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Providing straightforward information pertaining to drugs, drug use & drug policy. The Grey Pages promotes drug-related literacy and advocates a system of viable and tolerant drug policies. This is my personal collection of commentaries, essays, tid-bits, and other such writings on everything ranging from drug use, drug policy and drug-myths, to drug-science, addiction, human behavior, and the workings of the human brain. I started this blog with a particular focus on opioids, and over the past year have found my interest gravitate toward the intriguing, ever-changing world of designer intoxicants (i.e. "research chemicals" or "designer drugs").

Saturday, March 12, 2011

Alternatives to OxyContin (In the Treatment of Chronic Pain)

Attention: I advise against improper or illicit use of any opioid. The potency-related information cited on this blog is for harm reduction purposes, and should not be interpreted as an endorsement of legal or illegal drug use. .

Many are disappointed with the new OxyContin tablet...

Since the recent reformulation of OxyContin, efficacy of the new medication has took a plunge. Common issues have included gastrointestinal complaints due to the filler in the tablet, poor absorbtion of the tablet, and cases of tablets being regurgitated or excreted through the bowels fully intact. Perhas the most pressing concern is the reduced analgesic efficacy; with many patients requiring drastic increases in breakthrough medication, within this lies the possibility of many patients being labeled as drug seeking, when a Doctor just doesn't buy that the medication is not working. Indeed, some doctors adamantly attest to the fact that the new formula is exactly the same as the original - I'm not sure what is more disturbing; a doctor who actually believes this, or a doctor who simply misleads a patient about the new drugs effectiveness. I digress.

Switching to long acting therapy with Opana ER (oxymorphone) seems to be an increasingly common reaction for those finding limited relief from the new OP tablet. I believe many patients will see a significant improvement in anagesia with oxymorphone, in some cases even being superior to the original OxyContin. Of course this won't apply to 100% of the population, and knowledge of oxymorphone pharmacokinetics is crucial - there is over a 40 percent recuction in oral bioavailability with oxymorphone compared to oxycodone, and it is critical that the dosing reflects that. An oral dose of oxymorphone should be approximately 10-fold its IV/IM dose. I've written up a simple guide based on available dosages of OxyContin and their corresponding Opana ER equivalents. The manufacturer website has its own digital conversion, however it seems that doses may be underestimated in the name of 'caution'. Both OxyContin and Opana ER are 12 hour formulas, and the listed daily dosages are generally diveded into 2 separate doses, one every 12 hours - With uneven daily doses, a regimen of 3 times daily (q8 hours) will suffice.

Conversion from OxyContin to Opana ER

20mg OxyContin/Day = 10mg Opana ER/day
30mg OxyContin/Day = 15mg Opana ER/day
40mg OxyContin/Day = 20mg Opana ER/day
60mg OxyContin/Day = 30mg Opana ER/day
80mg OxyContin/Day = 40mg Opana ER/day
160mg OxyContin/Day = 80mg Opana ER/day
120mg OxyContin/Day = 60mg Opana ER/day


Note: Some report that the new OxyContin tablets seem weaker than cited above when taken orally. One reader claims "I would just like to state for the record that having tried new OP reformulation, opana er equivalency is 40mg oxycontin equals 30mg of Opana ER." 

I may as well also remind readers that Exalgo (long acting hydromorphone) is another option.

Exalgo is the brand name for hydromorphone long acting tablets, Exalgo is generally taken once daily; every 24 hours. Long acting morphine formulations are available in 12 hour tablet form, or 24 hour capsule form. Exalgo is available in three different strengths, with each strength being roughly equianalgesic to the following daily opioid regimens:

Conversion to Exalgo (Hydromorphone XR) from other long acting Opiates.

Exalgo 8mg: 40mg/day morph ER or hydrocodone . 20mg/day oxycontin . 10mg/day opana ER
Exalgo 12mg: 60mg/day morph ER or hydrocodone . 30mg/day oxycontin . 20mg/day opana ER
Exalgo 16mg: 80mg/day morph ER or hydrocodone . 40 mg/day oxycontin . 30mg/day opana ER

6 comments:

  1. Opana ER is no longer being manufactured in 15mg or 7.5mg dosages as of March 11, 2011.

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  2. Conversion of oxycontin to opana er in uppert chart states 40 mg oxycontin equivalent to opana er 20mg,
    However lower chart for exalgo XR states equivalent of oxycontin 40mg to 30 mg or opana er.
    I would just like to state for the record that having tried new OP reformulation, opana er equivalency is 40mg oxycontin equals 30mg of Opana ER. Thanks for your site, I fully concur with everything stated
    -GC. 1/13/12

    ReplyDelete
    Replies
    1. I switched to exalgo after two years of nucynta. I am in my second month of exalgo and taking 36 mg a day with minimal effectiveness. I just seem to get minimal relief from it. I am also taking 75mg lyrica 3x and 10mg Norco 4x. I was on both er and it nucynta and worked extremely well till the last two months. I fell bad for my dr because he wants to help but the exalgo just does not seem very good. I know people go crazy over hydromorphone, but I just do not see the benifits.

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  3. The Exalgo conversion needs to be x2 times per day. 8mg Exalgo per day is equal to 10 mg oxycontin er per day at best.

    ReplyDelete
  4. Norco/Hydrocodone is half the strength of Oxycodone. 1.5 hydro = 1 Oxycodone.

    ReplyDelete