Hydromorphone was a major letdown. I took 4, 2mg tablets and felt less pain relief than I would from 2 10/325 Norcos. IMO it's a waste of money. Oxymorphone was slightly better but the Opana (15mgs) seemed to wear off after only 6hrs. Don't know if you take an IR form of Oxy or an ER, but I'd pass on the hydromorphone and try for Morphine or Oxymorphone. All 3 (hydromorphone, oxymorphone and morphine) have poor gastrointestinal absorbtion %. If it were me I'd take IR morphine or ER morphine as a comparible oxycodone substitute.

Hi pillar,
My pain Dr. told me Morhine also has low bio-availability.
Khilee

Well, someone told me a 30mg oxycodone = 11.5 dillaudid (hydromorphone).

Your 2 10/325 is 20mg oxycodone and I assume about 8mg dilaudid. You said you took 4 2mg hydromorphones. I probably would have taken a few more than that.

I ended up going back to doc and getting scripted Morphine Sulphate and when I heard a months prescription was gonna be $20, I knew right there they were gonna be [censored]!! Oxycodone must really have all these meds beat with a stick. It's all about bioavailability.

IV morphine is around 6 times more potent than oral morphine, which shows that it has low oral bioavailability. Yet some doctors who treat patients with 10mg IV morphine will prescribe 10mg oral morphine to the same patient, and then wonder why the patient reports that it is insufficient.

Just wanted to report back that the MS(morphine sulphate) pills were horrible. Not even close to the oxycodone IR they were supposed to replace. Even when I took the equivalent doseage.

The hydromorphone seems to be the most promising IF this shortage keeps up. App is coming up in a few days and it's now been over a month since this saga started. Hopefully they have it all straightened out.

Fortunately, I drive past my pharmacy literally on the way to see my doc. I will stop by and ask if they have rectified the situation and if not, I will ask to see what they do stock.

Opana is hydromorphone and is close in compisition to dilaudid. Hydrocodone 10/325 is not anywhere near oxymorphone, it's hydrocodone with a low dose of tylenol.

Opana is actually oxymorphone, not hydromorphone (the most well-known brand of which is Dilaudid, in the States, at least). Do they still use Palladone (an ER formulation of hydromorphone) in the US? I know it's available in the UK, but seem to recall it being withdrawn in America.

Has anyone heard that Mepergan Fortis is being taken off the market? My wife is a nurse and she said that one of the DRs in their office wrote a script a couple of weeks back and the patient came back to their office to say the pharmacy would not fill it.So she called the pharmacy and they told her that it has been taken off the market temporarily so the FDA and DEA can look into how it is scheduled or something like that(isn't a schII anyway). She could not remember for sure the reason. Anyway the DR had to write two seperate scripts one for demerol and one for phenergan.The pharmacist said he thought it would be back in a couple years. The good ole DEA what would we do without them? LOL Sorry to be off topic.

Do you mind me asking what equivalent dosage you took? There are quite some differences between sources.

I think very recently the FDA initiated a review of Mepergan Fortis under its drug Efficacy program (DESI) to determine current status as a medication that is "less than effective" than its original approval way back when. As a result of this, hospitals have been notified that Mepergan Fortis has been withdrawn from the market for the time being. Usually these DESI medications can remain on the market pending review but it sounds like this one did not.

Total bummer. It has always worked great for me. When I had my wisdom teeth cut out, it was the only thing that worked for the pain. Granted, it wore off really quickly, but it still did it's job.

Those litte tabs (2mg dilaudid)are so small and "tight" I find it helps to crush them and mix with warm coco with lots of sugar, there is no time release component so I don't think the Doc would have a problem they dont last long so I use for breakthrough pain only. JMO

Darn, when did mepergan get taken off the market?
It was a great 'emergency' pain med for me. I don't get it rx'ed very often. I actually have some from a small script about 9 months ago left over.

