Generic Morphine Sulfate ER

Generic Morphine Sulfate ER

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Old Whitebeard
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Generic Morphine Sulfate ER

Hi, everyone. I am an Internet engineer, not a pharmacologist. I would like to ask about your experience with generic oral morphine products.

I recently made the mistake of accepting Mallinckrodt Morphine Sulfate ER 30 mg as a generic substitute for MS Contin 30mg. These tablets made me sick. I still had some brand name MS Contin 30 mg (manufactured by Purdue Pharma, and yes, it is expensive) and I went back to the brand name drug, then tried the Mallinckrodt pill, and got even sicker.
Malaise, belching all day, nausea (but not the point of vomiting), stomach and intestines gurgling all day. The next day I took the brand name MS Contin 30 mg, and I felt much better. Better pain relief, no nausea. A little woozy at peak, but I can tolerate woozy; I cannot tolerate nausea all day.

I have found complaints about Mallinckrodt MS ER pills on other web sites. What does Mallinckrodt put in these pills that causes nausea? I called Mallinckrodt and asked that question to one of their pharmacists; there was a long pause before he said he did not know. He is going to send me a list of "inactive ingredients".

Last year I was using Morphine Sulfate CR by Watson Labs. It was as good as brand name MS Contin. I called Watson Pharmaceutical to find out where I could buy it this year. Watson rep told me they had stopped manufacturing morphine.

Several years ago CVS filled these prescriptions with MSER from Ethex. However, last year Ethex pleaded guilty to two felonies for not reporting manufacturing problems to the FDA. According to what I read, the parent company KV Pharmaceuticals closed Ethex.

Apparently Mallinckrodt is selling their inferior product into the void left by the withdrawal of Ethex and Watson from the market.

I am trying an off-green Morphine Sulfate ER 30 mg Endo tablet, which is available at one local pharmacy.

I would be interested in knowing more about the experiences of other people who get scripts for MS Contin. Have you used a generic MSER tablet from another manufacturer that was satisfactory?

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Metalneck
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Hey OWB!

Im on MScontin CR that I get from Walgreens .... it is a generic from RHODES. I haven't had any of the problems that you have mentioned but do have issues with other generics made by other companies (Fentynl patches - Watson vs Sandoz Vs Mylan - Only the Sandoz brand seems to work for me, and it is often back-ordered from the factory.

So Yes .... I do beleive that some generics don't have the same effect and can cause adverse effects. I know that many of our chronic pain family members have had issues with the new formulation of Oxycontin. (gastric distress was one of the more often unwanted side effects).

Talk with your pharacist and see what other brand they maybe able to order - or maybe switch pharmacys?

Regards,

d

ouchithurts
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I have them

I also have the generic from Mallinckrodt. Everytime I take them I am soooo sick. I will only take them if I am in extreme pain. Maybe I need to ask for a different brand?

pcyoung
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Narcotics

My experience with Narcotic pain relievers has spanned the whole gambit. Being an engineer and my livelihood depends on my mental acuity; I have always been concerned about the long term effects of opiates on my cognition.
What I have found is that our brains have what is called neuroplasticity and will become tolerant of any medication fairly shortly.
Long acting opiods, while assisting with the pain, has a liability. That liability is that the side effects become more predominant and their ability to reduce pain decreases with dose.
The other effect long acting opiates have is that they actually will proliferate the opioid receptors. Thus making one more sensitive to pain and many times the pain increases.
The strategy that has worked very well with me is in taking immediate release pain medication. My evening dose is a few hours before I go to sleep.
For those times the pain does not wake me up, my neurotransmitters and receptors have a break. In some cases I wake with withdrawal symptoms.
However, the benefit of this course has been that I have been able to maintain the dose for pain for years. My tolerance does not build as quickly.
Those times when the pain is not that severe I taper down to give my brain a break.
I have witnessed other pain patients who have continued taking long acting narcotics and most , if not all, begin a precipitous decline including depression and more pain.
I refuse to succumb to the memory loss and the mental decline I have seen with others. While I have had to battle with the doctors to allow me to continue taking short acting; relatively recent articles in scientific and medical journals bears my approach.
My life would be too difficult to continue. The quality of life is so diminished that I would (and have) contemplated ways to find permanent relief.
Before beginning my narcotic regime, I was irritable and just an asshole to family and friends.
Narcotics have been a life saver to me and I believe that others should benefit from the relief I have now. So I try harder to care for others and try to be helpful.
The brain is very adaptive and can accommodate the pain medication at great cost to your personality and your intellect.
Yes its difficult once a month to reduce the medication but then it works more effectively for me and I can recenter myself.
Before I did this I was taking so many long acting that I was a zombie and so out of it...it is your body and physicians may not have experienced the long term degradation associated with long acting opiods.
Manager your life and at least limit long acting to only once or twice a week. Get some short acting ones and find the right dose. BTW - with short acting you can also better titrate your pain level.
I hate the nightmares that accompany taking too much and do not want to sink into that condition called "morphine-ism " this is a condition where your passion for life simply drips away.
Pain meds are to improve the quality of life so that you can contribute and help others. It can rule your life also.
Hope this helps. But be careful! take control of your brain health!

