Psycho-Babble Medication Thread 240948

Shown: posts 1 to 25 of 29. This is the beginning of the thread.

 

Need Names of Drugs Like Fentanyl

Posted by juanantoniod on July 11, 2003, at 15:12:20

Hello all,

I hope you don't mind this sort of off-topic request. Since you all seem to know a lot about medications, and this is the only place I know to go, I thought you might be able to help me.

My pain doc has prescribed Fentanyl "lollipops" for my back pain. The insurance company has denied this, saying it's not on their "Recommended Drug List" and that it's not approved by FDA for this use.

Does anyone know what drugs would be similar to Fentanyl that I could check for on the Recommended Drug List? I know about Demerol, Dilaudid, Morphine, Percocet and Oxycontin and I've tried all those, with no relief of the pain.

Any help would be greatly appreciated.

Thanks!

Antonio

 

Re: Need Names of Drugs Like Fentanyl

Posted by stjames on July 11, 2003, at 15:43:54

In reply to Need Names of Drugs Like Fentanyl, posted by juanantoniod on July 11, 2003, at 15:12:20

Fentanyl patch.

 

Re: Need Names of Drugs Like Fentanyl

Posted by juanantoniod on July 11, 2003, at 16:19:17

In reply to Re: Need Names of Drugs Like Fentanyl, posted by stjames on July 11, 2003, at 15:43:54

Sorry, I should have said I tried this too.

Thanks, though.

> Fentanyl patch.

 

Re: Need Names of Drugs Like Fentanyl

Posted by McPac on July 11, 2003, at 22:57:58

In reply to Need Names of Drugs Like Fentanyl, posted by juanantoniod on July 11, 2003, at 15:12:20

Torodol?

 

Re: Need Names of Drugs Like Fentanyl juanantoniod

Posted by Larry Hoover on July 12, 2003, at 6:57:17

In reply to Need Names of Drugs Like Fentanyl, posted by juanantoniod on July 11, 2003, at 15:12:20


> Does anyone know what drugs would be similar to Fentanyl that I could check for on the Recommended Drug List? I know about Demerol, Dilaudid, Morphine, Percocet and Oxycontin and I've tried all those, with no relief of the pain.
>
> Any help would be greatly appreciated.
>
> Thanks!
>
> Antonio

This isn't what you're asking for, but, I'll throw it in anyway.....

Make sure you supplement with DLPA (short for d-,l-phenylalanine) while using pain meds. It can reverse tolerance and enhance the antinociceptive (anti-pain) effect.

Lar

 

Re: Need Names of Drugs Like Fentanyl

Posted by den2 on July 12, 2003, at 7:23:47

In reply to Re: Need Names of Drugs Like Fentanyl juanantoniod, posted by Larry Hoover on July 12, 2003, at 6:57:17

mptp, methyl-phenyl, do that sheet up

 

Here is a list

Posted by jlo820 on July 12, 2003, at 9:46:25

In reply to Need Names of Drugs Like Fentanyl, posted by juanantoniod on July 11, 2003, at 15:12:20

Go to: http://www.globalrph.com/pain.htm

 

Re: Need Names of Drugs Like Fentanyl Larry Hoover

Posted by Juanantoniod on July 12, 2003, at 22:32:12

In reply to Re: Need Names of Drugs Like Fentanyl juanantoniod, posted by Larry Hoover on July 12, 2003, at 6:57:17

Thanks, Lar! That is very helpful since I have a high tolerance to these medications. I will definitely try it.

>
> > Does anyone know what drugs would be similar to Fentanyl that I could check for on the Recommended Drug List? I know about Demerol, Dilaudid, Morphine, Percocet and Oxycontin and I've tried all those, with no relief of the pain.
> >
> > Any help would be greatly appreciated.
> >
> > Thanks!
> >
> > Antonio
>
> This isn't what you're asking for, but, I'll throw it in anyway.....
>
> Make sure you supplement with DLPA (short for d-,l-phenylalanine) while using pain meds. It can reverse tolerance and enhance the antinociceptive (anti-pain) effect.
>
> Lar
>

 

Re: Need Names of Drugs Like Fentanyl

Posted by avid abulia on July 12, 2003, at 23:25:45

In reply to Re: Need Names of Drugs Like Fentanyl Larry Hoover, posted by Juanantoniod on July 12, 2003, at 22:32:12

Wow, it sounds like you've tried some pretty gnarly stuff there with no luck... what kind of back pain is it, might i ask? Because, opiods aren't very effective for nerve pain.

