India Opioid Analgesics

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zaborav Says:

I need to know what opioid analgesics and benzodiazepines are prescribed in india as I am on 120mg OxyNorm, 8mg clonazepam, 6mg Xanax per day and 24 to 36mg bromazepam as required

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Mmc33 Says:

Desperately seeking help / advice for dealing with severe chronic pain.

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Verwon Says:

Zaborav, for countries other than the U.S. and Canada, it is really hard to find a comprehensive list of their approved medications, because they generally don't regulate them as strictly.

However, I can tell you that they do have equivalents, from what I have seen for most of the medications you are taking. You'll just have to discuss with a doctor or pharmacist there to see if they have the same ones or if you have to switch to something different, but in the same class.

https:/­/­www.medschat.com/­wiki/­Xanax/­

https:/­/­www.medschat.com/­wiki/­Bromazepam/­

https:/­/­www.medschat.com/­wiki/­Clonazepam/­

https:/­/­www.medschat.com/­wiki/­Oxycodone/­




Mmc33, it would be helpful if we had a little more information.

Can you please post back with more details, such as what's causing your pain? Are you seeing a doctor? What have you already tried?

To control severe, chronic pain, most people take an immediate release formulation of an opiate, such as Oxycodone, so it kicks in fast and it's taken with a time released one, such as Oxycontin, to give better control for a longer period of time.

https:/­/­www.medschat.com/­wiki/­Oxycodone/­

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zaborav Says:

I have been living with chronic pain (spondyloarthritis, osteoarthritis, lumbar problem (muscular - DAMN the NHS for withdrawing Soma 18 months ago, there's nothing else works for my back) for nearly 20 years and, living in the UK, have been talking over that time to so many brick walls with medical degrees it's untrue. It took a Spanish doctor to put me on OxyContin 40mg tds, reduced later to bd, now OxyNorm caps 20mg qds. Tolerance is the problem as with any drug, and i can not get a doctor to change me onto hydromorphone (Dilaudid 6mg or Palladone 2,6mg, two caps qds is the equivalent) even for a month to allow my Oxy tolerance to recover a bit.
What is wrong with british doctors? My father was one and certainly he wouldn't act or prescribe in the way today's crop of quacks do.
Those are the best meds I've come across for chronic severe pain. You'd probably start on 10mg Oxycontin twice a day and get titrated up till the pain is adequately relieved. My current 80mg/day just isn't enough any more and my doctor refuses even to DISCUSS the 'hydromorphone break' or increasing each OxyNorm dose to 30mg. Both are far superior to morphine in several ways; no nausea as with MST (MS Contin) or Sevredol, and they're stronger with less side effects. Dipipanone 20mg qds would be an alternative (30mg qds in the case of the dosage of Oxy I'm on).
Although carisoprodol (Soma, Carisoma) isn't a painkiller but a skeletal muscular relaxant, that's what stopped my back hurting. If anybody on the board knows a good place to get some imported from at a reasonable price (it is NOT a controlled drug) then I'm sure there are many people who'd be grateful. Listaflex can be bought from Argentina but as with most online pharms, it's dreadfully overpriced. I used to get 200 x 350mg from a place in india for only US$50 but they've gone arse up. Disappeared, leaving me with only the Listaflex source i can't afford.
Sorry for havering a bit there but I DID mention the best analgesics I know of and hope it helps.

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ZABORAV Says:

Verwon, typo? Should that not be 'acute' rather than 'chronic'? The m/r version, OxyContin, is far more likely to be given to the chronic patient, whereas acute pain will normally be dealt with using instant-release opiates like Sevredol, OxyNorm, Palladone, but NOT SR or m/r versions.

