Morphine Makes Me Too Sleepy
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An_223498 posted:
Here's the problem. I'm on Oxycodone for break through pain, and MSContin for long term pain relief. The problem is Morphine makes me too tired. I sleep too much. Which is fine if I'm just sitting home, but it's not on the 1 or 2 nights a week I have to work. So I want to ask my doc to change me from MSContin to something else, but I don't know what else won't cause drowsiness? Does anyone have any ideas? If I could have the OxyContin pills that might be the answer, but my insurance won't pay for that pill. So I get the immediate release Oxycodone pills, and I'm on the maximum he can give me. He has offered me Dilaudid several times, but I never had that drug. I need something that will either perk me up, like Oxycodone does, or at least not make me sleepy like Morphine does. Any ideas?
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annette030 responded:
Try taking less oxycodone to start out with, it may be that the combination of morphine and oxycodone is more than you need. Sedation from opiates is usually do to taking too much.

Oxycodone is not meant to perk you up, just to relieve pain.

Take care, Annette
 
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An_223499 replied to annette030's response:
Can anyone answer my question? I don't need to be told what to do with these meds. I've been on them for years. I need something that won't make me so sleepy.
 
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_swank_ replied to An_223499's response:
The only way to find out whether a drug will make you too sleepy is to try it out. Oxycodone does not perk most people up so that alone should tell you that people react differently to different drugs. You say you don't want to try Dilaudid because you've never had it so how are you ever going to know if it works for you or not?
 
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annette030 replied to An_223499's response:
Okay, if you don't want to be sedated, don't take opiates. They all have that as a side effect according to everything I have read in my drug handbooks.
 
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An_223500 replied to annette030's response:
Yes, of course they do. Especially if you take too much. However, I find that Oxycodone does not do this to me when I take the proper amount. Which I do. But I find that with Morphine, even when I take the least amount that's effective for me, it still makes me tired, and causes my depression to get worse. One solution would be to take the OxyContin pill, but my insurance won't cover it. So I thought maybe the Oxymorphone pills wouldn't make me drowsy neither. But I can forget that, because I looked them up in my insurance co. formulary and Opana is not covered. So that's the end of that idea. However, Hydromorphone is covered, so I asked my doc to let me try that instead of Morphine. He agreed. But he said he can only give me 16 mg a day, and compared to the amount of MSContin I take, I don't know if it will be enough. But if it still makes me tired, lazy, and depressed, it doesn't matter. I really hate having chronic pain.
 
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ctbeth replied to An_223499's response:
Is the sedation a new thing? Since you've been taking this combo for years, has anything else changed to been added?

For me, I was sedated a little when I began taking MSContin, but I grew accustomed after a few weeks.

Have you discussed this problem with your prescribing MD?

I was taking Exalgo, which is a once-a-day long-acting Dilaudid, and it did not make me tired at all. It also didn't do much for my pain, so my MD changed it.

Please discuss this with your MD. It sounds as if oxycodone is well-tolerated. If you take this without the MSC, you'd have to take meds every few hours and may not get adequate coverage that a long-term agent will provide. Is there any way that your MD or atty can intervene with the insurance company?

Have you and your MD discussed Fentanyl patches?

Of course, sedation is an adverse effect of all opiates, but we all respond differently to the individual meds.

My concern is that you've been taking this regime for "years" and haven't adjusted.

I don't take oxycodone for b/t anymore, but, when I did, it made me tired and the morphine did not. It's so individualized.

Please take note that the oxycontin formulation has recently been changed. I don't take it, so I haven't been involved in the discussions regarding this, but there are many and very knowledgeable people who have offered lots of info. Please read up on the new oxycontin and see if you think it may be right for you.

Good luck,

Beth
~ gratitude and good attitude~
 
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nowthis replied to An_223500's response:
That is so funny that Oxycodone percs you up, and MS Contin doesnt because i take The same thing- Roxicodone 15mg & 30mg MS Contin, and Oxycodone does give me a little perc too, though the MS Contin doesnt make me tired. I've never taken a narcotic that has made me tired , sometimes it woud be nice at night to get a little tired from my meds, but its great that it doesnt because i can drive anytime i need/want without fear of getting a dui due to grogginess from meds.

