Does 100 Mg Morphine Sulfate Extended Release Pill Taken Every Twelve Hours (2 Per Day) Equal 100 Mcg. Fentanyl Patch Applied Every 48 Hrs.? (Top voted first)

Updated

My question concerns drug conversion. The Fentanyl works well, most of time, for my chronic pain, but my insurance now says I can only get it again in March of 2015. This is still Oct., 2014, so I will be out of patches at end of October. I don't understand this, because just stopping the patches would/will cause terrible withdrawal, because if you are only couple days late, withdrawal starts. This happened also recently as my dr. changed (at my request to try something else)100 mcg. patch to only 15 mg. of morphine ER every 12 hours, because of patches costing almost $400 for one month, which I cannot afford, due to "doughnut hole". The change made be very sick within two days, so I had to go back to patches. I didn't think the 15 mg. extended release morphine was enough to equal the patch strength to help pain. I looked online, but then in reading insert in box with patches, it says conversion is at least 315 mg of oral morphine day. Elsewhere, I found that extended release morphine should equal about 60 mg. four times day to be about equal to the 100 mcg patch taken every 48 hours. Is this the right dosage to be converted to, so as not to cause withdrawal, and/or will withdrawal take place mostly because the body misses that particular drug? I do have three 10/325 Norco for breakthrough daily, which do not seem to help much. What other medication could patch be changed to that insurance hopefully will cover, or I could have doctor request to be covered? I have been on patch and other medications because of chronic pain n my back and severe neuropathy in my legs and feet for a few years now, in addition to other pain conditions. I hope a medical person familiar with drug dosage conversion can answer. Also, that the required e-mail address is confidential. Thanks.

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6

I am a MD. A fentanyl patch delivers 100mcg/hr (2400mcg/day). To replace that a MINIMUM of 15mg of Morphine an hour (360mg/day morphine MINIMUM) would need to be given. Be careful with conversions! Especially when going from dosage an hour vs per day! I have seen MANY doctors do incorrect conversions causing untold agony and unnecessary harm to patients. It is sad that less than 15% of patients misuse, sell or are true drug seekers (that means logically 8 of every 10 patients truly are in pain). I wish the citizens of this country would push the law makers to get the DEA out of my Medical Practice. I risk losing my license if I prescribe to addicts or undercover DEA agents pretending to be patients. It is a sick waste of tax dollars and scares many providers to order sufficient pain meds for people in pain.

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5

I have done this switch and it was ridiculous in my opinion. I was changed from 1 75 mag patch to 15mg mscontin 2 or 3 times a day. That is way too low! I fired the doctor that did
That to me. I now take 200 mgs of ms contin 3 times a day. When I was on just oxycodone I was taking 120 mg oxycontin 3 times a day and had 5 to 6 30 mg ir oxycodone for breakthrough on both the ms contin and oxycontin when on them..I could no longer afford oxycontin so had to switch back to ms contin..the patches would cause horrible blisters wherever I put them so had to get off of them. I feel the pain relief was more level on the patches once you built up a plasma level. If it wasn't for my skin reaction I may have still been taking fentanyl transdermal system as my long acting. I've always kept my breakthrough to oxycodone due to its great oral bioavailablility and would still be on oxycontin if it would ever go back to being generic. It works much better at half the dosage strength in my opinion over morphine or ms contin rather.

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10

The search term "opioid converter" yields free, web-based apps that calculate such opioid conversions for you! - , !

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2

Not according to a conversion form online and also insert with patches box. I was being conservative inmy estimate, so I am confused now by this response. Thanks for responding, though.

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3

I'm just going by a straight conversion. Fentanyl is listed as being 81 times stronger than Morphine.

However, what that doesn't take into account is the difference between one being absorbed through your skin, via the patch and the other being taken orally. Few converters do that, because most don't include the patches. They just use oral and IV/IM.

So, I am very sorry to confuse you.

Really, if the manufacturer lists a conversion, then it would be best to go by that, since they are the ones that have done the studies on this.

Are there any other questions or concerns?

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4

The way I read it, 15 mg is not nearly enough to equal the amount of one patch for one day, more like 300 mg divided,which seems like a lot, so reason for question. Thanks.

