugs to minimize drug interactions.

My daily Oxycodone-Dose was 70 mg. I also tried doses up to 100 mg but it didn't improve the situation. Last week I started adding 100 mg Tramadol every 12 hours which dramatically improved my situation but I don't really wanna use two opioids over the long term.

So my questions are:

a) is there somebody who can share his experience with Hydromorphone?

b) has someone made similar experience with an opioid and benefited from a switch?

I really hope that Hydromorphone is now working out for me. If not I had to go on Methadone but the side effects and the reputation of this drug are ugly.

Ya and I had to promise him that I stop taking Pramipexole. Today I had the thought that I am somehow psychological addicted to these Dopamin-Agonists. They somehow calm me down and I am afraid that I wont be able to sleep without them.

So Hydromorphone has to do a lot for me and on Monday Med Schools starts.

This last minute things make me totally crazy in this situation ...

[rthom]

I have taken hydromorphone and hydromorph contin, I find they work well for the WED symptoms and the short-acting helped with the pain. I kept my long acting low though because I had trouble with the meds making it hard to sleep as they reved my brain I guess. It was and is a hard question, to take the opiods and be kept awake by their side effects or to not take them and be kept awake from the WED. I currently use the oxycontin 2 5 mg. every 4 hours (horrible amount of accedimediphine [wrong spelling--tylenol]), and have 4mg tabs of hydro as breakthrough meds. However I almost never use the Hydro because of the alerting side effects (sorry can't remember the word--gabapentin side effect--horrible word recall). It is better than nothing by far but not enough to get me sleep. So if I take hydro I need to take sleep meds as well, then I'm exhauseted during the day and in my work I need to be alert and sharp.
Personally I could not do my school on the meds (but I had gabapentin on board as well), I was trying my best and paying tutors yet still got 15-30 % on my math course, I had to quit---soo embarassing. WED keeps me from succeeding at post secondary education, I've tried a few different courses, but now I wonder if I would have a better outcome without the gabapentin on board.

[ViewsAskew]

I have used hydromorphone and did not like it. For me, it had more side effects than methadone. First, it didn't work nearly as long as 6 hours - abut 3-4. That meant that I was dosing much too frequently. I'd sleep 3 hours and be awake, have to take drugs, etc. I always sleep 7-9 hours with methadone.

Second, it cause severe, and I mean severe, myofacsial trigger points in my head, next, and shoulders. I had the equivalent of a migraine the entire time I took it. All opioids do this to me, but methadone is the least problematic. Hydromorphone and oxy are the worst. I have had the trigger points for years - they are worse with lack of sleep - but they are manageable except when I take certain opioids. It's odd because some doctors use opioids to treat myofascial pain. Not so for me. Then again, several drugs have a reverse effect in my system, so maybe this is part of the same. I wouldn't expect this for most people.

[QyX]

Ya, I also have some activating effects from the Opioids. I am taking the Antidepressent Valdoxan to fall asleep. Also Pramipexole calms me down but my Doctor wants me to withdraw because of augmentation.

I was in the hospital once. There they suggested Oxycodone as a stand alone treatment. Back then in the hospital I was withdrawing Diazepam and got "kicked out" before I reached 0 mg. So I continued the Diazepam withdraw at home and after that I developed sleeping problems again but also had the pain.

I am somehow unhappy to take Opioids but I don't know what else I could take.

When Hydromorphone works as a good pain killer I am thinking of adding a (very) low dose of Doxepine to maintain sleep.

Today I have to sleep without Valdoxan. I ran out of pills and didn't recognize this was happening. The only thing I have always enough are Opioids. I consider them helpful but they only seem to do 50% of the trick.

Very often I read about methadone that it is causing sexual problems and problems with sleeping in 20% the cases after 3 years on the drug.

I asked my Doc for a smaller amount of Hydromorphone but he came with the big pack. So I have to try and can't just tell him that I don't like it because it is activating me. Had the same discussion with Oxycodone so we added Valdoxan and it somehow helps but it is still far away from perfect.

[rthom]

why can't you tell him it is causing you to be more active? I had assumed it's an adrenaline thing with me. However i believe it's important for my dr to know everything that is happening with my meds if they are bothering me.

[ViewsAskew]

I haven't had sexual issues with the methadone, but I hear it does happen. I did with pramipexole, though. I couldn't reach orgasm - like 45 minutes later I'd be like, OK, we can stop now, having spent 35 of those minutes on the edge, but never making it over. VERY frustrating. I hated that drug...still do!

Methadone DOES activate me, though. But, all opioids do, so take your pick from that perspective. Once I fall asleep, though, there little else I've ever taken that allows me to sleep as well. Best of all? I don't get any opioid high from it - I actually do not like the opioid high - it makes me tense, nervous, my jaw clenches, and I'm angry. So, methadone wins hands down for me. And, it resolves the WED symptoms 100%. Not the PLMs, but the WED.

I would, though, prefer to only take it half the time or at most 2/3 of the time. When I take it regularly, over time I do get lethargic. If I could vacation from it every weekend, for example, I'd be very happy with it, all things considered.