My doctor will write it for me as a backup emergency med to go to if nothing else works and he's not in office, or it's the weekend.

I know it's not a great first choice med for a lot of folks, but I'm like the poster above, it works great for me when I need it.

hydromorphone is dilaudid's generic.

warm coco with lots of sugar



They used to liquify them of other purposes I will not mention. Dils were very short acting but the real thing.

I guess you could get the two meds. that were in mepergan (which is demerol and phenergan) scripted seperate if you needed it that bad, but that would be more trouble and also cost more I'm sure. Don't yall just love the good ole DEA

OPANA IS AN ER MEDICATION BUT YOU CAN GET IT IN LARGER DOSAGES, AND OF COURSE, IF YOU BREAK, CHIP OR CHEW THEM THEN YOU WILL GET THE FULL 40 OR WHATEVER MG ALL AT ONCE. ALTHOUGH MY CO-PAY FOR OPANA IS $60 SINCE THERE'S NOT A GENERIC FOR IT YET, IT'S STILL WELL WORTH IT. JUST FOOD FOR THOUGHT.

Slight correction - Opana is Oxymorphone not Hydromorphone. Just as "Oxy"codone and "Hydro"codone are composed. Oxy is a more synthetic medication than the Hydro meds but they're supposedly more potent (although I like the Hydro's on both meds better.)

For those of you who need to find more information on drugs, try WebMd.com it offers a wealth of info on each drug - the site has pretty much everything you'll find in a PDR (physician's desk reference).

My insurance requires that I pay for my script and they reimburse me for 80%. Opana went up from $400 a month to almost $600 a month. That took it right out of my price range.

Insurance takes their sweet time about paying and I refuse to pay that much up front for ANY meds.

I am going to talk to my doc about hydromorphone because that's all my pharmacist seems to have. Well, morphine, but that did nothing for me.

What is up with this shortage of meds and then raising prices of what is available? I guess that's for another thread!

I have heard may reports saying opana is not that good taken orally , oxycodone is better is this true ?
Is there any more effective way of taking it excluding injection ?

Spencertracy, I take Opana and it just doesn't do much for me. I am going to ask my pain doc if he will swith me to Roxicodone.
Khilee

wait a few months... now is not the time to switch.

there is a nationwide shortage of 5, 10, 15, & 30 milligram oxycodone IR. unless you are going the time release route (oxycontin) you will be hard pressed to find any pharmacy that has stock to fill your Rx.

Thanks funkybreakz, I forgot about that.
Khilee

Hi - Opana is an ER (extended release) medication and it's chemical name is Oxymorphone, not hydromorphone. It comes in various strengths and is very effective if taken properly with any/all other medications you are prescribed.

There is IR instant release opana also.

My doctor prescribed me Hydromorphone in replacement of Oxycodone. I definitely like Oxy better by far. These 4mg tabs of Hydromorphone seem extremely weak. I suppose the bio-availability is low.

Also, the script was written take 1 tab every 8 hours? Is that a normal count?

I can't wait until Oxycodone is stocked on the shelves again.

Normally, it's Rx'ed as 1 tab q 3 to 6h prn. Eight is really stretching it.

I just knew something was wrong the way it was written to me. Thanks for the knowledge, you rule!

I was recently seen in ER for severe pain related to a herniated lumbar disk. They injected me with 1 mg of hydromorphone, which worked great on my pain... for 20 minutes. Another IV dose proved the same. They gave me 2mg oral dilauded to take home with me, and I feel far less effects from the 2mgs than from 10 mgs of Norco. Even 5mgs of dilauded just barely gives me relief, and only for about 2 1/2 hours. I am really unhappy with the dilauded, especially because I was told not to take any other drowsy-inducing drugs with it, which means I only get 2 1/2 hours of relief but then have to wait the full 6 hours before I can even take a Soma or something as simple as an antihistamine for my seasonal allergies. I have read that people have better luck with the hydromorphone in higher doses, but I would advise you not to get your hopes up if you are used to something like Norco or stronger and your doc prescribes any less than 8 mgs of the hydromorphone. All it does is make me swimmy, depressed and pissed that I have to wait for it to get the heck out of my system.