Also, i saw someone mention Toradol. Have you tried using an opioid with a high-potency NSAID like Toradol? Also, adding a neuroleptic to an opioid can work sometimes, i've not only worked in an emergency department and seen some people get morphine with no relief, and then get demerol added to that and still no relief, and then get Toradol, and still no relief until they got Inapsine or Haldol... but i also have my own experience with some pretty darned bad headaches, to tell me that morphine dunt always do it, i need Toradol and Phenergan (a weak neuroleptic but strong antihistamine)... of course, it totally incapacitates me, i sleep for 14-16 hours after that, but i don't know how much the incapacitation is due to *just* drugs or if i sleep so long because of the migraine as well.

~AA

 

Re: Need Names of Drugs Like Fentanyl avid abulia

Posted by Juanantoniod on July 13, 2003, at 0:02:17

In reply to Re: Need Names of Drugs Like Fentanyl, posted by avid abulia on July 12, 2003, at 23:25:45

The pain is muscle pain from muscles in my upper back (thoracic) cramping. I was previously on a cocktail of Gabitril (I think that's a neuroleptic), Skelaxin, and either Fentanyl, Demerol, Dilaudid or Vicodin. These helped the chronic pain, so I stopped taking them but I still have episodes of acute pain. So, I need something strong enough to deal with these.

My insurance company denied the Fentanyl Transmucosal (lollipops) when we submitted a Prior Authorization for them. So, I need to choose a drug from their "Recommended Drug List" (formulary). Unfortunately, the Demerol, Dilaudid and Fentanyl Transdermal (patch) do not help with the acute pain, even at high doses. (I once took 300mg of Demerol and got absolutely NO relief.)

As for Toradol, I think it does absolutely nothing to help. I recently had an injection at my pain management docs and it did nothing. I also have a history of severe muscle tension headaches where I have had to go to the ER or urgent care, and the Toradol they tried before giving me Demerol did nothing as well. However, the injectable Demerol took the edge off the headache but did not eliminate it completely.

I think I am opiate tolerant since even high doses of these meds does not take away the pain, or knock me out.

I'm anxious to try the DLPA that another poster, Larry Hoover, recommended to reverse tolerance and enhance the anti-pain effect.

Any other advice would be greatly appreciated. I'm considering trying to get Buprenorphine, an injectible pain medication. Since I already take injections for my diabetes and low testosterone, it would not be a big deal for me to have to inject a pain medication once in a while, if it works.

Thanks for any input you have.

Antonio

> Wow, it sounds like you've tried some pretty gnarly stuff there with no luck... what kind of back pain is it, might i ask? Because, opiods aren't very effective for nerve pain.
>
> Also, i saw someone mention Toradol. Have you tried using an opioid with a high-potency NSAID like Toradol? Also, adding a neuroleptic to an opioid can work sometimes, i've not only worked in an emergency department and seen some people get morphine with no relief, and then get demerol added to that and still no relief, and then get Toradol, and still no relief until they got Inapsine or Haldol... but i also have my own experience with some pretty darned bad headaches, to tell me that morphine dunt always do it, i need Toradol and Phenergan (a weak neuroleptic but strong antihistamine)... of course, it totally incapacitates me, i sleep for 14-16 hours after that, but i don't know how much the incapacitation is due to *just* drugs or if i sleep so long because of the migraine as well.
>
> ~AA

 

Re: Need Names of Drugs Like Fentanyl Larry Hoover

Posted by juanantoniod on July 13, 2003, at 0:59:40

In reply to Re: Need Names of Drugs Like Fentanyl juanantoniod, posted by Larry Hoover on July 12, 2003, at 6:57:17

How much should I take and how often? For example do I need to take it regularly to build up a supply in my system, or do I just take it with the pain meds?

Thanks again for your advice!

