Oxymorphone Generic, Cvs/caremark, Provigil = Oxyco Useless
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I was just Rx'd Provigil (modafinil), which is a mild stimulant for Narcolepsy, Sleep Apnea, and Shift Work Sleep Disorder. In my case, it's for mixed sleep apnea and Hypersomnia, (which is similar to Narcolepsy).

Well, I am currently scheduled to have a lumbar L5-S1 DISCECTOMY. Consulting w/ the Neurosurgeon and agreeing to surgery was around 3 days AFTER I started taking the Provigil (modafinil). The Neurosurgeon Rx'd oxycodone/APAP 10-325 for pain control in the meantime...oh surgery is in 3 weeks.

Here's the real question. I have ALWAYS been a strange opiate metabolizer when it comes to Pro-Drugs or drugs that rely on being broken down by specific liver enzymes in order for the REAL effective metabolites to do their magic. For instance, and I apologize if this is common knowledge to some, but I know most are not into Pharmacology, as I know from nerding out like this with multiple people in a variety of professions. I am in the medical field and even my cohorts are like, "uh, stop! You're killing me!". - OK, now that you know why I'm explaining, JUST INCASE, I'll give you an example.

Take hydrocodone, for example. It's broken down by 2 major enzymes in the liver. The main metabolite, of which several are produced, happens to be hydromorphone, aka Dilaudid. --- For some reason, I never, even before Provigil (which I will get to), got relief or tingly from hydrocodone. However, oxycodone, I have discovered, does its job. Here is the kicker, it's metabolized by the SAME enzymes inside the liver as hydrocodone. Maybe 1 of the 2 enzymes that are chiefly responsible for the metabolization of both drugs is more potent than one or the other. Anyhow, oxycodone - a Pro-drug, is broken down into several metabolites as well. The main one being noroxycodone, but there is another metabolite created in the process called oxymorphone, but only about 5% is created, so it's not so much the powerhouse of oxycodone's effectiveness.

Well, I'm sure, as a lot of you know, oxymorphone is for sale as it's own FDA approved drug. Here is my thing. There are several known studies showing that oxymorphone, while metabolized by the liver, into several constituents, IS NOT broken down by the same enzymes as hydrocodone, nor oxycodone.

OK, with the nerd work outta the way...I will get to the point and questions. After I took the oxycodone Rx'd from the surgeon, it didn't do s***. I looked up interactions between oxycodone and Provigil (modafinil). It, to my freaking demise, turns out that Provigil is an Inducer of the same two enzymes that metabolize hydro and oxycodone. Inducing is a BAD THING. Basically, it's not giving my body the time to metabolize the oxycodone in the liver. Therefore, I'd have to take a HUGE amount...like at LEAST 80mg's of Immediate Release oxycodone. What a waste of a prescription. The 90 Percocet I got, would be gone in a FLASH!

So, after research, I found out that oxymorphone was in generic form and like I said, it's not affected by the two main enzymes. In my book, that would mean I could take the Provigil, which I need and has been life changing, honestly...AND I can take oxymorphone IR and it would work. I'd have proper analgesia, etc.

My question is this, well multi-questions. 1) Has or is anyone taking oxymorphone and Provigil at the same time currently? If so, how are the results? - 2) I have CVS/Caremark for insurance. Does anyone else that has it, know if it's covered under that insurance? I looked up the Formulary for CVS/Caremark, and I saw Opana ER was covered, but it did not mention the generic for oxymorphone in either IR/ER. So I'm concerned for two reasons. ONE, being that I was planning on calling my surgeon, and asking him if switching to oxymorphone IR 10mg, would be OK; of course, I'd have to explain I didn't know Provigil induced oxycodone metabolization, and that it is not touching my pain, (sciatica btw). TWO, if he says no problem, will my insurance cover generic oxymorphone? I have great insurance when it comes to generics. Well, generics just happen to be FREE...no matter the cost. Generic Provigil, modafinil, for instance...costs me 0.00 dollars, but the slip from Walgreens say, "your insurance just saved you $878 dollars. WTF, for generic? Holy F***, even the 90 tablets of generic Percocet 10/325 said insurance saved me $206 dollars. Now come on! Who the hell can afford these medications? Robbery in the highest order. The point really is this, my deductible for Name-Brand drugs is over $300, from what I remember. I can't do that right now, I'm on leave from work, waiting to be approved for short-term disability, wine, wine, wine some more...I know.

I'm sorry for such a long post, but I type like I talk, so all apologies to the exhausted. In case the wordy message, which btw, the rules of this website when typing a message say, verbatim, "Please be detailed", LOL - so I'm just following instructions.

Summary, is there generic for oxymorphone? Has anyone taken oxymorphone with Provigil (modafinil)? Does CVS/Caremark cover oxymorphone IR?

Thanks for the privilege of prose and response. It's much appreciated. Especially if someone actually replies in helpful kind!

