No such thing as

Discussion in 'Fibromyalgia Main Forum' started by cpalance, Oct 27, 2002.

  1. cpalance

    cpalance New Member

    From what I understand

    there is no Morphine Patch. There is a Duragesic Patch the medicine in it is Fentanyl. Here is an article that I copied so that we can all understand the difference and in what form it comes. I was just given the Duragesic Patch which I was asking people about on another post. It is 50 to 100X's stronger than morphine and the only one that comes in a patch. It takes the pain away, but it gave me a migraine headache, can't keep my eyes open, itch all over, etc.



    Morphine vs Hydromorphone vs Oxycodone vs the Patch Downloadable PDF file

    Re-issued by Dr. Peter Lawlor, Editor (no changes). Grey Nuns Community Hospital. Original Contributor: Paul Walker, MD - Issue #17 (Collect them all) February, 2002.

    The spectrum of available opioids has increased. Why do we need alternative opioids?

    Concept of individual variability in opioid response
    - relative intensity of analgesic and toxic effects
    - spectrum of toxicities experienced
    varies with different opioids within the same individual and between different individuals on the same opioid

    May be due to:
    · Genetically - determined expression of opiate receptor subtypes
    · Incomplete cross-tolerance 2° to differential receptor subtype affinity or efficacy
    · Opioid metabolite accumulation
    · Pain mechanism - specific opioid response

    Recent proliferation of reports re. improvement in analgesia-toxicity balance with opioid switch.


    Morphine: (immediate release - Morphine HP, Statex, MOS, MS-IR, Morphitec; slow release - MS Contin, M-Eslon, MOS-SR, Oramorph SR, Kadian)

    preferred routes: oral, subcutaneous, rectal
    the standard/benchmark opioid, usual first choice
    10x more potent mg for mg than codeine
    parenteral maximum concentration: 50 mg/ml

    Hydromorphone: (immediate release - Dilaudid, PMS-Hydromorphone; slow release - Hydromorph Contin)

    preferred routes: oral subcutaneous, rectal
    approx. 5x more potent mg for mg than morphine
    parenteral maximum concentration: 100 mg/ml
    the usual alternative to morphine

    Oxycodone: (immediate release - Supeudol; slow release - OxyContin)

    preferred routes: oral subcutaneous, rectal
    used for many years in Finland as the opioid of choice
    originally introduced in combination with ASA (Percodan, Oxycodan, Endodan) or Acetaminophen (Percocet, Oxycocet, Endocet, Roxicet) for moderate pain.
    hallucinations reported in studies.
    approx. 1.5x more potent mg for mg than morphine (controversial)
    parenteral maximum concentration: 50-60 mg/ml

    Duragesic Patch
    Fentanyl: (transdermal - Duragesic; parenteral - Sublimaze)

    high lipid solubility
    50-100x as potent as morphine
    transdermal patch convenient in patients with stable pain control. Caution advised in uncontrolled pain syndromes (not suitable for rapid titration)
    possible ¯ in constipation and sedation
    GI withdrawal syndrome described with switch to patch
    conversion ratio uncertain (use published conversion table)
    no convenient form for rescue doses
    subcutaneous infusions pump needed for continuous infusion high cost of drug. Consider switching drug when opioid toxicity develops eg: sedation, delirium, hallucinations, myoclonus. - calculate an equianalgesic daily dose of the new opioid, reduce this by 20-30% to account for incomplete cross tolerance between opioids, divide into multiple daily doses at regular intervals (q4h for immediate release opioids). Provide approx. 10% of the total daily dose available as a rescue dose.

    Maybe this is why the doc's were looking at you sort of funny. You probably made them think, uhoh there is a new drug and I don't know about it.

    I hope this helps
    CHP


    [This Message was Edited on 10/28/2002]
  2. cpalance

    cpalance New Member

    From what I understand

    there is no Morphine Patch. There is a Duragesic Patch the medicine in it is Fentanyl. Here is an article that I copied so that we can all understand the difference and in what form it comes. I was just given the Duragesic Patch which I was asking people about on another post. It is 50 to 100X's stronger than morphine and the only one that comes in a patch. It takes the pain away, but it gave me a migraine headache, can't keep my eyes open, itch all over, etc.



    Morphine vs Hydromorphone vs Oxycodone vs the Patch Downloadable PDF file

    Re-issued by Dr. Peter Lawlor, Editor (no changes). Grey Nuns Community Hospital. Original Contributor: Paul Walker, MD - Issue #17 (Collect them all) February, 2002.

    The spectrum of available opioids has increased. Why do we need alternative opioids?

    Concept of individual variability in opioid response
    - relative intensity of analgesic and toxic effects
    - spectrum of toxicities experienced
    varies with different opioids within the same individual and between different individuals on the same opioid

    May be due to:
    · Genetically - determined expression of opiate receptor subtypes
    · Incomplete cross-tolerance 2° to differential receptor subtype affinity or efficacy
    · Opioid metabolite accumulation
    · Pain mechanism - specific opioid response

    Recent proliferation of reports re. improvement in analgesia-toxicity balance with opioid switch.