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7

Hi - I know its been a while hope you are on a decent conversion these days. 20 years ago a doctor would have done direct conversion. What they are meant to do now if using any opioid sustained release is to halve the daily dose the body "should" be absorbing. I was on 2x75mcg fentanyl every 48 hours due to patches coming off. so the doctor had no idea how to convert me safely - so low balled me as with your experience to 40mg Kapanol twice daily - 12 hrs apart - due to severe withdrawals I ate up 100 x 5mg valium in 4 days, my Doctor sought out other specialists - found one who was caring and had empathy after reading the referral of the state I was in re withdrawals (ie; I was ready to hang myself of the local bridge - I didn't tell anyone but was ready I just couldn't handle it anymore) anyway the ne specialist hopistalized me immediately on oral 10mg morphine per hour - I was to go ask when I wanted, unfortunatelyI was admitted at 6pm - and by 2pm with option of valium s well I bombed out till morning - so kinda blew the results in y opinion, next day I dropped to 5mg per hour - but ws to go and ask for it when I felt withdrawals coming on etc, I was so fatigued from withdrawals from the previous 4 days I did my best to go ask for it as appropriate. came out on 60mg Kapanol next day as I felt ok by then... with another 15mg oral. by that night I took the other 60 but didt sleep - stage 1 withdrawals - luckily he gave me his mobile and suggested I call him so we can get he dose right as would need to be adjust by 10mg where appropriate. 20 years of daily 300-400mg Morphine has sucked all the calcium out of my teeth (im 42) and have dentures. My testosterone was not checked during any of that period as is so low I ended growing man boobs (great) - so now use that wipe on testosterone. With 1000mg calcium tab + vitamin D tab (you need vitamin D so your body can absorb calcium - if you don't go in the sun much as you work in an office etc, or house bond take the vitamin D = it wont hurt). I am getting fine pain relief with 50 or 70 mg Kapanol, bu it only lasts 4 hrs in my system before stage one withdrawals come on (runny eyes - agitation - etc) so have had blood test taken - will find out my nanogram blood serum levels. ie: if it's low and your in pain say 25ng/pl blood level they up your dose. If you have a high ng/pl blood level say over 175ng/pl and you say your still in pain they will put you on different medication as your body is absorbing heaps of morphine but your still in pain? = so ie: its no longer working so pain med change time :( = be honest though as you goal is pain relief not a drug habit. Hope this helps anyone - took me years to learn this - before the internet was so good (all hail google)...peace

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9

You are "a" (sic) MD? How come you don't know basic grammer?

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11

The lawmakers and insurance companies are doing more harm then good.
I have never had a bad UA nor called for extra medication. My MD had me on a program that allowed me after years of pain to finally become a useful member of society again. Early 2017 after a fractured hip as I tapered from the additional surgical meds my MD left the practice. My new MD is now lowering my meds below presurgical. He says it's for my own good. Fully aware that I rely on acupuncture and non perscription supplements he is significantly lowering the medication. I'm really trying to cooperate, but the pain and mobility level have me spending more time in bed then out. I have no desire to go overboard, but I want enough to continue my volunteer and work activities.

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12

ask your doctor for opanna for breack threw pain allong with what your takening the should be taken inbetween.

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13

I was on durogesic patches 100mg what dosage would I be on if I changed over to zapandol 100mg daily and what quantities do they come in

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1

Hello, Lady! How are you? Yes, the email address is confidential and revealed to no one. It is automated. You'll receive a notice that I have responded to your post, but I will never see your email address, nor will anyone else.

As to the conversions, 81mgs of Morphine would be equal to each 1mg of Fentanyl. At 100mcgs, you're looking at only a tenth of a milligram, so that would be 8.1mgs of Morphine, so the 15mg should have been enough. However, you were going from something very potent to one that isn't nearly as strong, so some withdrawals were bound to happen, at first. On top of nausea, dizziness and diarrhea, the withdrawals can also include rebound pain, which may be even worse than the pain you've been trying to treat.

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.

Usually, such withdrawals only last a week or 2, as your body adjusts to the new medication.

You may want to speak to your doctor about what you can do to taper off the Fentanyl and slowly add the Morphine. That might help to minimize the withdrawal effects.

Are there any other questions or concerns?

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8

300 mg ER or ms contin is equal to 3 30 mg oxycodone's. Fentanyl patches are about the strongest medication you can get bar none. Also the patch is known to fail and dump potentially lethal doses of the drug into your body. The government is cracking down on doctors manufacturers insurance company's. They've jacked the prices up by changing tiers of certain meds. Fentanyl I believe went straight to tier 4 on the insurance chart. As did all ER (extended release) regardless of form. Patch pill pump whatever. Bottom line you ain't seen nothing yet. Get a proper conversion chart from a proper source I.e. manufacturer the amount of active ingredients in prescription drugs by law can swing as much as 20%. Take into consideration your patch will not be as affective so you may have changed patches too soon and that's why your short. I don't make this stuff up. I'm an insider who knows what going on. Good luck.

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