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Ridgerunner007 Says:

Zaborav,
I am not a USA medical doctor, but, I am now retired, since 2007, from being a Substance Abuse Specialization
Counselor, with, a B.S in Psychlogy, and took a lot of courses @ Imperial College of Science, Technology, & Medicine at the University of London, United Kingdom, towards my post graduate diploma in Drug and Alcohol Misuse and Intervention, as well,as worked with special private psychotherapy, and, public, self help groups, in the USA from 1971, until 2007, when I both "burned out" and, went into semi-retirement, disengaging from this subject matter. With that being said, in my humble opinion, you obviously, have many co-morbid dx's, and, are on a very heavy, amount, of fast acting and long acting benzodiazapines, as well, as, in the very high ranges of natural opiate, and//or synthetic opiate analgesics, that concerns me greatly. To address your original question, what meds are available in India, I highly reccommend, the 2011 version, of, "Martindale: the Extra Pharmacopoeia" 37th edition, that has ethical pharmaceuticals in over 40 countries of the modern industrialized world, current edition based on verified data, from October of 2010, and released for sale in April of 2011. (0ver 3.600 pages) in two volumes, and, India is one of the 40 listed countries in this book, but it is not inexpensive, it sells in USA dollars for $695.00 retail. I have three of them my latest one, is the 2009 version, ISBN 978-0-85369-840-1 and ISSN numbers of
0263-5364, published since 1883, yes, over 125 yrs ago, by Pharmaceutical Press (a trademark of RPS publishing, the publishing organization of the Royal Pharmaceutical
Society of Great Britain.
I am brand new to this public forum, as of today, thus, I am not at all familiar with the rules and regulations of this forum, that I find facinating to read. With that being said, I am reluctant to give any personal advice, or to try to practice medicine without a license, and certainly, without a face to face intake (one on one interview). I can say this, I know of a person I grew up with as a child, who is recovering from bladder cancer, in partial remission, who self medicates, upwards to as much as 100 mg a day, of
a mostly, compounded Oxycodone 5 mg tablets, and, titrates in USA generic Endo Percocet, that is 5mg of Oxycodone, with, 325 mg of APAP, to minimize the damage to his liver, a male age 62 yrs old, and a Vietnam War veteran plus, he takes like you do, approximately 6 to 8 mg of the generic version to USA Roche Klonopin, a/k/a better known as Roche Rivotril, and, has recently, been substituting this past year, the Clonazepam, from about 5 yrs of using (as you say) approximately 6 mg of USA Pfizer Xanax, in its generic form my Mylan Pharmaceuticals, the highly addictive, alprazolam. He is no longer under a regular local MD's care, as both of his parents, whom he was Caretaker for, in their 80's, have both been institutionalized, this year, due to both the late stages of Alzeimers Disease, Dementia, and, Bipolar Disorder I, along with long term pain management issues, both of his parents were opiate tolerant to. He is 50% self medicating, and, demonstrates, many traits, of a Major
Depressive Disorder, when I visit him on occasion. I have another close acquaaintence, who, is also 62 yrs old, who, is a long term Pain Management patient here in the USA, who, was formerly the Department head of Columbia Universisty, School of Pharmacology, who was stricken with a massive stroke, at age 46, (sixteen yrs ago) and is monitored weekly, for, his daily use of Methadone, which was up to 70 mg per day, and, he still holds a top secret secret security clearance, with a USA federal agency, I chose to keep confidential, and is in severe pain, and is goiing downhlll fast, and his M.D. prescribed him, for one week, the USA pain med, Duragesic, (Fentanyl) transdermal patches, and even using two transdermal patches at a time, the pain was only partially measurably controlled, and his judgement, was impaired. He returned to the 70 mg a day of Methadone, but, after being on this med for over a decade, the tolerance, build-up, is no longer controlling the pain, and, his job description, requires, a certain level of highly focused mental acuity. He has most recently switched to OxyContin, and, I am not sure what med he is using for "breakthru pain" as he is exhibiting a loss of motor control in his left leg, left foot, and, his left, shoulder, left arm, and his typing fingers on his left hand. this was predicted years ago, from damage he suffered from a massive stroke, in 1995.