I haven't heard about hydromorphone for quite awhile (years)....way, way way back in the day, Dilaudid was the pharmacutical version of herion....4 mg would take you to your knees..
i remember reading in the PDR, "not for injection" but that was the best way back then to reach were we wanted to go!!
...in the early 80's they cost $50 per 4mg pill, very expensive for its time, but it would do the trick...
kind of like oxycontin is now...

I never took one orally, but i heard that it would knock you out for awhile...doesn't seem to be the case??

Yes. But short lasting.

I'm one of those people that hydromorphone doesn't work on. My doctor put me on 4mg pills back about 5 years ago. I was screaming in pain for days and finally I went back and told him and he gave me a script for percocets. They worked great for the pain. I never tried to take 2 of the 4mg pills at once so maybe 8mg was what I needed to control the pain, but the 4mg did nothing at all. I mean nothing. It was a horrible few days before I got up the nerve to tell my doctor that they weren't working.

You never stated the dosage, I have to take the 200 mscontin to work plus an IR 10 opana for breakthru. The 200's work pretty good for me ultil the steriod shots start to wear off.

mindbody- That's a very descriptive recap of your experience with hydromorphone. But I have to ask you, is that the reason you are going to a methadone clinic everyday now?
If so, it might be helpful for readers of this discussion board to hear the end of the story regarding your history of using this "heaven in a pill."

I've tried it, actually am prescribed it currently. It's not a bad medication, I can function more highly on it as it doesn't make me sleepy. I actually feel a sense of extra energy over the same dose of Oxycodone.

hydromorphone is am awesome pain killer--but has very low bioavailibility--even at the clinic i worked at they IM it with phenergan---practically useless orally---learn to IM it and youll be fine--this is science not just my ancedotal evidence---trust a former dilly expert--gotta use a needle for this stuff--if u refuse then stick to what u get

The dose should reflect this, as with morphine, so oral administration would be no problem in appropriate doses. However, looking at the Palladone IR doses in the UK (1.3mg and 2.6mg), and considering it is indicated for severe pain in cancer, they do seem rather low. 1mg oral hydromorphone is equivalent to 4mg oral morphine, so these doses would be equivalent to 5.2mg and 10.4mg oral morphine. Perhaps for very weak patients with renal or hepatic impairment, they may be sufficient, but otherwise, and considering tolerance, I can imagine patients needing several of these capsules in one dose.

Palladone SR 'only' goes up to 24mg, which would be equivalent to 92mg oral morphine. MR morphine products go up to 200mg.

Of course, initial treatment should begin with low doses.

I live in Upstate South Carolina and Hydromorphone is very hard to get most doctors would rather give you Lortabs and send you on your way. Hydromorphone is highly regulated in South Carolina and Lortabs are not so I guess that is their reasoning.

I was RXd 8mg's for awhile, I thought it worked well. Interesting that there seems to be such a wide range of experiences here.

When doctors transfer you to a different PK, dont they usually "factor in" bioavability differences in determining your dosage? Dont the analgesic converters factor that in?

How else would they calculate an equipotent oral dose if they arent correcting for bioavability differences? That seems odd to me (and dangerous!).

I find the DEA's whole outlook on pain meds too be warped. They pull anything that can be abused from the market.... well sometimes... Technically any pain pill can be abused. They stopped making palladone because it was dangerous. Then they release Opana which is several times stronger. Between these two they released Fentynal patches and started noticing needle holes in the patches on patients in hospitals. Either that or no patches where there were patches before. Narcotics are narcotics. People have been addicted too them since they discovered what the poppy could do. Why does the government think they can change this and still have narcotics on the market. Either let people die miserably from cancer and other diseases (out of the question in my mind) or deal with a few idiots overdosing and killing themselves (we should hand out needles and pills and let darwin do his work.