> This isn't what you're asking for, but, I'll throw it in anyway.....
>
> Make sure you supplement with DLPA (short for d-,l-phenylalanine) while using pain meds. It can reverse tolerance and enhance the antinociceptive (anti-pain) effect.
>
> Lar
>

 

Re: Need Names of Drugs Like Fentanyl juanantoniod

Posted by Larry Hoover on July 13, 2003, at 6:39:12

In reply to Re: Need Names of Drugs Like Fentanyl Larry Hoover, posted by juanantoniod on July 13, 2003, at 0:59:40

> How much should I take and how often? For example do I need to take it regularly to build up a supply in my system, or do I just take it with the pain meds?
>
> Thanks again for your advice!

I've never found clear recommendations about dosing, other than suggestions that 500 mg/day DLPA were helpful. You could safely double or triple that dose. One source suggests taking it alternate weeks (probably to prevent changes in regulatory activity at the receptor level). It makes sense to split the dose up, to try and maintain a consistent blood concentration, but you are best to take it on an empty stomach, for maximum uptake.

Lar

Med Hypotheses. 2000 Oct;55(4):283-8.

DL-phenylalanine markedly potentiates opiate analgesia - an example of
nutrient/pharmaceutical up-regulation of the endogenous analgesia system.

Russell AL, McCarty MF.

Brampton Pain Clinic, Bramalea, Ontario, Canada.

In the author's clinical experience, concurrent treatment with
DL-phenylalanine (DLPA) often appears to potentiate pain relief and also
ease depression in patients receiving opiates for chronic non-malignant
pain. An analysis of this phenomenon suggests that it may be mediated, at
least in part, by up-regulation of the 'endogenous analgesia system' (EAS),
a neural pathway that projects caudally from medullary nuclei to the dorsal
horn of the spinal column; when stimulated by chronic pain or therapeutic
measures such as opiates or acupuncture, the EAS suppresses activation of
second-order pain-receptive neurons in the dorsal horn, and thereby
alleviates pain. Since serotonin and enkephalins are key neurotransmitters
in the EAS, it is reasonable to predict that measures which promote
serotonin activity (such as 5-hydroxytryptophan and serotonin-reuptake
inhibitors) as well as enkephalin activity (such as D-phenylalanine, an
enkephalinase inhibitor) should potentiate EAS-mediated analgesia - a view
consistent with much previous medical research. Comprehensive support of the
EAS with well-tolerated nutrients and pharmaceuticals may amplify the
analgesic efficacy of chronic opiate therapy, while enabling dosage
reductions that minimize opiate side-effects. Analogously, this approach may
complement the efficacy of acupuncture and other analgesic measures that
activate the EAS.

 

Re: Need Names of Drugs Like Fentanyl Larry Hoover

Posted by Juanantoniod on July 13, 2003, at 7:15:55

In reply to Re: Need Names of Drugs Like Fentanyl juanantoniod, posted by Larry Hoover on July 13, 2003, at 6:39:12

Thanks, Lar!

I'll try 500mg daily and see how it works. I read that people can take up to 1500mg daily (as you said) so I will keep that in mind as well.

Thanks again, this gives me new hope that the pain meds might work again.

Take care,

Antonio

> > How much should I take and how often? For example do I need to take it regularly to build up a supply in my system, or do I just take it with the pain meds?
> >
> > Thanks again for your advice!
>
> I've never found clear recommendations about dosing, other than suggestions that 500 mg/day DLPA were helpful. You could safely double or triple that dose. One source suggests taking it alternate weeks (probably to prevent changes in regulatory activity at the receptor level). It makes sense to split the dose up, to try and maintain a consistent blood concentration, but you are best to take it on an empty stomach, for maximum uptake.
>
> Lar
>
> Med Hypotheses. 2000 Oct;55(4):283-8.
>
> DL-phenylalanine markedly potentiates opiate analgesia - an example of
> nutrient/pharmaceutical up-regulation of the endogenous analgesia system.
>
> Russell AL, McCarty MF.
>
> Brampton Pain Clinic, Bramalea, Ontario, Canada.
>
> In the author's clinical experience, concurrent treatment with
> DL-phenylalanine (DLPA) often appears to potentiate pain relief and also
> ease depression in patients receiving opiates for chronic non-malignant
> pain. An analysis of this phenomenon suggests that it may be mediated, at
> least in part, by up-regulation of the 'endogenous analgesia system' (EAS),
> a neural pathway that projects caudally from medullary nuclei to the dorsal
> horn of the spinal column; when stimulated by chronic pain or therapeutic
> measures such as opiates or acupuncture, the EAS suppresses activation of
> second-order pain-receptive neurons in the dorsal horn, and thereby
> alleviates pain. Since serotonin and enkephalins are key neurotransmitters
> in the EAS, it is reasonable to predict that measures which promote
> serotonin activity (such as 5-hydroxytryptophan and serotonin-reuptake
> inhibitors) as well as enkephalin activity (such as D-phenylalanine, an
> enkephalinase inhibitor) should potentiate EAS-mediated analgesia - a view
> consistent with much previous medical research. Comprehensive support of the
> EAS with well-tolerated nutrients and pharmaceuticals may amplify the
> analgesic efficacy of chronic opiate therapy, while enabling dosage
> reductions that minimize opiate side-effects. Analogously, this approach may
> complement the efficacy of acupuncture and other analgesic measures that
> activate the EAS.
>
>