All I feel secure as a "newbee on this forum, is to by all means, do not run out of your med supply, especially, of your benzo supply, target specifically, the alprazolam. withdrawal, on 6 mg a day of Alprazolam alone, IMHO, takes a taper, of at least 8 to 10 weeks, the Clonazepam, may be a life saver from potential seizures, if you taper down too quickly, on the Alprazolam, marketed in India during 2008 and 2009, as Alplax, Alprocontin, Pacy, Restyl, Tranax, Xycalm, and Zolam.
Clonazepam, as of October of 2008, marketed this long acting benzo/anti-seizure med, as Epitril, Epizam, Ozepam. Bromazepam, is not listed in a October audit of pharmacies in India during October of 2008, but may now be available from a more recent audit, October of 2010, for the 37th edition, current year of the "Martindale" it is widely available in countries near you geographically, such as Indonesia, as "Lexotan", Malaysia as Lexotan, and as
Akamon, Thailand as "Lexotan", Italy as "Lexotan", Brixopan, and, Compendium, as well, as Spainas Lexatin, and, even Germany, "under eight , yes, 8 different manufacturers. Nicolas Piramil, historically, used to market under license from Hoffman LaRoche, a alleged high quality form of Diazepam, that, has a half life in between, the very short half life of alprazolam, estimated at 16 hours, and Clonazepam, estimated as long as 100 hours, with Diazepam, following in the middle, around 50 hours of half life.
The Ashton Manuel, is one excellent source, published in the UK, for benzodiazepine withdrawal. (info at one time was on the Internet).
Regarding opiates, in Turkey, "Adolan" is the tradename, known chemically in the USA, as "Demerol" (Meperidine Hydrochloride Injection, as the tablets, are disfavored by most opiate tolerant patients, and the tablets, offer very little pain relief, in the European Union, it is also called Pethidine Injection, not listed in India, either way. Finally.
have you ever tried, Pentazocine tablets, or, Pentazocine Tartrate Injection? The "Martindale still shows in 2009, that pentazocine, in its pure form, was still available in India as "Fortwin" and as "Pentawin" The "Fortwin" is listed as only available as Pentazocine Lactate, this is the injection version, available in vials, or ampules, by Ranbaxy of India, and, also "Pentawin" also only available as the Lactate version, which is for injection either by IV or IM shots, manufacturer in India, listed as "Biochem"
CAUTION: Pentazocine is rapidly being withdrawn worldwide, since a 2003 Conference co-sponsored by the United Nations, & WHO in Vienna, Austria, and, was re-classified, in Europe and non-EU nations,as well, as in Asia, under much stricter controls, and is classified a Schedule III, or class A or class B , a benzomorphan dirivative, an opiate analgesic, that has mixed, opiod agonist and antagonist actions. The subcutanious route, can be used, but is ill advised, due to sometimes serious skin reactions. Also, for the seriously opiate dependant patient,, there is a calculated risk of goingi into withdrawals, because of its weak opiod antagonist actions.
IMHO, it was demonized in the USA, about 30 years, ago, and was the 2nd most abused ethical pharmaceutical in the USA during 1978 to 1982, when, the USA manufacturer changed the formula, to curb so much recreational abuse, specifically the tablets. I think it is a outstanding pain relieving medication, tablet or liquid, form especially for the opiate non-dependant patient. It has fallen in great disfavor, worldwide, due to, again, recreational abuse, and I have seen Pentazocine reduced since 1999 to 2009 from 21 countries, to only 10 countries left, offering the tablet forms. Japan has outlawed the narcotic analgesic, due to abuse, just, like, the USA, Canada, UK, and Australia, and South Africa, banned the production of Methaqualone, during the middle to late 1980's, due to so much recreational abuse, unfortunately.
I expect the tablet version, to be extinct, in less than 4 to 5 yrs worldwide, but, the Pentazocine Laclate, will be around for a long time, in the future, as it is very well received in the Middle East, and nearly every country in Africa, mostly stocked in hospitals, and, Urgent Care Centers, and with Dental surgeons. IMHO, if you run out of meds suddenly, you may well be in a situation, with life damaging consequences, and, furthermore, in the USA, accidental overdoses, are not uncommon, with the use of high levels of Oxycodone, and with relatively high doses of benzo's. Please take care of yourself, I'd advise a clinical medical professional to oversee your already high tolerances to multiple meds. Good Luck to you.


