nickiea
Stranger
Reged: 01/15/02
Posts: 4
Loc: AR.
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Has anyone had any experience with the pain medication Avinza.My pain doctor has started me on this medication & I had never heard of it. I was wanting to get feedback from anyone who has been on it. 
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jack_in_ca
Newbie
Reged: 06/01/03
Posts: 43
Loc: California
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Accordint to Google it's a timed-release morphine sulfate like MSContin.
Peace,
Jack
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"Hello, Saddam?...George...Yeah, I know...my bad..."
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trey22
Newbie
Reged: 07/24/04
Posts: 30
Loc: new jersey
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yeah does your prescription come in capsule form?
i believe they tried me on this a few years ago.
at the time, i was on percocet and oxy for my condition.
i tried the oxy for the whole day, and the percs as needed.
this med you speak of replaced the percs. it didn't work as well, imo at least. i might be off......could have been the combo of the oxy. oxy was it for me at the time. all else pailed in comparison. thank god i am off that and won't go near it ever again. bad stuff.
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PJoseph
Journeyman
Reged: 09/12/04
Posts: 66
Loc: South of I-80
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I think Avinza is a once a day Morphine preparation.
Fentanyl (Duragesic patches) are supposed to last 72 hours and don't for a large population of its users.
Oxycontin tabs are supposed to last 12 hours and also don't provide relief for that long for a large population of its users.
So be aware that the Avinza marketing of the drugs length of relief and reality of the length of relief might not jive for a while
The good news is that, at least for oxy and duragesic, the stats/complaints are starting to pile up and the docs are adjusting their dosing accordingly.
Having said that, I am sure there are tons of readers on these meds who for whatever reason, be it geography or conservativee beliefs of their doctors couldn't disagree more on the topic of their doctors willingness to adjust patient's doses based on only the word of the lowly patient. Some Doctors consider the Pharmaceutical Reps word gold when it comes to prescribing.
Maybe it's because the doctor gets something made of pretty gold for prescribing the Reps drugs-JUST A GUESS! NO ACTUAL KNOWLEDGE-and no money so go ahead and sue me anyway.
PJ
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WickedNoah
Member
Reged: 10/02/04
Posts: 122
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Yeah, OxyContins last 8 hours, according to patients, not the advertised 12 hours.
Duragesic patches are SUPPOSED to last 100 hours, but you're right, they don't. Since it takes 18 hours for the patches to start working, at least one poster puts another patch on after 72 hours, while leaving the first one on. That way, as the first rapidly diminishes in strength, the new one is helping to cover for it.
Avinza, though - it's only 100mg morphine, and most morphine gets broken down very quickly by the body anyway, so it's really not for super-strong pain. But its time-release mechanism actually involves nanoparticles and DOES last as long as advertised. BUT... it's pretty weak.
Some docs are coming around to these facts, but it'll be years before they stop reading the pamphlets they get from the drug companies and start trusting their patients....
Noah
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moonbeam
Member
Reged: 05/23/03
Posts: 175
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The only thing that I have read in my nursing studies about morphine is that once it travels into the digestive tract, you actually lose approximately 50-60%. This means that you actually only get about 40-50% of actual medication. I think that this theory is probably true of most oral pain medications. The best route for pain relief is through IM or IV administration. I don't know why doctors don't factor this into consideration when prescribing oral pain meds. I know that my husband got very little relief from the Avinza. The doctor now has him on 4mg Dilaudid 4 times/day and he is much better with this.
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WickedNoah
Member
Reged: 10/02/04
Posts: 122
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Quote:
The only thing that I have read in my nursing studies about morphine is that once it travels into the digestive tract, you actually lose approximately 50-60%. This means that you actually only get about 40-50% of actual medication. I think that this theory is probably true of most oral pain medications. The best route for pain relief is through IM or IV administration. I don't know why doctors don't factor this into consideration when prescribing oral pain meds. I know that my husband got very little relief from the Avinza. The doctor now has him on 4mg Dilaudid 4 times/day and he is much better with this.
Well, morphine is a special case in that, unlike other pain meds, it's targeted by the recently-discovered UGT system that tags it for removal from the body. The UGT system is so new that most textbooks give it only a passing mention, but original papers (found by searching on Pubmed, at ncbi.nlm.nih.gov/pubmed) are of course up-to-date and if you can stomach their jargon, you can gain a lot of info that books don't have. Most meds (of any kind) are metabolized to varying extents by the cytochrome P450 system in the liver and other cells. But, only about 5% of morphine is metabolized by these enzymes, so it is definitely a very different situation.