Hope ya find something that helps!
 
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An_223501 replied to nowthis's response:
Now I have a new problem. Does anyone know of a reliable online narcotic conversion site? I have 1, but I don't know how reliable it is.

Let me also ask you all this. How much Dilaudid do you think I need to be equal to 240 mg of Morphine? My chart said about 60 to 70 mg depending on what I put in for a cross tolerance. Someone else told me Dilaudid is 3 times as strong as Morphine. That's worse, because then I would need 80 mg of Dilaudid to equal the Morphine dose I'm on. I think my doc is very wrong on this. But we will see.

I want to try and clear up a few things I said. When I said I've been on these meds for years, I didn't mean this exact combo. I meant narcotic pain killers. I was first on them in 1996 thru 99. But that time I was able to stop them after 3 years. Now I've been on various pain meds since 2002. I hate to say that all these years of being on these meds has given me a very high tolerance to them. It's actually scary. At any rate, I am now considered opiate dependent. In the past, before I became so dependent, I used to find that when I first started taking a new med it would sedate me some what, but as I became used to it, the med mildly stimulated me. However, I only found that to be true with the weaker narcotics. I mean Darvocet, Hydrocodone, and Oxycodone. I was only on MSContin for about 3 months in the past, and I don't recall it ever giving me the boost I get from Hydrocodone and Oxycodone. I also noticed back then that Morphine makes my depression worse, while the weaker narcotics make it better. I was also on Methadone for short time in 1997, and I found my body didn't like Methadone. So I have concluded that my body seems to like the weaker narcotics best, but my tolerance has now gone so high that I have to take something like Morphine. My doc did try giving me OxyContin last year, and my insurance wouldn't pay for it. If they would pay for it, I think I could use OxyContin for long term and Oxycodone IR for breakthrough. I think I would do very well with that. But I can't have it. I also can no longer use Hydrocodone because I'd need so much that I'd be taking an OD of Tylenol.

Someone said Dilaudid is available as a time released pill? I didn't know that. What is the name of the pill? That may be an option if it agrees with me.

Lastly, we did try the Fentanyl patch. I think I sweat too much, and I mean all the time. Even in the winter. Because after 2 or 3 months I was wearing 140 mcg of Fentanyl, and barely feeling it. For some reason, and I think it was because of sweating, my skin wasn't absorbing it. I had that problem with the Nicotine patch too.

Right now I'm worried about the small dose of Dilaudid my doc gave me. I think I better not fill it. I think I better ask him for the MSContin again. Because if I fill the Dilaudid, it may mess up my insurance. I just don't think 16 mg a day of Dilaudid is going to be enough since I'm used to 240 mg of MSContin.

I thank everyone for your help.
 
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ctbeth replied to An_223501's response:
The long-acting Dilaudid is called Exalgo.

May I make a suggestion?
It seems as if you have well documented your responses to various opioid meds.

Would you consider sharing this information with your pain management MD? He/She is the one who should be making this decision along with you, considering your responses and tolerance.

If you think the does is too small, perhaps you should try it and report to the prescribing MD if your pain is not adequately covered.

Many times MDs begin on lower doses to assess your response, especially people like you who have reported untoward effects.

The rationale is that the dose can be titrated up if it is too low, but if it is too high to begin with, there could be serious consequences.

Please do talk to your doctor. It sounds as if you have so many concerns regarding your medications that cannot be answered on the internet.


It is your job to be open and honest and give your MD the proper information to prescribe the proper med, dose, etc. It is not your job to do the math calculations and tell the MD what med you want.

Let him/her do the MD job and you do your part. This may be the answer you need to relax a little.

Good luck,

Bet
~ gratitude and good attitude~
 
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ctbeth replied to ctbeth's response:
P.S. You mentioned something I also want to address. You referred to the, "weaker narcotics. I mean Darvocet, Hydrocodone, and Oxycodone"

Darvocet is no longer available. It has been removed from the market.