 

Re: let us know if DLPA helps, 'kay? (nm) Juanantoniod

Posted by Larry Hoover on July 13, 2003, at 7:55:40

In reply to Re: Need Names of Drugs Like Fentanyl Larry Hoover, posted by Juanantoniod on July 13, 2003, at 7:15:55

 

I Will Larry Hoover

Posted by Juanantoniod on July 13, 2003, at 8:36:34

In reply to Re: let us know if DLPA helps, 'kay? (nm) Juanantoniod, posted by Larry Hoover on July 13, 2003, at 7:55:40

As soon as I get the supplement and some new pain meds, I will post with the results.

Thanks again!

 

Re: Need Names of Drugs Like Fentanyl juanantoniod

Posted by judy1 on July 13, 2003, at 15:59:23

In reply to Need Names of Drugs Like Fentanyl, posted by juanantoniod on July 11, 2003, at 15:12:20

I've used the 'lollipops' with EXCELLENT results- but like you my insurance didn't pay and I forget the cost- $200? I think. For acute pain I have crushed up ms contin- but that's a dangerous game (although it sounds like you have a high tolerance). The other option is a morphine pump- have you tried this?- where you actually control the amount of medication in your bloodstream. best of luck- judy

 

gabatril not a neuroleptic Juanantoniod

Posted by avid abulia on July 13, 2003, at 17:19:49

In reply to Re: Need Names of Drugs Like Fentanyl avid abulia, posted by Juanantoniod on July 13, 2003, at 0:02:17

Gabatril is not a neuroleptic, it is actually an anticonvulsant. I would highly recommend a neuroleptic (Phenergan would probably be the best choice, because it has very little propensity to cause dystonia, and it is one of the most studied for pain management).

It does sound like you are indeed *highly* opiod tolerant, unless you weigh in excess of 300lbs, if 300mg of Demerol didn't put you in an ICU on a ventilator.

Norflex might also be another option for PRN use, it has a different mechanism of action then Skelaxin (unless i am confusing generic names here, it has been known to happen but not often) and is particularly good for pain because besides being a muscle relaxant it shares common properties with the dissociative anaesthetics (i.e. ketamine)... also, i have a friend with fibromyalgia who says she has good luck with the transdermal gel version of ketamine, have you tried that?

 

Re: Need Names of Drugs Like Fentanyl

Posted by Ame Sans Vie on July 13, 2003, at 17:30:59

In reply to gabatril not a neuroleptic Juanantoniod, posted by avid abulia on July 13, 2003, at 17:19:49

Soma (carisoprodol) can be wonderful for acute muscular pain and cramping. Flexeril also helps some people. I'm sure you also need some type of opioid, but one of these could be a great adjunct.