Old Whitebeard
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Inactive Ingredients

I want thank everyone for their comments. I especially want to thank Metalneck for recommending Rhodes Pharma version of morphine sulfate sold at Walgreens, which I intend to try.

I checked the "inactive ingredients" of MS Contin and four generic versions. The generic versions of morphine sulfate manufactured by Watson Labs and Rhodes Pharmaceutical are shown on their respective package inserts to have exactly the same "inactive ingredients" as MS Contin, the brand name drug manufactured by Purdue Pharma. The generic versions of morphine sulfate manufactured by Mallinckrodt and Endo have some different "inactive ingredients".

More specifically, the Mallinckrodt product includes Hydroxypropyl methylcellulose in place of Hydroxyethyl cellulose, Lactose monohydrate in place of lactose, silicone dioxide in place of talc, and triacetine added for unknown reasons. FD&C Blue No. 2 is substituted for FD&C Blue No. 1. As I said, I am no pharmacologist, and I don't know which of these changes made me sick, but I can say unequivocally that this product made me sick.

I have searched the web and found several similar complaints from morphine users, and I believe that Mallinckrodt is selling an inferior product.

Lovetrotravel
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My thoughts

Hi there...

The actual federal law is written so that all generics have the exact same ACTIVE ingredients...but yes...they can all have different inactive ingredients up to 20% difference..

I have to disagree with pcyoung that says that long acting medicine has a stronger effect than short acting...the half life is of importance in any medication...for something like Percocet...it's only 4-6 hours...so a 10mg will release all the medicine at once...then within 45 minutes or so be at the peak...then taper down the next hours..

A 10mg of Oxycontin...exact same ingredient of oxycodone...will release 5mg within the first 45 minutes...at it's peak...then taper down within the next 5 hours and 15 minutes...at the 6 hour mark...it releases the next 5mg....and same release until 12 hours total from start to finish...

That is why most PM's will not prescribe a short acting medicine as a primary...the brain will actually build tolerance to this much quicker than a long acting medicine...as well as how much less effective it is for a smooth and constant pain control like a long acting medicine provides.

That is why it makes no sense to a chronic pain patient to take short acting medicines...they are only meant for 'breakthrough' pain as needed...The long acting medicines last 8, 12, or 24 hours depending on the medicine.

This is why people with SA meds have such up and downs with their pain...they have to keep taking medicine every 4 hours to acheive the relief...

I am good friends with my PM who is an Anethesiologist who specializes in pain medicine. We discuss these and other very interesting things over lunch or coffee...as well as being on medicine and learning things for over 10 years..

If anyone is becoming a zombie on their medicine...it's likely you are taking too much...the dosage is too high...

Just wanted to clarify and we can agree to disagree psyoung..

*To the OP...I am prescribed the generic MSContin both 30mg to take every 12 hours and the 15mg so I can choose to add either one to a dose instead of stuck with just 30mg...so my total for the day (24 hours) is 60, 75 or 90mg a day depending on the pain levels or activity I know I will have.

I have no insurance so pay out of pocket. I get mine...ENDO pharmaceutical...at Sam's club...it's less expensive there than at Walmart actually even though it's the same company...they get a better rate...And you do NOT have to be a member to use the pharmacy at box stores...it's illegal....

I have had wonderful coverage and limited side effects...which was some nausea and fatigue when I first started but dissapated within a few weeks..

I use OxyIR 5mg for breakthrough pain as needed...As well as a muscle relaxer too when needed.

I think it's really an individual thing...keep in mind that online...with anything...you will most often only get complaints...people don't post on websites when they are happy...so just take those complaints with a grain of salt...

I used Mallinckrodt products before and had no issues...I think it's really specific to each person with the inactive ingredients and issues...

I've never heard or seen Rhodes listed as a generic on any of my meds...but if it works for you...great..

If you need to switch again...call around to Sam's or Walmart to ask for Endo brand and see if that works..