    Morphine: (immediate release - Morphine HP, Statex, MOS, MS-IR, Morphitec; slow release - MS Contin, M-Eslon, MOS-SR, Oramorph SR, Kadian)

    preferred routes: oral, subcutaneous, rectal
    the standard/benchmark opioid, usual first choice
    10x more potent mg for mg than codeine
    parenteral maximum concentration: 50 mg/ml

    Hydromorphone: (immediate release - Dilaudid, PMS-Hydromorphone; slow release - Hydromorph Contin)

    preferred routes: oral subcutaneous, rectal
    approx. 5x more potent mg for mg than morphine
    parenteral maximum concentration: 100 mg/ml
    the usual alternative to morphine

    Oxycodone: (immediate release - Supeudol; slow release - OxyContin)

    preferred routes: oral subcutaneous, rectal
    used for many years in Finland as the opioid of choice
    originally introduced in combination with ASA (Percodan, Oxycodan, Endodan) or Acetaminophen (Percocet, Oxycocet, Endocet, Roxicet) for moderate pain.
    hallucinations reported in studies.
    approx. 1.5x more potent mg for mg than morphine (controversial)
    parenteral maximum concentration: 50-60 mg/ml

    Duragesic Patch
    Fentanyl: (transdermal - Duragesic; parenteral - Sublimaze)

    high lipid solubility
    50-100x as potent as morphine
    transdermal patch convenient in patients with stable pain control. Caution advised in uncontrolled pain syndromes (not suitable for rapid titration)
    possible ¯ in constipation and sedation
    GI withdrawal syndrome described with switch to patch
    conversion ratio uncertain (use published conversion table)
    no convenient form for rescue doses
    subcutaneous infusions pump needed for continuous infusion high cost of drug. Consider switching drug when opioid toxicity develops eg: sedation, delirium, hallucinations, myoclonus. - calculate an equianalgesic daily dose of the new opioid, reduce this by 20-30% to account for incomplete cross tolerance between opioids, divide into multiple daily doses at regular intervals (q4h for immediate release opioids). Provide approx. 10% of the total daily dose available as a rescue dose.

    Maybe this is why the doc's were looking at you sort of funny. You probably made them think, uhoh there is a new drug and I don't know about it.

    I hope this helps
    CHP


    [This Message was Edited on 10/28/2002]
  3. Vamp

    Vamp New Member

    Cindy

    VERY interesting info. and thanks for the post - I am seeing the doctor tomorrow that is in favor of this patch for me, and I am going to ask her about this. You posted just in time for me to check around about it....
    Thanks a LOT - helps to clear some of the controversy about the morphine patches.
    Vamp
  4. granmama

    granmama New Member

    Hi Cindy,
    There has been many replies to my post about the morphine patch. Somewhere I had heard that the patch existed, that's why I asked my primary about it. Morphine works wonders on my pain, but the shots are just temporary fixes.
    I have had the morphine pump after 2 separate surgeries, and the last surgery I got horrible itching. They gave me Benedryl in my IV. The pump was set to administer morphine every 10 minutes.

    When I had my back surgery in 1989, I was given a morphine pump after I was taken back to my room. I could not understand why I was in so much pain. I called the nurse and she would say push your button for the morphine, but still no relief. My husband came back into the room only to find morphine all over the floor. Needless to say, he got the nurses on the ball! My osteopath doc was very upset with the incident.

    I appreciate the information you posted. It has educated me more and I will address this topic on Friday with my doctor.

    granmama
  5. cpalance

    cpalance New Member

    I am so glad you had a chance to read it. It has been deleted about 4 times. They have also blocked me from posting my own posts it seems. I was asking for help on Sat. about the Duragesic Patch and it keeps getting moved to the archives. Obviously someone doesn't like me. Don't know what I did. Anyway, as far as the Morphene Patch goes, I think we all just call it that when it really is another type of medicine.

    I am going to copy and paste the post I was trying to get help on here, I hope you don't mind. It will probably get deleted also.

    Cindy

    Duragesic Patch 10/26/02 06:55 PM

    This Post Keeps getting moved to the archives

    And again, without anyone having a chance to read it. 10/28/02 4:53 AM
    Again 10/28/02 5:02

    So no one has a chance to answer me. This post was originally put on the board Friday.

    I just went on the Duragesic Patch yesterday. 75's and it didn't help at all yesterday, still had to take my Lortab. Today I am high as a kite and can't keep my eyes open. (no pain though)
    My question is, after you are on them for a while do you level out? Will I not feel sooooooo tired and will it level out to the point where I just don't have pain and I won't feel "out of it" once it is in my system? I love not having any pain, but if I can't function, that isn't good either. I love the fact that I woke up this AM and didn't have any pain.(This was Saturday) But now I have a migraine headache.
    Tracy I read your other post which was very informative, and I will be calling Janssen (maker of Duragesic Patch)for some clear patches to go over these,as you mentioned in your post. Mine is falling off already. I also wanted to know what the "Gel Deoderant" is suppossed to do? It seems to itch a little, will the deoderant help that, or is that to help keep them on?
    Thanks in advance for any information you can give me.
    Cindy

    If you have any help for me my email is on my BIO











    [This Message was Edited on 10/28/2002]
  6. teach6

    teach6 New Member

    Bumping for Cindy to see it's still here.

    Barbara
  7. granmama

    granmama New Member

    You have some very important questions and I hope you will get the answers as it will help me too, if the doc so decides to put me on it.
    I don't understand the deodorant thing though.

    I like the idea of no pain, who wouldn't!!!!!!!!

    Keep posting if you have more info.....please

    thanks,
    granmama