 

morphine pump sepsis, and DLPA

Posted by avid abulia on July 13, 2003, at 17:44:23

In reply to Re: Need Names of Drugs Like Fentanyl juanantoniod, posted by judy1 on July 13, 2003, at 15:59:23

Morphine pumps are a dangerous game, because they are highly prone to post-surgical sepsis (that is, wound infection--morphine is an immunosupressant, and also pro-inflammatory and pro-angiogenesis)... and of course there is the issue of building up higher and higher levels of tolerance with a continuous self-regulated level of morphine in your blood supply, you can only go so far before your body just can't take any more, your opioid system blows out altogether, and you keel over dead.

i used DLPA with good results, i had bought it in bulk powder form, and the recommended dose was 1tsp per day which was roughly equal to 2.7 grams. I ran out, though, and am a full-time student so i don't have sufficient funds to buy more at this time. D-phenylalanine has a very long half-life, because unless you are a bacterium your body is not set up to deal effectively with D isomers of amino acids (in fact, some D isomers, such as D-arginine and D-asartic acid are *highly* toxic because the body incorporates them into proteins but the proteins no longer work after that, and the body is very slow about dealing with them)... so once-daily dosing is okay for DLPA.

Marinol (the pharmaceutical analogue of delta-9-tetrahydrocannibinol) enhances the effects of opioids in pain relief, at levels below that needed for producing marked psychological effects.

Antihistamines are sometimes helpful, both because of peripheral anti-inflammatory effects and central anticholinergic effects.

There are new nicotinic acetylcholine agonists in the pipeline that are even more powerful pain relievers than narcotics, without the deleterious cardiovascular effects of non-selective agonists like nicotine. However, if you don't smoke or chew tobacco, a nicotine patch might help, as well.

Electrolyte balance has an effect on opioid tolerance as well (by effecting membrane resting-potential) and class-I antiarhythmic drugs such as Mexitil can help with opiod tolerance because of that (of course, there is the issue that they raise the risk for fatal heart attack, but everything has a price)... and Mexitil in particular has studies backing its use in mood disorders, as well.

Well, this has about exhausted my knowledge of analgesia here.

Best of luck.

~AA

 

Re: Need Names of Drugs Like Fentanyl judy1

Posted by Juanantoniod on July 13, 2003, at 20:07:24

In reply to Re: Need Names of Drugs Like Fentanyl juanantoniod, posted by judy1 on July 13, 2003, at 15:59:23

Thanks, Judy for the advice.

The lollipops are about $10 each. My doc prescribed 96 so that would have been almost $1000. However, if *I* was paying (not insurance), I might just ask the pain doc to prescribe less quantity. :) Based on your satisfaction with them, I think it's worth a try.

I've tried crushing Oxycontin, and MS Contin with little relief. The morphine pump might be a good idea and since I already have an insulin pump, it would not be a stretch for me to learn how to use it. Although I'm not sure how I would feel wearing 2 pumps!


> I've used the 'lollipops' with EXCELLENT results- but like you my insurance didn't pay and I forget the cost- $200? I think. For acute pain I have crushed up ms contin- but that's a dangerous game (although it sounds like you have a high tolerance). The other option is a morphine pump- have you tried this?- where you actually control the amount of medication in your bloodstream. best of luck- judy

 

Re: gabatril not a neuroleptic avid abulia

Posted by Juanantoniod on July 13, 2003, at 20:13:02

In reply to gabatril not a neuroleptic Juanantoniod, posted by avid abulia on July 13, 2003, at 17:19:49

Thanks for the correction on that one. I will ask my pain doc about Phenergan, Norflex and Ketamine transdermal.

Yes, unfortunately, I am VERY tolerant. I weigh about 180 (5'7") and the 300mg Demerol did not even PHASE me!

> Gabatril is not a neuroleptic, it is actually an anticonvulsant. I would highly recommend a neuroleptic (Phenergan would probably be the best choice, because it has very little propensity to cause dystonia, and it is one of the most studied for pain management).
>
> It does sound like you are indeed *highly* opiod tolerant, unless you weigh in excess of 300lbs, if 300mg of Demerol didn't put you in an ICU on a ventilator.
>
> Norflex might also be another option for PRN use, it has a different mechanism of action then Skelaxin (unless i am confusing generic names here, it has been known to happen but not often) and is particularly good for pain because besides being a muscle relaxant it shares common properties with the dissociative anaesthetics (i.e. ketamine)... also, i have a friend with fibromyalgia who says she has good luck with the transdermal gel version of ketamine, have you tried that?

 

Re: Need Names of Drugs Like Fentanyl Ame Sans Vie

Posted by Juanantoniod on July 13, 2003, at 20:15:42

In reply to Re: Need Names of Drugs Like Fentanyl, posted by Ame Sans Vie on July 13, 2003, at 17:30:59

Is it possible to be muscle relaxant tolerant as well? I used to respond to Soma, but it stopped working. Flexeril is something that I haven't been on much so maybe that would still work.