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Re: Ridley (# 12)

May I ask if you are located in las Vegas? I had a question about the oxymorphones. Thanks

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Yes...I am on Provigil (my newest demon) for MS related fatigue, ocycodone IR 10mg qid (worthless since the provigil) AND THANK GOD Oxymorphone ER 10 tied...Oxymorphone ER is my only saving grace in this instance...which bare with me, I had a major run in with the daytime Pharmacist and his minion day time tech who were adamant that my Oxymorphone ER was going to be pulled from the market Sept 1, 2017...which IT IS NOT...However, the BRAND Opana IS being pulled but the generics ARE NOT...I AM EMBARASSED to be a former Biopharm Industry worker both in the form of a pharmacy technician and then as a clinical research coordinator for ALL major pharmaceutical companies...I killed it at my job in clinical research...but when my Multiple Sclerosis and Lupus took a turn for the worse and I started feeling guilty for getting people to volunteer what health they did have for these trials leading many to unknown, sometimes horrific side effects or worse...I couldn't do it anymore... physically or mentally...

I have CVS/Caremark and yes, oxymorphone is covered...mine has a median co-pay about 40$/month but I pay 3 times as much as that for the stupid provigil...Pharmacists and Doctors as a whole are ABSOLUTLY CLUELESS on what they're doing and only want your $$$$...such as the time I was on birth control pills and had a sinus infection and was placed on antibiotics which cancelled out my BCP AND WAS NEVER TOLD OF THE INTERACTION...the result, 19 years later I have a beautiful son...now I have to choose weather I want a functioning breakthrough pain medication or be functionally awake during the day to be a part of my 14 and 6 year olds life at a 5-6 pain scale level...so I'm awake and in intense pain or going through life in a somewhat zombie state...DON'T trust ANY of them. DO YOUR OWN RESEARCH.

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Nope, never said I was taking Suboxone. I know the post was LOOOONG, but maybe a reread would be in order?

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I take Oxymorphone ER, Oxycodone, Provigil, Valium, Ambien CR and a bunch of other crap for MS, RA and LUPIS...I have CVS/Caremark insurance and they cover everything BUT Provigil (as of 7/1/17 it needs a PA)...they won't however cover my non-controlled/non-addictive muscle relaxer tizanidine...it's considered to be a "holy trinity" with everything else...anyhow...the Oxymorphone ER works fine with Privigil. Oxycodone, is like taking Tylenol. Opana (brand Oxymorphone ER) is being pulled from the market Sept 1, 2017...pharmacists and pain management doctors have been telling me the generic isn't set to be pulled off the market as of yet...here's to hoping the generic stays for those who really need it.

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Marg, i am not at all trying to ruffle feathers, just confused, as i don't recall you mention, but were you taking Opana & suboxone at the same time? If so, how can that possibly be? I am just a curious gal who happens to have been on suboxone for a while now, & unless I am not as well-informed as i thought i was, i don't see how that would be possible? i am grateful in that the time i've been on suboxone i have not had to deal with any major pain or procedures that would require something above & beyond OTC analgesics, but i'm not getting any younger, either, and who knows what could happen in the future if genetics play any role, as i've seen my mother have both hips & one knee replaced in the last 13 years. Just confused, merely.

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Yes Opana ER does come in a generic the doctor has to write it AZ oxymorphone ER 40 milligrams is the strongest made.. Then there is an opana IR which obviously if you want the generic the doctor needs to write it oxymorphone IR 20 milligrams is the strongest made.. However if the doctor writes your prescription Opana ER or IR and Rite dispense as written or substitution permissible even if you wrote substitution permissible the pharmacy will not fill with the generic version because the name is Oxymorphone ER or IR I have been on that medication for years and I had to go through a bunch of drama for a few months to get everything situated correctly..

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VLynx, We can knock that grain of salt down a little bit as I did say "virtually" painless! But, I agree with you as well. Way overall though this type of procedure, according to how our surgeons operated, had minimal discomfort , I did not know his MSD was going to be an over nighter where most often they are not. Just tryin to put him a little at ease & not to worry.

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I wish I could help you on your quest. I'm not familiar with how oxymorphone works. For me I'm sticking to my Adderall and oxycodone and my others but yes it's costing me well over $1,700 a month with no insurance, it's bulls***.

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Thanks for the response. No, in fact, this is going to be and old school open discectomy. And the surgeon said I'd be into hospital at least 2 days after surgery, followed by a minimum of one month off of work recoup time.

But you saying that the oxymorphone ER comes in generic form? Because he agreed to write the Rx fro oxymorphone but he wrote it for Opana 30mg. Frustratingly enough he did not write the prescription Opana ER 30 mg, rather he wrote Opana 30mg q 4-6hrs prn. So, I had to go back to his office after a MANHUNT of Walgreen's Pharmacy's all telling me, "we don't carry this mg., I'm sorry.". Only the Walgreens by my house, or rather my usual Walgreens was the one to say, "OH he was to write ER for extended release on there, otherwise we can't fill it.".