[rthom]

I never get an upioid high from the oxy or hydro.. they just keep me slightly awake.

[QyX]

I am taking Opioids for 6 months now and never had something I could call high and I never really tried getting one. I am afraid of developing tolerance and loose the positive effects of the opioids.

This week I had a very good sleep with the combination of Oxycodone + Tramadol. In the past Tramadol was strongly activating me but that somehow changed.

Monday evening will be the first day where I am gonna try Hydromorphone. I hope a Opioid-Montherapy in combination with the Melaotnin-Agonist Valdoxan will work long-term for me.

The past week with Tramadol + Oxycodone was the best week I had in the past 3-4 years!

[rthom]

good to hear, hope it goes well for you!

[QyX]

good to hear, hope it goes well for you!

Thank you =)

I would stay on this combination but with Oxycodone causing this red eyes it is just a no go.

Will report how the Hydro works.

Tomorrow my first full week at med school starts.

[rthom]

my eyes were dry and scratchy from the meds and I developed black spots in my vision right away, I continued to take the meds and now my visio is a mess, no problems that they can find--I know it's about the meds though.

[badnights]

I rook oxycodone for a month, but not enough to touch my WED, which was out of the world, then I was ssitched to hydromorph contin, which I've been taking in gradually increasing dose for 3 yrs now and I'm up to 18 mg spread thru the day but mostly at night.

I was on codein for a year also. I wasn't on the oxy long enough to tell, or strong enough to tell, but both codeine and HM have an alerting effect on me. I was given zopiclone to fall asleep, and that sort of deals with it. (There is thank god no next-day drowsy effect from that.) I still have circadian issues, no idea how much is from the HM and how much part of the WED itself.

The only big problem I have with the HM, and it took me a while to realize it was happening (it's not even listed as a possible side effect on the handout that c omes with it, though it's not hard to find on the web), is an almost complete inability to orgasm. It has not affected my libido, which is very strong, just the ability to climax. It is pissing me off greatly. I have it on the list of things to talk to my doctor about, though from what I could find out, there is not much to be done about it except trying a different opioid.

Those are the two side-effects it has on me. It is also constipating of course but I have never had a problem with that, because I have never given it the chance! I eat about 1/4 cup raw bran in a porridge every day, with cut-up apples and yogurt. Other stuff too, to make it taste better, but those three ingredients are key to keeping my bowels happy.

Good lcuk with the switch to HM and I hope it works for you.

[ViewsAskew]

The only big problem I have with the HM, and it took me a while to realize it was happening (it's not even listed as a possible side effect on the handout that c omes with it, though it's not hard to find on the web), is an almost complete inability to orgasm. It has not affected my libido, which is very strong, just the ability to climax. It is pissing me off greatly.

I hear you! Pramipexole did that do me - it was awful!

[QyX]

So this is my Hydromorphone story:

I started Hydromorphone last week Monday night. So this is my 12th on HM now and I decided to go back on Oxycodone.

The reasons:

- Hydromorphone caused some kind of sleep addiction. I was sleeping 16 - 18 hours per day and I always wanted to sleep more and more. Lying down was never so good. It's not that Hydromorphone was activating me but higher doses then 16 mg/day did. This doesn't work out with Med School.

- Hydromorphone totally killed my libido.

- I lost energy and motivation for Med School

So I am back on Oxycodone from tomorrow on. My Doc already mailed the prescription.

With Oxycodone I have energy and motivation but this ugly dry eye problem. Looks like I also had it with Hydromorphone but it wasn't that bad as with Oxy. So I am gonna see a eye doctor now. There are some things that can be done. (Blocking the tear ducts).

For me it is very important to have a good start at Med School. For the next months I am done with experimenting. I also don't know what else I could try.

In Germany we don't have Hydrocodone and Oxymorphone. I could try Morphine and Methadone but with my history it is very likely that they will even cause more side effects.

I am tired of taking opioids. They help but they don't do wonders.

Hydromorhpone was producing a very good pain release and the effect was stable over 12 hours. Oxycodone only works for around 8 hours and the effect isn't so stable.

At the moment I have no motivation but in theory I could go to the University Hospital were I study Medicine into a specialized ambulance for WED/RLS but I don't know what else they could offer me except trying other Opioids.

I am quite happy that I get 80-90% pain relief with a combination from Oxycodone + low dose Tramadol and very low dose Pramipexol (0,18 mg around 9 p.m., more causes severe augmentation).

Looks like that's all I can get at the moment.

The Tramadol is also impairing my libido but without it I simply can't take the pain and higher doses from any other Opioid don't help. Only Tramadol does.

So I am able to go to Med School with this combination but I am still unhappy with my quality of life.

I also have the feeling that from this point on I loose my right to "complain" because I can at least sleep and do something productive over the day.

I am not happy but I play "happy" and "I am making progress" to the people around me.

I am unhappy with this situation. In total I tried 41 different drugs now.

[rthom]

It's interesting that the tramadol does anything for the pain. I also found different drugs helped in different ways.