By the way, the 50-60% for morphine that you read about can be as low as 15%, depending on what book or study you read. It makes your proposal for more IM or IV administration even more enticing. The problem is, patients will always mess this up and hit a major vein or artery if they do it themselves...
I need to add, though it sounds like I'm talking down, that you can't make the generalization that 50% of most meds make it through untouched - hydrocodone, for instance, may NEED to be metabolized to become active, while the benzodiazepine temazepam (Restoril) isn't metabolized at all. You get a whole range of data actually, from 0% with temazepam to 98% with BusPar. Each drug has to be treated differently; there's no finger rule here.
I'm just saying this b/c I'm a neuroscientist with a degree in neuropharmacology and I see this all the time.
Noah
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moonbeam
Member
Reged: 05/23/03
Posts: 175
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Thanks Noah. I can see that I will be calling on you quite often now that I am in my pharmacology classes. In fact it is quite funny how they teach us to "trust our patients" and believe their complaint of pain, and then turn around and we see on our patient's chart a standing order for Tylenol 325mg q4h and nothing stronger for a patient that may be undergoing chemo. There may be a reason for a doctor prescribing a mild pain reliever for cancer (some cancers may not elicit pain, etc). I'm a first year nursing student so I am still very niave and inexperienced. I just find it all very interesting (and in some situations, sad). I had a patient in the hospital last quarter who was admitted with sob and chest pain. He complained of "hurting all over" and told me several times that he wanted to die because he was tired of hurting. His doctor had him on regular strength Tylenol. It just made me wonder. If they could control his pain, would he still want to die?
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WickedNoah
Member
Reged: 10/02/04
Posts: 122
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Quote:
Thanks Noah. I can see that I will be calling on you quite often now that I am in my pharmacology classes. In fact it is quite funny how they teach us to "trust our patients" and believe their complaint of pain, and then turn around and we see on our patient's chart a standing order for Tylenol 325mg q4h and nothing stronger for a patient that may be undergoing chemo. There may be a reason for a doctor prescribing a mild pain reliever for cancer (some cancers may not elicit pain, etc). I'm a first year nursing student so I am still very niave and inexperienced. I just find it all very interesting (and in some situations, sad). I had a patient in the hospital last quarter who was admitted with sob and chest pain. He complained of "hurting all over" and told me several times that he wanted to die because he was tired of hurting. His doctor had him on regular strength Tylenol. It just made me wonder. If they could control his pain, would he still want to die?
Oh my gosh, a poster told me in a PM that she was turned down by her doc for 800mg Motrin. As you know, but some dbers don't, Motrin is ADVIL!!!! Advil's usual OTC dosage is 400mg, so what my friend was asking for was simply a more convenient form of taking Advil... Unbelievable. I hope I NEVER have the experiences some of you have had.
To address your question about that poor old man on reg. strength Tylenol: first, I'm so, so sorry for him.... I have an example that shows that pain meds make a ton of difference to people in very bad situations:
My best friend's mom in high school had terminal cancer, and she died my junior year. Right up until she passed, she was friendly, positive, and an absolute joy to talk to. We'd watch Bogart movies together. She was on a lot of pain meds. If she wasn't, I'm sure she would have killed herself. But the pain meds let her live the rest of her life at home, with friends and family. The difference in quality of life is incomparable.
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moonbeam
Member
Reged: 05/23/03
Posts: 175
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Can you give me some information on Meperidine? I see that it is prescribe quite often in the hospital for patients on a PCA or given IM. I never liked the way it made me feel (all goofy and forgetful) when I was given it, although it did seem to work for the pain. What is the difference in Meperidine and Dilaudid?
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WickedNoah
Member
Reged: 10/02/04
Posts: 122
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Quote:
Can you give me some information on Meperidine? I see that it is prescribe quite often in the hospital for patients on a PCA or given IM. I never liked the way it made me feel (all goofy and forgetful) when I was given it, although it did seem to work for the pain. What is the difference in Meperidine and Dilaudid?
I, too, have heard that meperidine is used often in hospitals. I have never been told directly WHY this is because I'm in the basic research part of the hospital, but there's a clue that may help: fentanyl is also used a lot. Meperidine (Demerol) and fentanyl are related, with fentanyl being a heck of a lot stronger, as you know. The other similarity is that they have short half-lives, so you can administer analgesia and have the drug get out of there quickly. That's a big plus in the hospital, much more so than in outpatient situations. Also, it has few peripheral side effects to deal with.
