Re: MS CONTIN update:for those duscussing extended release status of generic

Bob Brown wrote:

I was prescribed MS CONTIN but a generic was substituted.
The Generic is, from the bottle printing, "Morphine Sulphate ER 15mg"
and it is made by "walt-ward" company.

I had a visit with my doctor on wednesday april 25th. He told me he
saw no danger whatsoever of an overdose. He also told me he had
treated more than 50 patients with this exact same drug for chronic
pain and none of them had any problems. He also was clear, again,
about his dosage instruction. He said I could, if needed, take 2 pills
every 3 hours if I needed, or simply take 1 tab every 6 hours.

Bob, the instructions for the MS-ER are all wrong! These are meds that are LONG ACTING, and not made to be used every 3 hrs or so! If the pain is coming back that soon either you are undermedicated or you need BREAKTHRU medication, thats an immediate release kind!

The problem in rx'ing ER (long acting or 'Extended Release') kinds of meds is that they take allot longer to get in the system and arent really helpful when the pain thats broken thru is immediate. Also, when you are taking some of these every 3 hrs or so, there is a cumulative effect that doesnt happen with "IR" (immediate release) meds! And so you COULD overdose, cuz what makes these meds go from IR to ER will keep more of that med in your system waaay longer then is normal for a drug like morphine!

He said
I should decide what seems to by my best dosing based on my pain since
everyone is different.

If only it were that simple. See above.

He needs to develop a good baseline of long acting meds that is CONSISTENT from day to day, and works on most of the pain. THEN when some pain breaks thru, you should get an IMMEDIATE RELEASE medication to treat it.

Anything else is a recipe for disaster.

And that is how patients are able to decide what works, but within safe limits! I doubt hes just gonna hand you a blank rx pad!

What hes doing is irresponsible & dangerous. Yeah, let him be generous with yer meds, but still, be sensible too. Having a CONSISTENT, STEADY amt of drugs in your system all the time is far better to treat pain then having levels constantly going up & down! THen you are better treated, and its easier to track how you are doing too. No ER medication is going to handle ALL your pain. Thats why theres breakthru meds.

I am fat and that was another consideration in
him knowing I had no danger of overdose.

Actually, Ive seen someone who doesnt weigh 100 lbs soaking wet take over 2000mg/day of oxycodone! And Ive seen a big guy take one T-3 and end up wretching till he vomits cuz it was too strong for him.

Weight really isnt a big factor. Tolerance is.


If you are taking something ever 3 hrs that can stay in your system 12 hrs (plus), sooner or later that cumulative effect is gonna bite you on the arse.

I take 9 other drugs besides
this one and have for more than 15 years. He said I was a good
candidate for this high level of pain medicine.

That isnt a "high level" of pain medicine! Its just what your body is used to. It wouldnt relieve the pain of a hangnail for me, but it could kill someone else. Ya see? But when yer putting something in the system every 3 hrs thats gonna last up to 12, mebbe more, and you keep it up, then there is a risk of overdose.


He was as upset as me about the insurance company making 'medical
decisions' and going against what he said was an appropriate drug, the
oxycontin. He ALSO agreed with me that having something to relieve my
chronic pain was far better than having nothing at all.

But he wouldve served you better to stand up to the ins. company and insist you keep what was working, esp. since the MSContin isnt really any more expensive then OyxContin...not in comparable doses and generic v. non generic.



I just wanted to clear this up, especially those who thought this
generic of MS CONTIN was not extended release. It is extended release.

It was being prescribed like it was IMMEDIATE RELEASE, and I still believe thats wrong. The way he's rx'ing the ER for you is how the IR is supposed to be dosed. It aint rocket science here.

You forget, most of us here have been on this rollercoaster ride of uninformed docs, nasty ins. companies, wrong meds, improperly rx'ed meds and no docs even out there to help us for yrs. Some of us even have decades under our belts. Im one of the "decades" group.


And the most important thing is that this drug is working very well.

Ultimately thats all that counts.

I
am able to go 6-8 hours sometimes without another 1-2 pills.