Secobarbital,you are asking if we are our brothers' keeper.What is the endgame if there are no laws to protect one from him or her self? Vice of any type is usually self inflicted.If what one does harms only the "victm" and close relationships,should the government intervene? I don't think so,and the final result would be some sort of thinning of the herd.The cost to a society for providing care and treatment after any kind of personal destruction has to be less than violent crime, prison,and law enforcement.
My experience with hydromorphone was educational.A very close family member for whom I was caring had an unlimited supply of 4mg. pills.With his terminal condition, the Dr. gave whetever I asked for.This was mid 70's.With all the recreational possibillities{Seconal, Tuinal,Eskatrol,Thai stick and other non-medical herbs)Dilaudid orally only worked on a schedule of 8mg. every 4-6hrs.The Dr. made a point of telling me it was the most potent med available.The only option he said would be to find decent heroin.
As parisset mentioned above,people would pay $25.00 for a 4mg. pill that did not get them high,it took the "sick" away until they scored.

secobarbital, did you just say something about needle holes in patches on the patients? I guess that could be true, but since you cannot suck that gel up into a syringe, thats a little funny to me.

I have tried hydromorphone, but like I've said many timesb efore, its not really all that great unless IV, and I don't recommend this at home. as IV'ing pills is not healthy and you won't be here for much longer. I've only had both becuas eI've been to th ehospital for a car crash.

Have you tried to suck that Fentanyl out of the patch or just heard that from someone you know?
I've seen people who are on probation attempt to do this because they believe they can beat their urinalysis tests since the drug is synthetic.
It is amazing how far someone will go even with prison facing them if they screw up.
I hope you were never in a situation like that?

I don't know what's changed about hydromorphone but I took it years ago. And as another said, orally, it did absolutely nothing for me. It was completely non-bioavailable. However, IV it was very powerful and lasted around 6 hours full strength in 4mg form. I was recently given 2mg IV in the hospital, while in extreme pain. It helped, but certainly didn't overwhelm the pain.

HAHA, the best line of the week. I will second that motion!

Never had the IV in the hospital, but recently was precribed a healthy dosage orally because my other med wasn't doing the trick. I have to agree 100% with your assessment...completely ineffective. I guess is did make me drousy, but that's about it.

I actually posted here about it, asking for some sort of home remedy thing to see if there was something I could do (outside of introducing additional meds) to increase its potency. It never worked, and I just switched back to a higher dosage of the previous med after 4 days.

I've had it IV a few times for kidney stones. Yes, IV it is very strong, in fact when you get the dose of it and are laying down and know you are, you will fill like you are still falling. For me IV or IM either one, works better and longer than Morphine IV or IM.

One ER doc gave me the oral med once going home when I had a kidney stone, I thought it would work great, but the 5 mg perc actually worked better.

I've got a friend that was just switched to this for break through pain and she thinks the Lortab 10 worked better for break through.

everyone's chemistry is different.

Yes everyone's chemistry is different, but I've not know anyone using oral dilaudid that feels it has been the great pain reliever it is expected it to be.

It might be a Schedule II because of the ways it CAN be abused if you want to.

I think it has to do with bioavailablilty. Did someone already say this, lol? IV goes directly and oral has to go through the process of digestion. Y'all who know your stuff will go, duh. And I'm throwing Sally the laptop out into the backyard if I have to use the back button again.

My ER Morphine Sulfate is similar. When I had my surgeries, IV, it was powerful. But the oral is not so much so. There is a "black box" warning on the lit - don't drink alcohol, it will release all the meds. OD time. I don't drink, but it was good info. Probably true for all ER meds. Also, probably TMI, if you have a colonoscopy, you lose it all.

I have never taken Dilaudid. I always thought it was the strongest of pain relievers out there. As to Fentynal (sp?) - I have heard of people taking the meds out of the patches. I'm not sure how they did that, but there you have it. I've also read the anesthesiologist are often addicted.