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Zaborav Says:

Well I found that highly informative. I do understand that certain groups in society do abuse certain medicines; something I understand from my first couple of doses of oxycodone, dipipanone, dextromoramide etc - however, after the first few doses there are no effects which would encourage one to "do it again" as that slight euphoric feeling disappears pretty quickly.
I also understand perfectly well the issue of iatrogenic habituation, which for somebody of my age who isn't going to be off opiates or semi-synthetics EVER, isn't an issue at all. The issue is the best way of keeping pain free. Tolerance changes due to wildly fluctuating intake of one drug or another is not something that has ever happened with me and I am well aware of my dosages of each drug, the major analgesic and the rescue meds for breakthrough, inevitable when you are prescribed a 12 hourly drug whose duration of action never exceeds 8 hours and can be wearing off in as little as six, yet the Health Board simply refuses to sanction tds prescriptions!
Now as for alprazolam, I found lorazepam to be a much more addictive drug - my dosage was one 2.5mg tab qds - and the withdrawal feeling MUCH worse, vicious and faster to appear than that of alprazolam. In other words, yes, I have indeed run out from time to time and yes, the unpleasantness is terrific, not to mention life threatening. But being that I have always got even the lower strength of Rivotril for epileptic seizures and off-label the prophylaxis of panic attack, again an advantage of alprazolam over other BZD anxiolytics as it is much better at treating the anxiety disorder which leads to that kind of pure panic episode where one is convinced that one is dying, here and now, drawing one's last breath, and no, that is not an SVT but my heart beating or even fluttering at such abnormal rate it simply has to be its last effort at keeping going... One foot in the grave etc.
I thank God for giving us alprazolam over any other anxiolytic; it is superior to all and does not lose potency in long term use as lorazepam, oxazepam and especially the dreadfully weak diazepam.
I have discovered that (having used pentazocine as Fortral capsules several years ago before they were banned and found them rather ineffective) oxycodone is not marketed there, but they tend to ptescribe Vendal SR morphine sulphate, a drug which I might have mentioned I am not very tolerant to, requiring to take a 50mg Valoid (cyclizine) with each 100 or 200mg tablet, the latter being not too far under equianalgesia with my oxycodone dose. Too many side effects and far too much nausea which continued usage does not drive away but rather makes worse. Cyclizine just helps.me to be able to take the painkiller, it still makes me feel not very well but at least in less pain. Morphine is not good at all. Oddly, diacetylmorphine never made me nauseous or interfered with my gastric system, but morphine does, badly. I will have to apply for a licence to export and import large quantities of the medicines which my body accepts best, I am told. Morphine for emergencies only. And make sure I buy enough of the best Indian carisoprodol to last me two or three years, I believe shelf life is long, perhaps 5,500 tablets from the factory gate on leaving there? That is exactly five years' worth of 350mg Carisoma tds.
So I have discussed the matter and am ready to go, not that I do not resent governments making money out of these damnable licences. I have ascertained that I will not ne able to take local alprazola, products as all bar one brand seems to be sold as combination with sertraline, a drug which makes my anxiety disorder ten times worse, as does citalopram, another bright idea from a not so bright young doctor. Indian lorazepam is only 2mg, unlike the regular 2.5mg strength sold in any other country I know of. So I would require five daily, not four. Oddly they also have a 500mcg lorazepam. I can't imagine anybody requiring such a small dose by itself, but perhaps one to go with each strange 2mg tablet to bring my dosage up to that normal in Western countries, what?
Just saying that all the time has not been wasted and I have done the research, and knpw how my pharmaceutical regimen is going to work!
Wish I could say the same of my typing skills, which are still atrocious.
Thank you everyone for your.input... Appreciated so much. My leopard's spots don't fade, you know. Some 36 years on benzodiazepines can't just stop or change much. And I do know at leat two people on higher dosages of oxycodone than myself. One takes a 120mg and a 30mg Oxycontin twice daily, 300mg daily dose and his hydromorphone rescue is 11.7mg. Another winter like the past three and I shall probably need even more than that.
Make of that what you will. Anyway thank you again.

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Astromokey Says:

MMC33 Chronic pain and all health issues should be individually net searched with LYME DISEASE attached , watch a movie called , UNDER OUR SKIN , .