Thanks for the input!

> Soma (carisoprodol) can be wonderful for acute muscular pain and cramping. Flexeril also helps some people. I'm sure you also need some type of opioid, but one of these could be a great adjunct.

 

Re: morphine pump sepsis, and DLPA avid abulia

Posted by Juanantoniod on July 13, 2003, at 22:17:48

In reply to morphine pump sepsis, and DLPA, posted by avid abulia on July 13, 2003, at 17:44:23

AA,

About how long do you think before I can expect any noticeable change from taking the DLPA? I got the DLPA today in 750mg capsules and I took one already. BTW, I have Marinol, but I find that, as it increases the senses, it also increases my sense of pain. It also seems to counter-act any pain relieving effect of medication. These are probably just peculiar to me, of course.

Thanks again for your help!

> Morphine pumps are a dangerous game, because they are highly prone to post-surgical sepsis (that is, wound infection--morphine is an immunosupressant, and also pro-inflammatory and pro-angiogenesis)... and of course there is the issue of building up higher and higher levels of tolerance with a continuous self-regulated level of morphine in your blood supply, you can only go so far before your body just can't take any more, your opioid system blows out altogether, and you keel over dead.
>
> i used DLPA with good results, i had bought it in bulk powder form, and the recommended dose was 1tsp per day which was roughly equal to 2.7 grams. I ran out, though, and am a full-time student so i don't have sufficient funds to buy more at this time. D-phenylalanine has a very long half-life, because unless you are a bacterium your body is not set up to deal effectively with D isomers of amino acids (in fact, some D isomers, such as D-arginine and D-asartic acid are *highly* toxic because the body incorporates them into proteins but the proteins no longer work after that, and the body is very slow about dealing with them)... so once-daily dosing is okay for DLPA.
>
> Marinol (the pharmaceutical analogue of delta-9-tetrahydrocannibinol) enhances the effects of opioids in pain relief, at levels below that needed for producing marked psychological effects.
>
> Antihistamines are sometimes helpful, both because of peripheral anti-inflammatory effects and central anticholinergic effects.
>
> There are new nicotinic acetylcholine agonists in the pipeline that are even more powerful pain relievers than narcotics, without the deleterious cardiovascular effects of non-selective agonists like nicotine. However, if you don't smoke or chew tobacco, a nicotine patch might help, as well.
>
> Electrolyte balance has an effect on opioid tolerance as well (by effecting membrane resting-potential) and class-I antiarhythmic drugs such as Mexitil can help with opiod tolerance because of that (of course, there is the issue that they raise the risk for fatal heart attack, but everything has a price)... and Mexitil in particular has studies backing its use in mood disorders, as well.
>
> Well, this has about exhausted my knowledge of analgesia here.
>
> Best of luck.
>
> ~AA

 

Re: Need Names of Drugs Like Fentanyl Juanantoniod

Posted by Ame Sans Vie on July 14, 2003, at 1:18:43

In reply to Re: Need Names of Drugs Like Fentanyl Ame Sans Vie, posted by Juanantoniod on July 13, 2003, at 20:15:42

Unfortunately, tolerance does develop to Soma very rapidly. It probably should be strictly used on an as needed basis (i.e. less than 3 times per week). It exerts its muscle relaxant effect through general CNS sedation, and is metabolized to the old-school tranquilizer meprobamate.

 

Re: Need Names of Drugs Like Fentanyl Juanantoniod

Posted by judy1 on July 14, 2003, at 16:03:23

In reply to Re: Need Names of Drugs Like Fentanyl judy1, posted by Juanantoniod on July 13, 2003, at 20:07:24

Hi,
Yes the pops were $10 each, because my doc gave me a script for 20. My pharmacist would give me part of a script if I asked (and save the rest on his records), I wouldn't be too happy about shelling out $1000 either. One good thing about the pops is sometimes I wouldn't finish one and just wrap it back up (which is nice if you need more than one later). I would give it a shot and see if it works before trying the pump- although I've met people on the pump who were very satisfied. best of luck, judy


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