Morphine advice needed

[Jumpey]

Hi, Tramadol has recently stopped working for me. ,So I asked my GP to prescribe Temgesic. She considered it, to be fair, and did some research. However, she felt that be cause it was so potent I should try a less powerful opioid first. So she has prescribed liquid Morphine so that I can play around with the dose. Has anyone used Morphine successfully?And if so at what dose please?

[Elffindoe]

Hi. I have no experience of taking opioids for RLS

However, as far as I can tell you, simply, morphine is not recommended for RLS.

The best use of morphine is for acute short term pain. It may not be as high a potency as buprenorphine, I'm not sure about that. However, I wouldn't say it is low potency either.

Buprenorphine (e.g. as temgesic) has only recently started to be used for RLS so not all recommedations include it as a treatment option.

The usual opioids recommended for RLS are oxycodone or methdaone. In the UK oxycodone is licensed for RLS.

The point about these is that they are HIGH potency and that's why they're recommended for RLS. It also means that only a low dose is needed.

I can see wher you'r GP is coming from with the idea that morphine may be less risky than burpenorphine, but don't quite agree with that. The fact that a HIGH potency opioid is licensed for RLS and HIGH potency opioids are recommended for RLS is a better argument.

see these links

bnf.nice.org.uk/drug/oxycod...

mayoclinicproceedings.org/a...

Look under "refractory RLS".

Perhaps you can take thesew back to your GP for fiurther discussion.

This link might also be useful

academic.oup.com/sleep/arti...

[Jumpey in reply to Elffindoe]

I felt it was an inappropriate prescription but she felt I needed to try it.Thanks so much for the links I will discuss them with her.

[Joolsg]

I disagree with her reasoning. Buprenorphine is a powerful opioid but works at incredibly LOW doses. Also it works in a slightly different way to other opioids ( apparently more on the Mu receptors). Also, it's now preferred by the top US experts rather than methadone. I'm on 0.3 mg which is a lower equivalent dose to the 25mg Oxycontin I was taking that didn't work.However, tramadol causes augmentation so it's good that you're replacing it. I know of several people on Oramorph and it works for them. Just ensure you take an equivalent dose.

Hopefully it will work better than the tramadol. Your GP sounds like she's prepared to research and listen so you can always go back if the Oramorph doesn't help and you can take info from the US opioid study.

[Jumpey in reply to Joolsg]

Thanks for replying Jools.Yes she is willing to listen.And I will go back if it doesn't work.Do you have any idea what dose they take?x

[Joolsg in reply to Jumpey]

I'm afraid I can't remember. There's an opioid equivalence table somewhere so it converts the doses of the most common opioids. For example 30mg of Oxycontin is equivalent to 0.4mg Buprenorphine. Also, the opioid study by Dr. Winkelman lists the average dose of each opioid taken by RLS patients in the study. I attach it below.

massgeneral.org/rls-registry

The average dose of oramorph is 30mg a day. There will be some on higher doses, and some on lower.

[Jumpey in reply to Joolsg]

Thanks Jools.x

[daisyw in reply to Joolsg]

Hi Jools, I'm prescribed 1.5 ml of oramorph, but I notice all the replies are based on mg which I find confusing. Can you explain please

[Joolsg in reply to daisyw]

I've just looked up the liquid equivalence and 30mg is equivalent to 1.5ml so you are taking the average dose as specified in the Massachussetts Opioid study.

[Jumpey in reply to Joolsg]

Where did you look this up Jools? I just looked it up and 30mg = 0.03ml

[Joolsg in reply to Jumpey]

The Massachussetts hospital. I am unable to copy the link but have taken a screenshot of the page.

Text

[Jumpey in reply to Joolsg]

Cheers Jools.I appreciate this very much.x

[BBMBRB in reply to Joolsg]

In uk there are 2 strengths of Oramorph 10mg/5ml and 20mg/mL.

[Joolsg in reply to BBMBRB]

That's interesting. US and UK have different equivalence charts.30mg of oramorph tablets would equate to 15ml of solution in the UK. I wonder if daisyw is on a different morphine solution or her RLS is controlled by an incredibly small dose of oramorph.

[BBMBRB in reply to Joolsg]

Depending on which solution is used - 10mg/5ml or 100mg/5ml

[daisyw in reply to BBMBRB]

10mg/5ml

[Jumpey in reply to Joolsg]

I think there are 2 strengths of oramorph. I have been prescribed 10mg/ 5ml strength. The other is 20mg/10ml.

