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Optimze Simultaneous Use Of Suboxone And Oxycodone For Pain. I’ve
Question: Optimze Simultaneous use of Suboxone and Oxycodone for pain.
I’ve had a case of severe foot and leg pain for the last 5 years. For the first 4 years Oxycodone at 40mg/day was quite effective to control the pain, but its effectiveness waned after that. Instead doctors prescribed 16 mg/day Suboxone to control the pain. The Suboxone has been effective for about 9 months, but now its effectiveness has also started to decline. So, two questions: 1st: For immediate enhancement of needed pain control: I now have Suboxone and Oxycodone available to me: Can I take Suboxone and Oxycodone simultaneously in a 24 hour period according to some optimized routine to get improved control of my pain for at least a couple of weeks? 2nd question: Is there some other more powerful medication--more powerful than either Suboxone or Oycodone-- which physicians can prescribe which is likely to control my pain to a level less than 3 ?
I’ve had a case of severe foot and leg pain for the last 5 years. For the first 4 years Oxycodone at 40mg/day was quite effective to control the pain, but its effectiveness waned after that. Instead doctors prescribed 16 mg/day Suboxone to control the pain. The Suboxone has been effective for about 9 months, but now its effectiveness has also started to decline. So, two questions: 1st: For immediate enhancement of needed pain control: I now have Suboxone and Oxycodone available to me: Can I take Suboxone and Oxycodone simultaneously in a 24 hour period according to some optimized routine to get improved control of my pain for at least a couple of weeks? 2nd question: Is there some other more powerful medication--more powerful than either Suboxone or Oycodone-- which physicians can prescribe which is likely to control my pain to a level less than 3 ?
Brief Answer:
These drugs should not be used together.
Detailed Answer:
Hello and welcome to "Ask a Doctor " service.
I have read your query and here is my advice.
These two drugs cannot be used together because of the potential serious interactions between them.
Suboxone ( opioid antagonist ) may produce additive sedation if used with oxycodone ( narcotic ).
The maximal dose of suboxone is 32 mg/day increased gradually, so, I think that you could use suboxone alone increasing it gradually, but this should be discussed with your Doctor and confirmed by him.
Other alternatives include fentanyl patch, epidural injections, etc.
Hope you found the answer helpful.
Let me know if I can assist you further.
These drugs should not be used together.
Detailed Answer:
Hello and welcome to "Ask a Doctor " service.
I have read your query and here is my advice.
These two drugs cannot be used together because of the potential serious interactions between them.
Suboxone ( opioid antagonist ) may produce additive sedation if used with oxycodone ( narcotic ).
The maximal dose of suboxone is 32 mg/day increased gradually, so, I think that you could use suboxone alone increasing it gradually, but this should be discussed with your Doctor and confirmed by him.
Other alternatives include fentanyl patch, epidural injections, etc.
Hope you found the answer helpful.
Let me know if I can assist you further.
Above answer was peer-reviewed by :
Dr. Raju A.T
To: Dr. Erion Spaho
Date: March 4, @019
Dear Dr. Spaho,
I wrote to you on Saturday, March 2, about the 5 year pain in my left foot and leg. A recap of my letter of yesterday is that during the first 4 years of this ailment, I used Oxycodone at 40mg/day; it was quite effective to control the pain, but its effectiveness waned after that. Instead doctors then prescribed 16 mg/day Suboxone to control the pain. The Suboxone has been effective for about 9 months, but now its effectiveness has also started to decline. So, I have come to you for help to find a safe, medicine-based means for getting my level-10 pain under control—down to level 3 or less.
I come to you now particularly because I’ve got a new physician; I think your expertise will help my new physician get off the ground in the right direction to best help me. I believe your expertise will help me use old medicines—Oxycodone and Suboxone--at optimum dosage and timing. Also, I asked you about possible new-to-me medications for my getting better control of that pain in my left foot and leg.
In this second letter I have changed some of the questions to you and, to which I want you to return written answers. Some are the same or similar as in my first letter; others have a somewhat different purpose. The difference in your answers and responses now is to address the new doctor I’ll have in a couple of days. When I see him I will request him to provide pain medication which will help me get the pain under control in my left foot and leg. If he suggests Suboxone or Oxycodone, I want to make sure that he is willing to write the prescription(s) for the upper range of these med’s recommended level for my age (80) and health (good). If it is OK with you, I will show your letter to my new doctor. I will show him your name, suggestions and signature to add some weight to my verbal arguments.
