Changing To Dilaudid From Fentanyl

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Celeste Says:


I am changing from 125 mcg of Fentanyl with 10 mg oxycodone 4x daily to hydrpmorphone and Lyrica since pain isn't being controlled. What should the new dosings be? I weigh about 170 lbs.



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Verwon Says:

Hello, Celeste! How are you? I'm very sorry that you're in pain.

As to the Lyrica, there is no conversion for it, since it is not actually an analgesic like the others. It is actually an anticonvulsant that has also been shown to help with certain types of nerve pain and some mood disorders. Its side effects may include nausea, dizziness, headache, dry mouth, mood swings and weight gain.

And if your switching out the Oxycodone for the Hydromorphone for breakthrough pain, you'd need 3.75mgs of Hydromorphone to equal each 10mgs of Oxycodone.

This is a narcotic analgesic, so it has the potential to be habit forming and may cause side effects, such as nausea, dizziness, drowsiness, dry mouth and constipation.

Is there anything else I can help with?

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Celeste Says:
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That was helpful but interesting enough, they prescribed 22.5 mg of hydromorphone contin, 3x daily to replace the fentanyl 125 mcgm and 2 mg of hydromorphone short release, 4x daily. Does that seem about right to you? Can I substitute the left over oxy it 10 mg for the 2 mg hydromorphone 2 mg initial release?

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Verwon Says:

I think the most operative question first is how much is it helping your pain?

Before you make any other changes, or go back to the Oxycodone, you need to see how well this dosage and combination works for you.

What works well for one person might not work for another and vice-versa.

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Celeste Says:

It is working ok, but I wanted to know if I could use the extra Oxy IR 10 mg, since I have extras left. Is it harmful to combine long acting hydromporphone with Oxy IR. Although the other works well enough on a daily basis as they say it is impossible to control my pain completely and thankfully, they don't want me to take huge amounts as I have many issues, but since a transplant, none life threatening, when I had gum surgery today, even taking 2 of the 2mg hydromporphone IR, hasn't helped with the pain. This is the kind of situation, that since the hydromporphone IR lasts for such a short time, that if ok to mix, I would use the leftover Oxy 10mg IR.

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Verwon Says:

Only your doctor can really advise you on the safety of that, since a lot of it depends on your overall health.

One person might be able to safely combine, if they are in good health and tolerant to opiates, but it might be dangerous for someone else.

I really wish I had a better answer for you on this, but I don't, since I am not a doctor.

As to the gum surgery, yes that can be very painful, but usually only for a few days, before it greatly eases. Did they tell you to do salt water rinses? That's often the best pain reliever you can get for oral surgery.

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Celeste Says:

Thanks for your help! :) The gum surgery pain, which I have had numerous times, was so horrific last night, but luckily, it was almost gone when I woke up. Whew! As far as the Oxy IR, I have been taking narcotics for 25 years, and at one time 3x what I am taking now. I could probably use the extra Oxy IRs, but I will wait and ask my doctor. The most interesting thing I learned is that the dose equivelant for the Oxy IR that you said, was close to 4 mg instead of the 2 prescribed. I want to stay on the lowest dosing possible, which is why they changed opioids hoping just a different one would make the change. I find that the 22.5 mg of hydromporphone every 8 hours, and the 2mg IR every 4, seems to provide manageable comfort. The Lyrica has helped the sciatic pain that was caused by a piece of disk lodging in the nerve when it ruptured, necessitating my 4th back surgery.Thanks for all your help and quick answers.

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Verwon Says:

Very welcome, I'm happy to help!

Please feel free to post back, if I can help with anything else.

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Sandy Says:
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I also switched like you only I was in 150 mcg of Fentalyn. I am now prescribed 6 mg of hydromorphone contin twice daily (this is long acting dilaudid) and 2 mg of hydromorphone for break thru pain every 4 hrs. Everyone's pain tolerance is different and you should talk to your doctor about it. Good job coming off the Patch! It was hard wasn't it?

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Celeste Says:
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Hi Sandy! I am sorry you found the change from Fentanyl to hydromorph contain difficult but it may have been the dosing change. I was taking 125 MCG of Fentanyl and they changed me to 24 mg of Hydromorph contin 3x daily. Quite a difference to the much smaller dosing you received. I had 2 different drs work out the conversion to make sure it was accurate. Along with the 2 mg short acting, I am the mist comfortable I have been in years. I hope you are comfortable too. The difference in dosing may have to do with that I have been taking narcotics for 27 Yeats. Maybe you have been on it a much less shorter time period. Hope all is good with you.

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Sandy Says:

Thanks for sharing your experience with changing over narcotics. I also did up my dosage for long acting but I found the side effects too much! I didn't function well. I too have lived with chronic pain for over 13 yrs. I wanted too come off all narcotics but my pain was too much and I needed it! I did not want to be on these meds for the rest of my life but I see no other way. Soon, when the doctors are scarce we will have to go to emerg for ten hours just to get a prescription and then they might not give it too you. Who knows how we will cope then. Good luck too you and any other sufferers out there!

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Grayman Says:
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Re: Verwon (# 1)

I know that this is an old post, but someone asked me what the conversion is from Fentanyl to Oxycodone to avoid withdrawals too quickly. Can you give me an example of how much Fentanyl (either mcg/hr or total) equals 80 mg Oxycodone a day? I can help my friend from there after finding the equivalent strength and understand Fentanyl lasts around 60 hrs give or take a few hours.

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