[daisyw in reply to Joolsg]

It's not actually for my RLS it's for something else but I do think that it helps the RLS a bit. I was surprised at the difference in the the calculations I had found in the UK ie 30mg=0.03ml as to the ones you had found. The Oramorph solution I take is 10mg/5ml

[Joolsg in reply to daisyw]

And you take just 1.5ml not 15ml?.

[daisyw in reply to Joolsg]

Yes 1.5ml orally via a plastic syringe

[Joolsg in reply to Jumpey]

The website ismass.gov

My Samsung phone can only download but not copy the link.

[daisyw in reply to Joolsg]

Thanks a lot. When I looked up the info I also got 30mg=0.03ml

[daisyw in reply to Joolsg]

Thankyou

[RestLessLeg in reply to Joolsg]

Hi Joolsg,When you say tramadol causes augmentation do you mean worsening symptoms similar to the effects of the DA’s?...

[Joolsg in reply to RestLessLeg]

Yes. Tramadol is the only opioid that does cause augmentation in the same way as dopamine agonists. Dr. B and other experts in the USA mention it in their books & on webinars.

[RestLessLeg in reply to Joolsg]

Is there any chance there might be a link/links to the evidence supporting this? If I mention this to my doctor he’ll probably dismiss it unless I have written evidence to back it up.

[Joolsg in reply to RestLessLeg]

I'll look up in my file of research papers and send over asap.

[Joolsg in reply to RestLessLeg]

pubmed.ncbi.nlm.nih.gov/172... are other reports. I'll send when I find them.

[Joolsg in reply to RestLessLeg]

dovepress.com/intractable-r...

[RestLessLeg in reply to Joolsg]

Much appreciated Jools... ☺️

[Joolsg in reply to RestLessLeg]

It's also mentioned in Dr Buchfuhrer's textbook 'Clinical Management of RLS' but unless you buy a copy, that's more difficult to show your doctor. I'll take a photo of the relevant page.

Text

[RestlessNights11]

Yes Tamgesic is THE only thing w one Sifrol!! I forgot to pick mine Tamgesic up yesterday and what a nightmare last night was…I had 3 hot showers. Hope this helps you.

[Birdland]

I was prescribed morphine sulfate by Dr Buchfuhrer while I was coming off of ropinirole. I have a difficult time tolerating opioids so he kept trying different ones. Methadone was the first he prescribed. Oxycodone was second the third was morphine. They all helped my RLS symptoms generally about the same. The reason why he kept prescribing different ones was because of the awful side effects I was experiencing. He thought maybe I could tolerate one kind better than another. In the end I wasn’t able to tolerate any of them.

[Jumpey in reply to Birdland]

I'm sorry you had such difficulties .Do you remember the dose of morphine he suggested?

[Birdland in reply to Jumpey]

Yes, I still have the bottle. They are 15 mg morphine sulfate tablets. Up to 2 tabs nightly.

[Jumpey]

Cheers.x

[RLSofManyYears]

Last year I asked my GP for Temgesic and I was prescribed 1 - 2 tablets per day (200ugm per tablet). I took 200ugm for 3 months and I slept right through the night with no RLS. However it gradually wore off and now I'm on the 2 tablets per night. I also take 300mg Pregabalin. I'm generally up a couple of times during the night but life is a lot better than it was under the dopamine agonists. Apparently this dosage is actually a lot less than is given for pain relief in hospitals. I hope your GP agrees to put you on Temgesic. I'm on a monthly repeat prescription and not every pharmacy stocks it - Boots for example doesn't.

[Jumpey in reply to RLSofManyYears]

Thank you.Sadly tolerance builds over time with all opioids. I have found that changing opiod medications and drug holidays help with this.x

[BBMBRB in reply to RLSofManyYears]

Boots should be able to get it in for you if you give them a prescription

[RLSofManyYears in reply to BBMBRB]

No, I've asked and it is not one of the meds that they deal with.

[Sleepylamb]

Would you please keep us updated if you decide to try the morphine. I wasn't able to use opioids or Buprenorphine due to side effects. I hope it helps you.

[Jumpey in reply to Sleepylamb]

I will.x

[senders]

You should see if you can get methadone. I found it works the best

[Jumpey in reply to senders]

Thank you.How much do you take?

[senders in reply to Jumpey]

I take 10 mg. I started with oxycodine that didn’t work, then went to morphine it worked for a bit but had to keep increasing the dose. I read that methadone works on a different dopamine receptor. It has some side effects but it works the best for my symptoms.

[Hidden in reply to Jumpey]

Hi Jumpy i dont know of anyone being prescribed methadone in the UK. 🙁