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Zaborav Says:

Just letting you know that a pharmacist in a large town just outside Delhi apparently read this and sent me his recommendations from his extensive stock via email; he is going to send samples (a common occurrence in India, even with nominally Rx-only drugs, regardless of Schedule!) of Cipla TRANAX 1mg alprazolam, 800mg, two days' dosage, of SR morphine sulphate, and a box of dispersible clonazepam 2mg, CLONOTRIL, taken dissolved in a little water and giving an extremely rapid onset of action as compared with Rivotril which is now made by Abbott rather than Piramal under the Roche licence. It is more expensive than Rivotril.
As for carisoprodol, he tells me he can provide PROSOMA, made by a small local company but considered the best brand of all; it retails at Rs.10 per strip of ten (16.5¢ for US readers) and as almost anything can be achieved in India by knowing the right people, all can be shipped complete with valid prescription in supplies of up to 90 days. I feel my back may soon be sorted once again though my problem with intolerance to morphine means I doubt I'll take up that particular drug.
As I mentioned, Fortral (pentazocine) was another analgesic to give me side effects - I can't understand why anyone would abuse something that may relieve moderate pain but at the cost of GI problems, nausea and a huge increase in anxiety levels, not to mention embarrassing ataxia onvious to those around me but of which I was at the time oblivious. Certainly did not make me feel good!
Thanks for everyone's help & comments.

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shelly Says:

Heh buddy what is the brand name for bromazepam that you have got and how u been given two values I.e 24-36mg shouldn't have the doc prescribed one value ?????

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VIJAY Says:

Hi i am a ragular user of morphine 60mg.tab. last 13 year resently my doctor past away now i am in big trable i cant live without morphine plz.help me to find morphine tab. in rajsthan india its urgent plz.help me otherwise ...

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Zaborav Says:

Answer to Shelley:
I get a supply of Lexotan (Roche) tabs 12mg and 6mg. The instructions are 'Take 24-36mg as required for panic'. There is nothing that says it must be a given dosage so long as it is within those parameters. For example, dependent on severity of my thanatophobic panic attack, I will take first of all the very fast-acting Xanax in 2 or 4mg dosage; whilst that kicks in and quells that dreadful feeling of the absolute certainty that I am in the process of DYING, I can then gauge that severity and therefore what dosage of the bromazepam I will need to keep me fine in the crucial few hours following such an attack. 24mg is the dose that I know keeps me nice and calm most of the time and helps me forget the episode's psychological effect; if it is particularly bad I will need another 6mg tab or another 12mg tab. I used to use diazepam for this but it is far too sedating at the dose needed (50mg) whereas bromazepam is far less physically and mentally sedating but is extremely effective at getting rid of all of the residual anxiety, which might trigger further attacks or prolong the thanatophobia.

A superb alternative,again relatively non-sedating, allowing me to remain conscious and mentally sharp without anxiety or continuation of my phobic reaction, is LYSANXIA which I used to take in dose of 2 x 40mg (but since Pfizer took over manufacture of this brand of prazepam from SigmaTau the highest dose unit has been only 20mg so four are needed) - medazepam, brand of choice RUDOTEL, is also suitable. It has effect and strength almost identical to diazepam but crucially without that primitive BZD's heavy sedative effect; 40 or 50mg does the same kind of job. Duration of action is MUCH longer than alprazolam, around 5-6 hours, exactly what is needed. Note that all of these are very similar chemically (molecularly) and have similar active metabolites, all counting desmethyldiazepam, half life up to 200 hours, and oxazepam as the major ones.
The prescriptions may be written here in the UK but none of them (excepting Xanax and generic diazepam) are able to be DISPENSED here so I travel to Belgium and Netherlands for 90 day prescriptions. That is also where I get my flunitrazepam 1 and 2mg (Roche Rohypnol for 1mg, Hypnocalm or the Centrafarm CF or Teva generic for 2mg), Palfium 5 and 10mg - now only in Netherlands since my registered a Belgian pharmacy stopped stocking it - and my Seconal Sodique pulvules and Amytal Sodique, in proportion 3:5 as strengths are 100 and 60mg respectively, allowing me to weigh the powders and re capsule in size 0 or even 00 caps to recreate the now withdrawn TUINAL (combination of 100mg of each barbiturate) which has been my main sleep aid for many years now. It is becoming almost impossible to.find Medichémie TOQUILONE COMPOSITUM Methaqualone 250mg/diphenhydramine 25mg, formerly sold in UK as MANDRAX; NOXYBEL 200mg Methaqualone has been found, and combined with OTC 25 or 50mg diphenhydramine. I can get Methaqualone on a Canadian prescription easily, the last country I think where it is a simple matter to be prescribed this low potency but effective sedative which is really only completely useful when used with diphenhydramine, Methaqualone on its own being a rather insipid and weak drug which certainly is not a sleeping tablet, more of a very sedating anxiolytic.