Then I went home and researched Opana further and found out that I'd look a FOOL if I went in there and he kept the dosage time from q4-6 hrs. So I had to call his office and say 'look I'm coming in tomorrow and giving you back the script. He's going to have to change every 4-6hrs to every 8-12 hrs. ---- I just don't understand whey this Neurosurgeon had no CLUE how to write this out. This running around and so forth was very exausting, not to mention made me feel "dirty" if that makes sense. Reason being the script was obviously so for off, it's as if I wrote the damn thing myself. So, tomorrow he better had corrected it when they call me, because being in pain for DAYS on end for Rx's that are written incorrectly and for waiting extra days for him to correct it because one day he's he's in surgery and not at the office and then one day he's at the office. I'm totally at his mercy, and it's just damn frustration. It shouldn't have been like this.

But hey, I appreciate your response. BTW my CVS/Caremark plan, under the formulary covers Opana, and all generics are FREE. So, cross fingers your right about it being available in generic.

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Yes Provigil is the Brand name and Modafinil is the generic. Provigil also comes in 200mg. But as a new patient starting off on this medication they always start low with 100mg.

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Yes, there is a generic of oxymorphone. Whether your particular plan covers it, I cannot say without knowing EXACTLY what plan you have, as even plans within Caremark/CVS vary. Although it seems to me that if they cover the ER version, they should cover the IR version, as it is typically cheaper. Why not call and ask them?

You should not have CYP3A4 interactions between oxymorphone and modafanil as oxymorphone is primarily metabolized through glucuronidation rather than the P450 system.

I would take the person who said the procedure is painless with a large grain of salt! It entirely depends on: the approach the surgeon, what has to be done, how big the disc that is being removed is, how much pressure the surgeon has to put on the nerve to get at the disc, and most importantly, personal factors. If it is an out-patient minimally invasive procedure, then the pain will be much less than if you have open back surgery. In fact, I would recommend you find someone who does the minimally invasive approach if you haven't already. Nevertheless, when a discectomy is involved, the procedure is generally more painful than for a simple laminectomy, foraminotomy and decompression. I am an anesthesiologist that does these cases A LOT! After outpatient discectomy, I would expect mild to moderate pain in the back and along the affected nerve distribution.

Best of luck!

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Is Modanifil the same as Provigil? As they make generic Modanifil . Also in 200mg , not just 100mg , which means you get more for your money .

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James, I won't get into the medication details too much even though I, myself, go thru all of the same issues. My pain management dr has to switch mine up every few months or so when I start getting used to them. Currently I am on the generic dilaudid (hydromorphone 4mg) prior to that Opana ER 20mg & also generic opana, also Suboxone you name it. But at the surgical clinic where I worked, patients were given Tramadol for post op pain, to me this is like tylenol. However, I know the procedure you are having like the back of my hand & have been in the O.R.to see it performed. So if it eases your mind at all I can tell you it is virtually painless, only abt a 1in.scar & you will immediately have relief. It's outpatient & you should be feeling fine when you leave to go home. You'll be getting some instructions on walking right away which really helps. I know everyone has their own level of pain tolerance but even if one cannot take hardly any pain, they still should do fine with this procedure. Hope it helps, and Good Luck to you!

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First off you just explained why oxycodone doesn't do s*** for me. A few months back my Dr was playing around with my meds trying to decrease me and he took me off my morphine and put me on oxy. It was like I had been cut cold turkey. Which I guess I kind of was.
Second, oxymorphone is the generic form of Opana. I can't answer about the provigil and opana together as I have never taken either. I have CVS Caremark insurance as well and have never had an issue with them filling any of my RX. Hope I helped some.

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I'm sure you know from researching that the inactive ingredients in these drugs can also cause problems with metabolism. I've found out the distributors make a big difference. First time I realized this was when I got Percocet from another smaller pharmacy. I had used Walgreens. The pills from the other pharmacy were shaped differently I couldn't believe the difference. Back to your issue. I thought the names you gave were the generic for Dilauded and Percocet. I'll have to look them up again. Also wanted to tell you that the general opinion where I live is that a lot of medication from CVS is simply not as effective. Takes too long to metabolize. One thing I learned from word of mouth was to ask for the oval Percocet. Apparently it's considered "surgical" Percocet. It's very effective. The other thing I wanted to note in talking about the metabolic process is that we have a hospital here which has pain medication that is not effective. So many people had talked about it I started researching which is my field. Someone had to say something! People hospitalized were having family and friends bringing their pain medication from home and sneaking it in! I got one of the pills. Actually Oxycodone 10/325. I found out the distributer. Then checked out the inactive ingredients. Found out that two different ones caused the medication to not metabolize easily. I mean the pills could be in your rectum before they broke down! So that's the only info I can pass on. First I believe the medication names you gave were the generic. Then check inactive ingredients. One pain pill against the other...hope this might help a little.

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