I wish you luck:)

nancrlong77
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mallinckrodt inferior patches making me sick

I am a very ill person , I am on dialysis 13 hours a night .To make a long story short, I am suffering from ischemic colitis , recently discovered dead tissue in my bowels. I am on peritineal dialysis , which is quite painful , I am on 150 mcg fentanyl every 48 hours.
When I picked up my prescription from the pharmacy it was for this horrible brand!
It makes me violently ill with a constant headache, forget about helpiing the pain.
I do not know what to do.
I dont know if my dr will write another script , but if she does , how will I fill it?I am sure my insurance wont pay for it, they just paid for that other sfuff,What horrible medicine.I can not do dialysis without pain medicine.
Any suggestions?"

Old Whitebeard
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Generic Alternatives to Brand Name Medicine

Hi, Nancrlong77

Wow, that's scary! Most of us on Spine-Health are suffering from pain, but your condition is much worse than mine. I hope someone else with more experience with patches will also respond, but let me start.

I tried a fentanyl patch once. It gave me a terrible headache, so I ripped off the patch and never tried fentanyl again. I don't know whether it was a generic, I don't know what the manufacturer was, and I think we threw away the box after keeping it around for more than a year. So I cannot be of any help with fentanyl.

I might have something to add about how to deal with insurance companies. When I had the problem with Malinckrodt morphine sulfate ER, I called the insurance company as well as the manufacturer. The insurance company representative told me that there are differences between generic pills, including the "inactive ingredients", the fillers and the coating. The insurance company said if I got a new script, they would honor it. I could choose whether to try another generic or I could try a brand name product. If I wanted a brand name product, I needed to ask my doctor to write on the script "Brand name medically necessary". I asked my doctor to do this once so that I could try the brand name MS Contin and make sure that my nausea was not caused by the morphine itself. Sure enough, the brand name medicine did not cause nausea for me.

I have been getting my prescriptions from my internist, but I am pretty sure that my pain management doctor would be as accommodating if I had gone to him.

The brand name medicine is expensive. So on my last visit to my internist, we discussed it, and we decided I should try the generic morphine tablets manufactured by Rhodes Pharmaceutical, as recommended by Metalneck. I am glad I did. I can distinguish no difference between the Rhodes product (sold by Walgreens) and the MS Contin manufactured by Purdue. They have the same "inactive ingredients" and I feel the same. That is, I wish I did not need to take morphine, but it helps my pain with tolerable side effects.

I would recommend that you send a PM (private message) to Ron Dilauro, who is an administrator on this site. He knows more about patches than I.

pcyoung
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fentanyl

Too much opiods ( fentanyl especially) will make you feel sick . If your metabolic functions are compromised i would ask your dr to try lower dose only when you hurt and a 50 mcg for chronic pain - but thatz only my opinion
but i have experienced headache and nausea - sick feeling
from fentanyl - sleep disturbences etc

pcyoung
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pill formulation has effect

pill formulation has effect on drug efficacy - Anacin vs regular aspirin with caffiene - Anacin works better - why? I believe it has to do with how rapidly the compounded pill becomes hydrated, if any of the inactive ingedients form a colloid or bind more favorably with the drug , the size, distribution of the drug particles, any effect fillers have on stomach lining etc although considered inactive these are not inert!
variations in microchemistry can alter soluability of drugs and how fast they solvate across the stomach lining into the bloodstream
so method to make drug is not the same as drug formulation.
Some contin like meds has dramatically different mechanisms to delay solution and access to stomach, intestine lining such as colliods , waxes and co soluable micelles which allow diffusion of drug - but people and their stomachs, diets are different - statistical testing shows only average values- just like side effects -
people are more different than similar in the details - we have ranges that change ( like blood pressure)
Conclude: diff pill manufacturers have diff effects diff people

Metalneck
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Hey OWB!

Im so glad that the Rhodes brand seemed to work well for you.

Its nice to know that we (although gardedly) can maybe sometimes point someone in a direction that may assist in this journey called pain management and life.

Thank you for the honorable mention. It is apreciated.

Nancrlong - As to Mallinckrodt making Fentnyl patches ... I wasn't even aware that they did. But I can tell you from my experience that I have had problems with both the Watson and Mylan brands and Only the Sandoz
seemed to work for me. Sandoz is supposedly manufactued at the same plant as the name brand Duragesic by J&J. But last I heard the Sandoz brand was on "Factory Backorder" with no known date for new shipments available.

As far as your insurance goes .... If you can get your doctor to write a new script - different strength or timing (Sig) I believe the insurance company will have to honor it as it is viewed as a new perscription ... not an early or duplicate of the previous. You can always attempt to speak to the quality assurance - untilization review department at your insurance company and attempt to explain the situation to them and obtain a pre-approval for the new/altered RX.

Praying for continued strength and assitance for us all,

d

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