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minoguesque Says:

Lots here and someone with very similar conditions and prescribed meds as me! Firstly Vijay, I know that Oxycodone is not available in India at all, in fact morphine sulphate is the ONLY opioid analgesic apart from Fortral (pentazocine, only in IV'able form) and much weaker ones like codeine but always combined with paracetamol. Dextropropoxyphene was available even after it was banned everywhere else as Proxyvon, but also combined with apap. You can easily get (and this applies to Zaborav too) the ONE brand of morphine tablet available - Verve's VERMOR, Rs.200 per blister of 10 x 60mg. Vermor SR is considerably more expensive so the IR Vermor-60 is probably your best bet. Verwon, I have pulled you up on several occasions for inaccuracy; you now claim that only the US and Canada can provide a complete comprehensive list of available meds, formulations, brands etc. Well India does too. The IP, Indian Pharmacopoeia, and Medguideindia list EVERY SINGLE approved tablet, capsule and inj. that may be bought or prescribed. And what about the UK? The BNF and BP both do the same. As do most EU countries. The Spanish list is even printed in FULL on the internet complete with prices. (Medguideindia is also available in this way with Maximum Retail Prices for every drug approved for Rx or OTC.)

The USA has a huge number of approved meds but from personal experience, I have found that most generics are of absolutely lousy quality. I mentioned in another discussion that Xanax is so expensive that it is hardly ever prescribed or dispensed there, and the most dispensed alprazolam is Sandoz GG247/248/249 - I have tried the GG249 2mg bar shaped tablets on a couple of occasions and they are so bad that even Cipla 1mg Tranax is preferable! It has to be the worst alp I have ever had. Yet it is what most Americans get. I wonder if they took their usual dosage but in European Xanax, Ksalol, even Teva Belgium or euroGeneric (EG) brand, would they get knocked silly for days? I doubt many Americans have ever had a decent alprazolam, the only one I know of that is even close to European quality is Greenstone. This is well known here in the UK.
Ridgerunner, your post is excellent and very informative and quite accurate too. I would agree that clonazepam is essential to keep taking. And that it is a potential lifesaver. I note around twenty brands in India, the former Nicholas Piramal RIVOTRIL (brand name licenced by Roche) now made by Abbott, and the dispersible! fast acting Torrent CLONOTRIL being best of these. And the most expensive. Clonotril is popular in the UK, being easily bought from internet pharmacies and prized for its extremely fast onset. Tastes of bananas. Rivotril and the UK generic I have tried both taste minty. I use it off label for preventing panic attacks. I have also used Lysanxia and Lexotan, and understand why there is a range of dosage recommended. I find Lysanxia 80mg to be the perfect med for the hours following major panic. Lexotan 12mg tablets are about the same strength as a 1mg alprazolam but longer acting, less sedating, less noticeable in effect but very effective. Generic bromazepam is half the cost and the Teva generic 12mg is excellent at €7 for 50.

Take a 90 day supply of OxyContin WITH YOU Zaborav, you are permitted to do so. If you need breakthrough meds then simply buy VERMOR, which might not feel as strong as European morphine tablets (Sevredol) but just double your dose. I needed 100mg when a 50mg Sevredol normally does me. Some good posts here. Interesting little thread even if it diverges from the original question quite a lot!

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Mick Stick Says:

VIJAY: You are in Rajasthan - the percentages of morphine prescriptions written there are lowest of ANY State but Maharashtra and Kashmir account for over 50% of non-palliative morphine prescriptions. I assume it is Vermor 60mg you use as there is no other approved brand of that strength. Napp do not export SEVREDOL to India; their 50mg tablets feel stronger and a lot more efficaciouz than Vermor-60 but are a LOT more expensive. However as one who requires a large analgesic dosage I am accustomed to paying a lot. Have you tried fentanyl citrate lozenges? They are the strongest available opioids & all strengths from 200 to 1600mcg are exactly the same price, the cost of fentanyl being negligible compared to cost of manufacture... so they simply sell all at same price!