Because of my liver issues, meds react strongly with me. I am careful.

OK, talking about myself again. Sorry. OK, Sally goes in the back yard.

Rain

Yes the route of administration makes a difference.

While you can take 30 mgs of morphine orally, you can't do that IM or IV. The most I have had IM is 8 mg and the most IV is 2 mg.

Now IV meds work quicker to stop the pain, they also wear off much quicker, a couple of hours, sometimes less.

Now a person that has not had many narcotics, I think that oral Dilaudid does more than it would for us. I do know that people around here have paid $80 a pill for Dilaudid. When I had it those three days IV, I'm telling you, I felt like I was ready to go to a party. Dilaudid IV or IM can be a very, very dangerous drug, it makes you feel great.

I know with plain Demerol it can be shot up so doc's don't write that as often, they generally write for demerol/phenergen. I don't know if that can be done with dilaudid also or not.

As far as pain relief, the oral didn't work as well as the IV or IM, but I think that is probably the norm with most meds..like morphine and demerol. The oral dilaudid did not give me that europhoric feeling, but that's not what I was looking for. If someone is looking just to get high, I don't understand the desire for dilaudid (oral) unless there is something I'm missing.

people will pay $80 a pill for dilaudid?! its terrible orally and IV it really only lasts about an hour, if that.

as for morphine, the highest single dosage I've had IV has been 30mg. but after my wreck when they gave me a pain pump, it was only giving me 1mg every 10 mins.

True,everyones chemistry is different.Fentanyl patches seem to be the equalizer though.As mentioned above the attempts to subvert the slow release of a transdermal patch can easily be fatal.An orderly I know, because he worked on the same floor as a Nurse I am close to,thought he could take an elderly patients patch,open it and lick the narcotic to get a nice buzz for the rest of his shift.He was found unconscious in a mop closet,taken to ER and lived.
Palladone was slow release hydromorphone(24 or more mgs.)and had the same warning as any med-including aspirin-DO NOT TAKE WITH ALC0HOLIC BEVERAGES.Quite a few people did'nt get the message and died.Great pill-no beer.Everyhing has consequences.

Dee,

30 mg with an IV dose? I don't even know what to say to that.

I think Dee meant 30mg. of morphine,not 30mg. of Dilaudid.At $80.00 per pill,even 8s,big money for the relief.

I know she meant that. 30 mg of IV morphine is enough to kill an elephant.

just to let you know, I'm a 24 year old male.

and I guess I have a naturally high tolerance, which has only gone up from years of taking pain pills.

don't worry about me, I've never ever have had any breathing complications or anything like that. I only increase my dose a little at a time if I'm no longer getting relief at the current dose.

Oh, sorry, just assumed a female.

For a 24 year old male that worries me, you don't have anywhere else to go. I understand what you are saying about increasing just a little at a time, but I'll try to offer you a word picture that might help.

Say you have a 1 ton limit bridge and for years trucks over 1 ton go over the bridge and no problem, then one day a truck that is under the 1 ton limit drives over and the bridge collapses. This happens in real life.

All of the over doing didn't break the bridge right away, it came when it wasn't expected and it should have been safe.

It's two issues, I worry about your safety, can't help it, I understand the doses of meds you are taking.

Second, you are at a place where you can't help yourself when your tolerance goes up, eventually you will get to a dose that will stop your breathing.

thank you for your concern Stacy.

Please listen to some of the information being offered to you.
While you refer much of your experience to the event of a car wreck, I'm sensing that a lot of this "knowledge" you are contributing comes from some very dangerous other behavior.
I cannot count the number of young people I've known who believed, as you seem to, that they knew what they were doing. I went to their funerals.

I had NO confusion about fentanyl doses. as I proved with a picture, the dose printed on the package is per hour, I was talking the total amount in the patch.

Orally it's not a very effective medication.