Now thats about the reported time it lasts, but 3 hrs? Nope, you need breakthru meds if you are needing something for pain that soon.

I have
yet to even come close to the amount of milligrams per day he has
allowed me to take. And again, this medicine is working to control my
pain to a great degree. I was surprised also.

At the risk of repeating myself, controling your pain is all that really counts.


Also wanted to note in addition to Generic ms contin, I am also taking
Lyrica 100mg 3 times per day, Baclofen 10mg 4 times per time and
Phenergan for nausea as needed. The combination of the [4] drugs is
working very well.

I use Cymbalta for nerve pain. I dont suffer from depression, and I dont feel it affects my moods anyways. I also use phenergran for nausea too. Great nausea drug...a friend told me about it. I HATE the feeling of nausea second only to pain thats outta control.


In case anyone wants to see more information on the generic for MS
Contin which is "morphine sulfate er Xmg" then please go to one of
these websites.
http://www.ethex.com/pages/pdf/58177031004_PIS.pdf
http://www.ethex.com/pages/prod_page.asp?PRID=58177031004

ANd if you can show me ANYWHERE on those pages (I havent read them, cuz I know this drug well...Ive been on MSContin for over a decade) where they even HINT at 3-hr dosing schedules, I'll withdraw from this thread and admit I was wrong. But it doesnt exist. No responsible doc rx's that kinda med like that. Its the IMMEDIATE release ones that you do 3 hr dosing on.


I hope this cleared some things up for a few of you who were concerned
about whether this generic was ER, it is. And also the concern of
OD'ing on this drug, which my doctor is not concerned about.

That doesnt mean a thing whether hes concerned or not. It can still happen.

BTW, this is NOT a personal attack. I am questioning your docs judgement, not yours. Im glad youve found it helps you and arent sick like you were the other day from it. I still believe someone needs to go slap the *** outta that ins. co. employee playing fast & loose with your meds cuz of their ignorance too, but thats got nothing to do w/you.

Hang in there. Its often a PITA to find what works, but it sounds like youve got there pretty quickly.

One last thing...you may find that in a week or two or three, you may not be getting as much relief as before. Thats cuz for many of us, the process of adjusting the dose to whats right for us can take awhile. Im told Purdue USED to post a titration chart on their website, showing how to adjust a patient dose of meds like OxyC & MSC, and showing the patient getting a steady increase in the meds over a period of weeks till their pain was finally handled well and it stayed that way. The website thing is long gone, but someone I know has a hard copy of that chart and its now a relic! But that really IS the ideal way of getting the right dose for patients w/chronic pain. Pity that its now extinct, keeping company with t-rex! Too many ppl have suffered as a result of docs thinking that giving a patient a single dose of pain meds is all its ever gonna take to keep them outta pain!

If that time comes and there is less pain relief for you in the coming weeks, call your doc. DO NOT self adjust that dose yourself! I really cannot emphasize to you how important it is for your body to have a consistent amt. of meds as a baseline. Thats the whole idea behind the development of the long acting meds, so patients werent dosing every 3-4 hrs, making their blood levels of the meds look like an outline of the rocky mountains on a graph! For you to use the long acting meds the way that short acting meds are prescribed is to remove the very reason they were developed and thatll sabotage your pain relief, not help it.



Thanks [I'll be happy to answer any question]

So will I, but prolly not really soon, since Im having major oral surgery tomorrow and would rather get run over by a car a few times. I'm seriously hoping that it wont be bad, but I am nervous about it anyways. I am having gen. anesthesia...its what is gonna happen after I wake up that worries me. I will try to respond tonite, if youve replied and Im not sitting here obsessed and cowering over tomrrows surgery!

I am glad you are doing well with your pain. Believe it or not, youve had several ppl pulling for you to get relief and to get past the ins. co. games that were being played......but please take your docs reassurances about how hes dosing your MS-ER with a bit of caution. Like I said, if you can find info on the websites you linked here about using the MS-ER or MSContin on a 3 hr dosing schedule, I will apologize profusely and never bring it up again.



Hope you have a nice relatively pain-free day


Same to you.

.

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