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Poppy Says:

Found this thread on Google while trying to find out where I can fill my prescription for PALFIUM brand dextromoramide tartrate - along with the superb dipipanone (Diconal, Wellconal) & Endo OPANA oxymorphone HCl, which being licensed for human use in the USA ONLY makes it virtually impossible for me to obtain - if anybody knows how (the only generic worth touching is Mallinckrodt, who make the best generic drugs in America, period) please post! I have had it only twice, dosage 2 x 10mg plus 1 x 5mg; potency identical to Palfium - these are as 'rescue' drugs for taking up to 3 times/day when on the 120mg OXYCONTIN tablets which say 12 hrs on the box but in actuality pain returns at levels requiring more analgesia after half that time. Also I find that 120mg purple tabs are more effective than using one each 80/40mg... the factor which links all these (plus Actiq - thanks for that reminder! - Oxynorm capsules and SIX x 2.6mg Palladone as we have no high dosage IR hydromorphone in the UK; have tried Abbott and Mallinckrodt 8 & 4 & 2mg TABLETS branded 'Dilaudid' which to me seem better than Palladone but same acquisition issue as Opana!) is the duration of action which in all mentioned bar morphine salts is in the 3 - 4 hour range, morphine being 5 hours and having a longer 'down' time. Some very interesting asides also about benzodiazepines which are currently being phased out almost entirely in the UK except in certain cases, mine included as I need clonazepam - Roche withdrew Rivotril 6 months ago so stuck with inferior Auden McKenzie generic of which I require 8mg/day as opposed to 6mg of brand, which I must now get dispensed, as another poster has mentioned, in another EU country along with Xanax and Rohypnol znd Hypnocalm, also tabletted midazolam and quazepam which is the only benzo sleeper which allows proper REM sleep. All 'Z' drugs, plus benzos midazolam and temazepam are now reclassified as Controlled Drugs of Sch 3, as are tramadol and tapentadol in terms of weak opioids previously POM Sch 4. Midazolam is now also a CD in Serbia as it is a fad amongst their youth to abuse it - here it tends to be 120mg diazepam washed down with Buckfast Tonic Wine, meant for 125mL nightly esp for elderly; it contains a good mix of vits and minerals but drunk by the bottle or three contains more caffeine than any Energy drink and causes social chaos, aggressive behavior and of course amnesia. The mix is implicated in around 75% of knife murders in Scotland!

However back to the original mmc3 query - I would like to change from 120mg OC bd to MST Continus 300mg bd for a change and to renew tolerance but doc refuses for a reason she will not expand upon... if like me you do not get the claimed 12 hours from your m/r analgesic, and I doubt many get close to that, a rotation of the rescue medicines mentioned. If you get 100 and 500mg vials of diamorphine powder but have no wish to use needles then do what I did and arrange with your doctor to use it in either dry powder inhalators or (my choice) metered dose bottles for aqueous solutions when diluted to correct strength for your dose - I use an old Beconase bottle and a dilution giving 50mg per spray (taken thus you need three times as much as by inj.) so, as with Actiq, you can add more if needed; ideally by atomiser bottle I need three sprays, sometimes four, between Oxycontin tablets. The advantages of diamorphine (Aurum/Teva generic - we can not get Bayer in UK) are: onset of action only a minute or so by insufflation wet or dry, & short duration of maybe 1.5, max 2 hours per inhalation. It works similarly to the opiate PCP devices which most people in hospitals of hospices have, ensuring no chance of overdosing - unless of course I got a decimal point wrong in my dilution but that is unlikely being so experienced! Oxymorphone 25mg would be nice as a change if I could get the Endo tablets - they do not get you as 'high' as Palfium but are equal in strength. And I do like tabletted high dosage hydromorphons too, very short acting but it hits fast and hard like Diconal.

