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What Are The Withdrawal Symptoms Of Morphine?
Question: I had to switch from morphine sulfate ER to another medication after my insurance refused to continue coverage of it and was initially changed to Embeda ER at the same dose of 60 mg. The Embeda made me have frequent headaches so my physician put me on Nucynta ER. I started feeling very ill within a few days. Looking back, it was probably from withdrawal of the morphine. I had sweating, sneezing, nausea, diarrhea, insomnia and extreme jitters. Then I was given Opana ER 10 mg twice a day. I still have nausea, less diarrhea, but now have parasthesia similar to neuropathy in both feet so badly that I can't sleep and about an hour before my next dose is due I start to sweat and feel really bad. I went to the doctor today and for the second time in two weeks my blood pressure was high, 160 over 90. Last visit it was 170 over 100. I have always had normal blood pressure until now. My doctor is trying to get a prior authorization to get me back on the time release morphine. I have severe arthritis in both hips, lupus and fibromyalgia. Am I differing from morphine withdrawal? Is there anything other than getting back on my original morphine prescription that will get me feeling good again and having my blood pressure back to normal? I have been miserable for nearly two months now and really upset with my insurance company.
Brief Answer:
some thoughts
Detailed Answer:
without an exam I can only give general information.
withdrawal is associated with sniffles/sneezes, aches, pains (which can be anywhere), increased sympathetic tone such as increased pulse and blood pressure. There are also usually gastrointestinal symptoms such as diarrhea, cramps, nausea or vomiting. If there is loss of fluid from the GI tract that usually changes salts, electrolytes, and acidity. These change the tone of nerves and this can feel like numbness.
In general, there are many things that can be done for pain and drug withdrawal. Which is best is highly dependent upon the individual patient, but there are several principles:
if something works, it is a good idea to not change it.
Withdrawal is treatable by giving narcotics and occurs 24 to 72 hrs after the last dose of a short acting drug and 1-2 days later for a long acting one.
some thoughts
Detailed Answer:
without an exam I can only give general information.
withdrawal is associated with sniffles/sneezes, aches, pains (which can be anywhere), increased sympathetic tone such as increased pulse and blood pressure. There are also usually gastrointestinal symptoms such as diarrhea, cramps, nausea or vomiting. If there is loss of fluid from the GI tract that usually changes salts, electrolytes, and acidity. These change the tone of nerves and this can feel like numbness.
In general, there are many things that can be done for pain and drug withdrawal. Which is best is highly dependent upon the individual patient, but there are several principles:
if something works, it is a good idea to not change it.
Withdrawal is treatable by giving narcotics and occurs 24 to 72 hrs after the last dose of a short acting drug and 1-2 days later for a long acting one.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your reply. I have 5mg hydrocodone to use for breakthrough pain. Would it help when it feels like the Opana is wearing off until my insurance company decides whether to give me my original morphine back?
Brief Answer:
Amount is a key point.
Detailed Answer:
My first response is non-medical and non-pharmacologic, "Geez, morphine ER is about the cheapest long term medication out there".
The pharmacologic question is the total amount of drug. If it is decreasing there can certainly be withdrawal it is much less likely if the amount is increasing. The Opana total 20 mg a day I believe is a somewhat low dose, the company website says it is equivalent to 60 mg per day of morphine or 40 mg a day of hydrocodone. THese are very average doses and are not considered notably high by current guidelines release about 2 weeks ago.
This also gives a ballpark estimate of the effect of 5 mg hydrocodone. Short acting hydrocodone has a bit of a delay of up to an hour to begin working and then has a duration of action of 2 to 6 hrs. taking it 4 to 5 times a day would be average and would be 20 to 25 mg a day. Combined with the opana this might be up to equivalent of 90 mg a day of morphine. But, there is considerable individual variability in how effective a given narcotic pill feels to a particular patient and that is plain not totally predictable.
http://www.opana.com/prescriber/resources/dosage-conversion-calculator.aspx
Amount is a key point.
Detailed Answer:
My first response is non-medical and non-pharmacologic, "Geez, morphine ER is about the cheapest long term medication out there".
