Oxycodone vs Diluadid

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bobthahog
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Hello every1, I havent posted anything n awhile because nothing new has happened. Well I will update every1. I have complex regional pain syndrome. I am currently prescribed oxycodone ir 30mg, 1 every 4 hours and methadone 10mg, 1 tablet 3 times daily. I just had my methadone increased 2 weeks ago. It was only twice daily. I had gotten 2 the point where I wasnt getting very good relief from the oxycodone. Well my dr said we could try diluadid. He gave me  #180 4mg hydromorphone.I was supposed to take 1 tablet every 4 hours. All I can say was, WOW. Those worked horrible. I wasnt gettin relief from 1 tablet at all. I called the very next day and was told I could try 2 tablets every 4 hours. Still, WOW. I was lucky 2 get 2 1/2 hours. I called 2 schedule an appointment because these were not cutting it.When I went n my dr was very understanding. I told him i had even tried 3 because I was having trouble walking due to the pain and even then I was not getting the 4 hours I was supposed to get. He said those obviously werent for me. He  put me back on my oxycodone and talked about increasing  the quantity but we ended up increasing my methadone from 2 to 3 times daily. So far this has seemed to help tremendously. It was just weird because every other time I switched types of meds the relief got better. for example when i switched from hydrocodone to oxycodone I felt much more relief. So my thinking was if I switched to diluadid it would work better. It actually got way worse. I have read that diluadid, when prescribed orally is not real effective due to the bioavailability and drs not prescribing strong enough dose. I definitely would rather have oxycodone as my immediate pain reliever. Anyone else have similar situation?

celticgreenman
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Large doses of Dilaudid

bobthahog,

It is mainly because the hydromorphone is underdosed.  For example, if your physician was to convert you from your 180mg oxycodone daily dose (30mg q4hr) along with the 30mg methadone daily dose (10mg tid), you would have to have almost 100mg of Dilaudid daily (according to the GlobalRPh opioid calculator). Most physicians just do not realize how large the oral doses of dilaudid have to be.

And, you are correct, hydromorphone works much better IV and PO.  And, again, physicians think about the IV doses and forget that orally, the doses have to be much larger.

But, if the patient is given the correct amount of Dilaudid, it actually works very well.  I was placed on Dilaudid after surgery, to cover the increased pain.  And, it worked very well, but I was given 20 mg q6h prn.

cgm

 

quincy
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Methadone + Oxycodone

My wife's PCP has Rx'ed her this combo and it seems to be working well except for the drowsiness side effect. He has tried her with both MS and the synthetic morphines to the same effect you describe . . . i.e. more pain, not less. You are not alone my friend . . . Q

bobthahog
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Thank you

Thank you guys, for your input. With what CGM said, me getting 4mg every 4 hours was nowhere what I was needing. That is crazy because you think my PMD would have known that that low of a dose would not be sufficient. I mean it was as if i was taking tylenol when I took only 1. I am going to be trying the spine stimulation out in the beginning of the year. He told me I will be on pain meds the rest of my life. Unless of course, they find a cure. This CRPS is no joke. There are times when I can barely walk. The bad thing is, this disease can spread to other parts of my body and to other limbs. Hopefully with the stimulation and meds I will hardly be able to tell I have this disease. Every have a good day and try and stay pain free.