If you have the kind of pain you appear to have then rescue analgesia adjunctive to a good m/r med (but if in USA do NOT use Oxycontin; it is not the same as anywhere else. Marked 'OP' I once got sent a packet of 120 unneeded 80mg tablets and they are less than half as effective as real 'OC' & give you awful side effects especially stomach cramps, constipation. They are sort of plastic inside unlike the Oxycontin dispensed in any other country. I have also been told not go use Endo Opana ER as they use the same mechanism, but use ER oxymorphone by Global which are properly made. They only go up to 40mg though so if hour pain level is as high as mine you would need multiple tablets which also claim a false 12 hours action. (WHY DO THEY DO THAT WHEN ALL EVIDENCE SUGGESTS OTHERWISE???)

To all casual readers I hope none of you EVER get the kind of pain I have had to deal with for 20 years, almost. It rules your life & I have complications involving panic anx phobias as well as epilepsy - hence clonazepam and Xanax (Ksalol and Frontin are good generics up to 1mg and Teva & Kela make acceptable 2mg as do Gador (ALPLAX) in Argentina, best of all generic alps, but I would rather spend more and take Pfizer and Upjohn's '90' & '94' tablets. Dipipanone and dextromoramide are the best and most effective 3-4 hr rescue analgesics & try my diamorphine method if like me you avoid needles like plague!

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15
Luv n Peas Says:

Interesting thread here. I am also a chronic pain patient who also needs anxiety meds so have sympathy with all of you. I do not intend to go into so much detail, suffice it to say, been there & taken that - except the America-only drugs, of which I would love to try oxymorphone which my US mates tell me is as strong as dipipanone or dextromoramide but they prefer oxymorphone particularly Opana as the generics are seemingly very poor quality & require twice as much as Endo for the same analgesia.
I have been to India and was stunned that they don't prescribe diamorphine, oxycodone or ANY other opiate bar morphine - this in a country which grows tons of poppy and makes active ingredients for so many opioid analgesics but denies them to their own populace!
I agree that VERMOR-60 is weak compared with European Sevredol and my 80mg dose of that needs at least 150mg of the Verve tablets, but as a box of 30 only costs the equivalent of GBP£6.00 it's no skin off the nose. As for anxiolytics Abbott VALIUM & RIVOTRIL are as good as Roche (they are licenced by that company) but there is a brand by Shalina, DIZAPAM, which feels more like 5 than 10mg but is great for bringing home as stock since you can get 3,000 for £6.50!!! Indian alprazolam is all bunk but Wyeth ATIVAN & SEREPAX are as good as anywhere else at a fraction of the price (Cipla LARPOSE is closer to the more familiar 2.5mg lorazepam strength than Ativan. In India they make it in 2mg which they do in other Asian countries as well but most brands are not as effective, & that goes for most benzos, as European brands and generics.)
It is probably best to make sure you take enough of your Western Oxycontin - but not the awful American ones - or MST Continus and better, more potent rescue meds to see you through your entire stay rather than rely on Vermor.
India is a beautiful country but you have to be very selective about brands when you have conditions requiring constant medications; particularly clonazepam of which there are hundreds of makes but only Abbott Rivotril and Torrent Clonotril dispersible will do the same as you are used to. My bottles/boxes always are labelled "DO NOT STOP TAKING THIS MEDICINE EXCEPT ON DOCTOR'S ADVICE". In fact stopping it can be fatal as sudden withdrawal can cause dreadful seizures and even heart attacks.
Best of luck to the two (or is it three?) posters planning trips there. You will certainly enjoy India as long as you are sensible about your medication regimens.

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16
madeline Says:

hi there, just wondering if anyone knows anything about wellconal tablets in malaysia? are they pink all the way through the pill, or just coated on the outside? also do they have a slight flavour? any help much appreicated..thanks :)

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17
Jim Says:

I have Multiple Sclerosis and my pain doctor and neurologist are completely paranoid about prescribing Opioid Medications (because of government, health insurance, ect.) regulations. Morphine is about the only thing that controls my muscular pain levels. Unfortunately, my stomach cannot handle Opioid Medications so I am stuck giving myself shots. They gave me a practically unlimited amount of Ketrolac but that is no better than taking glorified aspirin from my experience. Since my diagnosis in 2014 I have tried almost any medication you can imagine. But it all boils down to what works for chronic pain management and I am stuck taking 120 mg Morphine each day along with a prescription for 3 types of muscle relaxants.

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