In the letter you sent yesterday, you also suggested that I might also consider Fentanyl patches and injectable epidural medications for better pain control for me. Using estimates based on your best know-how, please suggest an appropriate range of patch concentration for Fentanyl effectiveness. Also, you suggested that injectable epidural medications might be a good option for my situation. Please list good candidate(s), dosages and concentrations.
Please send your responses within 12 or less hours.
Thank you.
Darrel Wilhoit
Date: March 4, @019
Dear Dr. Spaho,
I wrote to you on Saturday, March 2, about the 5 year pain in my left foot and leg. A recap of my letter of yesterday is that during the first 4 years of this ailment, I used Oxycodone at 40mg/day; it was quite effective to control the pain, but its effectiveness waned after that. Instead doctors then prescribed 16 mg/day Suboxone to control the pain. The Suboxone has been effective for about 9 months, but now its effectiveness has also started to decline. So, I have come to you for help to find a safe, medicine-based means for getting my level-10 pain under control—down to level 3 or less.
I come to you now particularly because I’ve got a new physician; I think your expertise will help my new physician get off the ground in the right direction to best help me. I believe your expertise will help me use old medicines—Oxycodone and Suboxone--at optimum dosage and timing. Also, I asked you about possible new-to-me medications for my getting better control of that pain in my left foot and leg.
In this second letter I have changed some of the questions to you and, to which I want you to return written answers. Some are the same or similar as in my first letter; others have a somewhat different purpose. The difference in your answers and responses now is to address the new doctor I’ll have in a couple of days. When I see him I will request him to provide pain medication which will help me get the pain under control in my left foot and leg. If he suggests Suboxone or Oxycodone, I want to make sure that he is willing to write the prescription(s) for the upper range of these med’s recommended level for my age (80) and health (good). If it is OK with you, I will show your letter to my new doctor. I will show him your name, suggestions and signature to add some weight to my verbal arguments.
In the letter you sent yesterday, you also suggested that I might also consider Fentanyl patches and injectable epidural medications for better pain control for me. Using estimates based on your best know-how, please suggest an appropriate range of patch concentration for Fentanyl effectiveness. Also, you suggested that injectable epidural medications might be a good option for my situation. Please list good candidate(s), dosages and concentrations.
Please send your responses within 12 or less hours.
Thank you.
Darrel Wilhoit
Brief Answer:
Detailed below.
Detailed Answer:
Welcome back.
In my opinion, points to discuss with your new Doctor about pain management include:
1. The possibility of increasing the dose of suboxone ( dose adjustments are required mainly in cases of hepatic or renal impairment ).
2. Epidural injections that may result in pain control up to six months (corticosteroids+anesthetics, for example 3mg/kg weight of methyl prednisolone with 3 ml lidocaine 1-2% ). Epidural injections may be repeated up to three times in a two weeks interval between injections.
3. Fentanyl transdermal use ( 25-100 mcg/ hr, every 72 hours ).
You can show our discussion to your new Doctor, anyway, we only can suggest and inform you about health issues, it is your Doctor who will decide together with you what's the best treatment for you.
Hope I helped you.
Feel free to discuss with me if you have further questions.
Detailed below.
Detailed Answer:
Welcome back.
In my opinion, points to discuss with your new Doctor about pain management include:
1. The possibility of increasing the dose of suboxone ( dose adjustments are required mainly in cases of hepatic or renal impairment ).
2. Epidural injections that may result in pain control up to six months (corticosteroids+anesthetics, for example 3mg/kg weight of methyl prednisolone with 3 ml lidocaine 1-2% ). Epidural injections may be repeated up to three times in a two weeks interval between injections.
3. Fentanyl transdermal use ( 25-100 mcg/ hr, every 72 hours ).
You can show our discussion to your new Doctor, anyway, we only can suggest and inform you about health issues, it is your Doctor who will decide together with you what's the best treatment for you.
Hope I helped you.
Feel free to discuss with me if you have further questions.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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