The pharmacologic question is the total amount of drug. If it is decreasing there can certainly be withdrawal it is much less likely if the amount is increasing. The Opana total 20 mg a day I believe is a somewhat low dose, the company website says it is equivalent to 60 mg per day of morphine or 40 mg a day of hydrocodone. THese are very average doses and are not considered notably high by current guidelines release about 2 weeks ago.
This also gives a ballpark estimate of the effect of 5 mg hydrocodone. Short acting hydrocodone has a bit of a delay of up to an hour to begin working and then has a duration of action of 2 to 6 hrs. taking it 4 to 5 times a day would be average and would be 20 to 25 mg a day. Combined with the opana this might be up to equivalent of 90 mg a day of morphine. But, there is considerable individual variability in how effective a given narcotic pill feels to a particular patient and that is plain not totally predictable.
http://www.opana.com/prescriber/resources/dosage-conversion-calculator.aspx
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much for your replies. I will talk to my doctor and hopefully get some relief. God bless you.
Brief Answer:
we have to have last word
Detailed Answer:
There's a peculiarity of this system that each message from you counts as a question that we are abjured to reply to.
You're welcome.
but, here's some other information.
First one should mention the pain issues other than narcotics. Obviously fixing the thing causing the pain (this is generally not very effective; in most people with pain on narcotics the thing that is broken is hard to fix and fixing it usually increases pain). But lupus requires close monitoring since it is liable to affect every organ (kidney, thyroid, skin, vessels and nerves). Immunosuppressant therapy with disease modifying non-steroid drugs is often advisable and consultation with a specialist (rheumatologist) is almost always done. Note that lupus attacking vessels and nerves is a fixable cause of pain.
Second, there are drugs that work on pain that are not narcotic. Gabapentin is one of the most useful. Amitryptiline works by mainly different methods and is generally advised in fibromyalgia.
Third.... and this is both purely mathematically correct AND a bit beyond current medicine is that pain especially drug withdrawal pain is a phenomena that is at multiple levels of abstraction simultaneously. There is the lowest level of abstraction--Drug levels. More drug more pain relief, less drug more withdrawal. But the withdrawal is a bit abstract from the drug level because it is not directly due to the level but the CHANGE in the level. The same level of drug, dependent upon prior drug exposure, can be either too much or cause withdrawal. If someone were on 100 mg a day versus being on zero mg a day, 50 mg a day reacts totally oppositely. Then, and this is important here, there is the change in the change of the level. The drug going up and down produces withdrawal. The WITHDRAWAL GOING UP AND DOWN produces resilience. If you get withdrawal every day or every few days, you get used to withdrawal.
Hope this helps, give reviews, but no replies if it did. BUT obviously, we look forward to further questions!
we have to have last word
Detailed Answer:
There's a peculiarity of this system that each message from you counts as a question that we are abjured to reply to.
You're welcome.
but, here's some other information.
First one should mention the pain issues other than narcotics. Obviously fixing the thing causing the pain (this is generally not very effective; in most people with pain on narcotics the thing that is broken is hard to fix and fixing it usually increases pain). But lupus requires close monitoring since it is liable to affect every organ (kidney, thyroid, skin, vessels and nerves). Immunosuppressant therapy with disease modifying non-steroid drugs is often advisable and consultation with a specialist (rheumatologist) is almost always done. Note that lupus attacking vessels and nerves is a fixable cause of pain.
Second, there are drugs that work on pain that are not narcotic. Gabapentin is one of the most useful. Amitryptiline works by mainly different methods and is generally advised in fibromyalgia.
Third.... and this is both purely mathematically correct AND a bit beyond current medicine is that pain especially drug withdrawal pain is a phenomena that is at multiple levels of abstraction simultaneously. There is the lowest level of abstraction--Drug levels. More drug more pain relief, less drug more withdrawal. But the withdrawal is a bit abstract from the drug level because it is not directly due to the level but the CHANGE in the level. The same level of drug, dependent upon prior drug exposure, can be either too much or cause withdrawal. If someone were on 100 mg a day versus being on zero mg a day, 50 mg a day reacts totally oppositely. Then, and this is important here, there is the change in the change of the level. The drug going up and down produces withdrawal. The WITHDRAWAL GOING UP AND DOWN produces resilience. If you get withdrawal every day or every few days, you get used to withdrawal.
Hope this helps, give reviews, but no replies if it did. BUT obviously, we look forward to further questions!
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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