By the way, long-term use of Demerol is toxic because one of its metabolites is toxic and builds up in your body. That's why it's not prescribed often for chronic pain. I don't know about fentanyl, but the Duragesic patch is fentanyl, distributed evenly over several days, so I'm guessing the risk is less...
Another thing, if you look at the structure of meperidine vs. morphine, you will notice nothing in common! It actually IS related to morphine, but it's hard to explain. There is one cyclic carbon group and a long strand that contains nitrogen in common. Here's a link to a paper that shows how it's related:
http://holivo.pharmacy.uiowa.edu/morphine/opioids_morphine.pdf
Dilaudid is hydromorphone. You know hydrocodone? Dilaudid/hydromorphone is just hydrocodone with the carbon in the 3 position bound to an OH group instead of an OCH3. That's it! Putting that OH instead of an OCH3 raises its affinity for opiate receptors from 10-100 fold, though, so that little change means a lot.
By the way, this one little change is what separates codeine from morphine, too. Cytochrome P450 2D6 cuts off this CH3 and turns hydrocodone into Dilaudid (and codeine into morphine), and for a long time it was thought that hydro worked by being turned into Dilaudid. Funny that it doesn't FEEL like Dilaudid. These days, this is being questioned because it looks as though only 15% of hydro is converted to Dilaudid, and a lot of people think that hydro's structure has activity on its own. The thing is, as I mentioned above, putting that CH3 there lowers the drug's affinity for the mu opioid receptor by anywhere from 10-100 fold... So somehow, despite hydro's CH3 addition, it still works. But not as fast as Dilaudid. Which is what you asked about...
Dilaudid acts fast, it's potent, and has relatively few side effects, as it's a relatively pure mu opioid receptor agonist, but it is very similar to morphine, so more people are allergic to it than to Demerol.
It's not often prescribed as a pill, though my best's friend's mom had a lot of it. Junkies have found that it feels just like heroin when injected, and is highly sought after by them. See the movie Drugstore Cowboy for an extended proof of this... Here's a link on how close morphine looks to Dilaudid, the relative potencies, alternatives, etc.:
http://holivo.pharmacy.uiowa.edu/morphine/opioids_morphine.pdf
Dilaudid is supposed to have few side effects, but more and more people who are treated with it after surgery are complaining about feeling only localized pain relief, even though it's administered by IV. Plus, some people hallucinate. Some people are allergic to it.
Hope this helps. Any specific questions are welcome.
Noah
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Kaos
Stranger
Reged: 09/18/04
Posts: 6
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Well from my experience with hydromorphone...I'd have to say it has a very potent effect especially when used IV. The rush is quite similar to heroin and morphine thought i'd have to say its more overwhelming. Though you don't find too many ppl that get it prescribed to them, as least from my experience. Good info there btw thanks for that link. Anyways as said before in this link its usually whats the new "hot" drug this week for whatever it may be...Pain...allergies...antideps. It's all the same to them. Well MOST of them. Occasionally you will find a doctor that does use his schooling and the word of the patient combined with a bit of research. But most just throw whatever at you.
PLaE,
Kaos
Edited by Kaos (10/17/04 12:34 PM)
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Opie_Yates
Old Hand
Reged: 08/11/03
Posts: 460
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Quote:
...There may be a reason for a doctor prescribing a mild pain reliever for cancer (some cancers may not elicit pain, etc).
So what kind of cancer doesn't elicit pain?? That's a new one on me.
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Better living through the pharmaceutical sciences.
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khioxn
Newbie
Reged: 07/22/04
Posts: 36
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I am currently taking Avinza 90 mg from my pain dr. It is very expensive even with insurance. She started me at at 30 then jumped me to 90. I take it once a day and sometimes have to take perc's in the evening if I have bad break through with back pain.
It works for tha pain somewhat, It doesn't make me totally pain free and drugged out but I can manage and sometimes I can relazzzzzzzzzzzzz.. meaning sleep ...
Good Luck
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nickiea
Stranger
Reged: 01/15/02
Posts: 4
Loc: AR.
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My pain doctor increased the avinza to 120mg daily. To me it is not as effective as the ms contin. I was on 60mg 3x a day. I had the best pain relief from the 40mg oxycontin but I had been on that dose for about a year. When I told him I thought it was loosing it's effectivness he put me on the ms contin. I would like feedback on anyone experiencing fluid retention from Avinza. I'm having that now & think it might be the medication.
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