As for " Hydrocodone and Oxycodone", these are NOT weak narcotics. They are ALL schedule II controlled substances, as is morphine and fentanyl.

see the following for more info:
http://en.wikipedia.org/wiki/Controlled_Substances_Act
~ gratitude and good attitude~
 
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nowthis replied to An_223501's response:
I honestly doubt that 16mg of dilaudid will be enough either. Like you Oxy IR works great for me, but i have to take 2 4mg dilaudid to get the relief that one 15mg oxy ir gives me.

Ofcourse everyone is different and it may work for you.

I hope you talk with your doctor and get this worked out.

All doctors opperate differenly, and if he prescribes you the 4mg 4x day, try it and report if its not doing the job, then you can atleast say you tried & i'm sure he will adjust the meds.

All we can do s try until we find the right dosage. I hope you get your's soon, as well as me this friday when i go to see my PM Dr.

Good Luck,

Johnathan
 
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An_223502 replied to nowthis's response:
I have decided to stay with the Morphine and Oxy. I'm not going to fill the small Dilaudid script. If I do, my insurance may not want to cover the Oxy script when that one is due. I'm not an ignorant person. I know 16 mg of Dilaudid isn't going to touch me. I'd need about 60 mg a day.

Beth, I want to explain why I called Darvocet, Hydrocodone and Oxycodone the weaker narcotics. First of all, forget about the DEA and how they classify these drugs. They don't even want us taking them for pain. So just forget what class the law puts a drug into. Instead, look at how the medical profession uses the drugs. When was the last time you heard of a dentist prescribing Morphine for a tooth ache, or even Morphine for a simple broken bone? Never, right? Like wise, when did you hear of someone coming out of major surgery being given Vicodin or even Percocet? Never, again. This is one way I classify these drugs. But there is yet another way. All these drugs come from the poppy plant, and start out as opium. From opium they get 2 drugs. They get Morphine and Codeine. Each has it's own uses. For example Codeine works better on a nagging cough than Morphine. Or maybe it's because to kill a cough with Morphine you have to totally sedate the person. Maybe that too is the answer we seek. Morphine has strong sedative properties, and Codeine does not. However you look at it, other than legally, Codeine is weaker than Morphine. Now as we synthesize Codeine we get Hydrocodone, and Oxycodone. And as we synthesize Morphine we get Dilaudid, which is Hydromorphone, and then comes Oxymorphone. Eventually we get Demerol and Fentanyl, but I think those 2 are totally synthetic and not properly Morphine derivatives. This is how I determine what's a stronger or weaker narcotic. Btw, Methadone is also a totally synthetic narcotic that's based on Morphine.

So what I have found is that my body prefers the weaker narcotics. The ones derived from Codeine, as opposed to Morphine, and the ones derived from Morphine.

I think I have the above facts correct. Chemistry was never my strong suit, so if someone knows better than me, feel free to correct me. I'm always open to learning new things.
 
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_swank_ replied to An_223502's response:
You cannot compare Dilaudid and oxycodone milligram to milligram. You need only 4-8 mg of Dilaudid to get the same effect as 15 mg of oxycodone. You'd likely overdose on 60 mg of Dilaudid. I was given 4 mg of Dilaudid in the hospital after a knee replacement and it was much more powerful than the 20 mg of oxycodone. Oxycodone did not touch the pain.
 
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nowthis replied to _swank_'s response:
Your right milligram for milligram their is no comparison. Everyone is different, Example- You say 4mg of dalaudid was better than 20mg of oxy for you, but i take 15mg oxy ir, and dalaudid works but i would have to take 8mg to get close to the relief that oxy does for me.

But your totally right that 60mg is just too much for a daily dose.

My brother takes 2 4mg dalaudid 4x day, so he takes 32mg dilaudid and 50mcg fentanyl patch every 2 days, which is a pretty generous doage for him, as he only weights 90lb and is 4'7''.

Just goes to show everyone is different in what helps & what doesnt.

Take Care,

Johnathan