Medications and Vaccination During Pregnancy

How dangerous are three pills only of Misoprostol 200mcg on a fetus in its seventh week of gestation?

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2006-07-24 03:55:23
2006-07-24 03:55:23

Three pills of 200 mcg of misoprostol if taken all at once is 600 mcg. That dosage is high enough to cause the fetus to miscarry. Even one 200 mcg dose of misoprostol taken at 7 weeks gestation is likely to cause a miscarriage. It is a dangerous drug to take if you wish to stay pregnant!

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200 mcg = 0.2 milligrams

0.2*1000= 200mcg sotherefore 0.2 is not equivalent to 125mcg

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mcg / 1,000 = mg200mcg = 200 / 1,000 = 0.2mg

There are 1000 micrograms in a milligram. Therefore 200 micrograms is 0.2 milligrams.

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Dependence and Tolerance are the most common, but that's true with many drugs that require long term maintenance doses. I've used them for 9 years now, and I've learned how to lower my dosages if I need to after I've had to increase them. My normal dose is 100 mcg, but I do occasionally need to increase it to 200mcg. Duragesic is well tolerated over time. Most of the time I forget I'm wearing them, and the effectiveness cannot be overstated. For long term chronic pain, there is no better drug.

Patches come in 5 dosages: 12.5 mcg (micrograms) 25 mcg 50 mcg 75 mcg 100 mcg Patient dosages are prescribed as a single patch dose, or if needed, a combination of doses to get the desired result. For example, my primary dose is 100mcg, but I've had to increase to 150 and 200mcg as necessary over the years. I once met a lady who had a brother that was a former cancer patient (he's since passed away) that was using 6 100mcg patches.

This refers to a Fentanyl Transdermal patch, which is commonly used for chronic pain patients like myself that need continuous long-term opiate therapy. It is regulated by body heat, and is extremely effective. There are several doses - 12.5, 25, 50, 75 and 100mcg patches, all of which can be used with one another to make specific dosages. For example, though my normal dose is 100mcg, I typically have to use 200mcg, so I'll use 2 100mcg patches.

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Not really - Neurontin ( Gabapentin) is primarily used as an augment to some opiates, though for most people with really severe chronic pain, it's just plain ineffective. It's not prescribed for withdrawal pain. The best way to avoid patch withdrawal is to add your new patch about an hour or so before the current one runs out. This gives the new one enough time to start ramping up the dose as the other one is running completely out. The other thing to do is use one of your breakthrough meds to help take the edge off if you've let your current patch run down too far. If you're looking at complete withdrawal, it's not easy, especially for long term users. After 9 years of 200mcg (2x100mcg patches) I was able to fully withdraw from them, but it took several months and 4 hard weeks of severe withdrawals (using breakthrough meds and other techniques I learned over the years) to get to the point where I could just take Percocet 10's. Aside from sedation (Flexeril was my friend) the other 2 types of meds that are really helpful when it starts getting rough are anti-anxiety and anti-nausea meds. The anti-anxiety meds is what helps take that "climbing the walls" feeling out of the withdrawals. Most doctors have no problem prescribing them for patients who are having withdrawal issues; all you need to do is ask and tell them why.

As a long term Schedule 2 opiate patient (Duragesic 200mcg, 100mg Demerol, Percocet 10/325's, MS Contin 30mg's, etc., over the past 10 years) I can tell you that over time as your body becomes dependent, you'll eventually feel pretty normal until the time your levels start getting low and you feel withdrawals. Like you, I considered a pump, but in my case it wasn't deemed a realistic option. I never liked the problems associated with it either.There aren't many studies concerning long term opiate use, in part because most high dose users tend to be terminally ill. I'm one of the anomalies, having had major spinal problems for many years. All opiates are morphine derivatives (except for synthetics), so it makes no difference which variation of the drug your taking - all of them do the same thing.The biggest problem I've had to contend with over the years is mood swings, but that's typical of most opiates. It's important that your family and friends are aware of this problem, since it can happen at any time. Prior to being disabled, I was a Karate instructor and learned much about mental control of pain, and how to increase pain tolerance. While this helps considerably, for those of us in constant pain, your mental barriers and chemical controls will not always work - remember that the pain is always there, and the morphine only alters your brain's perception. Eventually those barriers break down, and it comes out in the form of mood swings. My wife and daughter have learned over the years to just close my door and leave me alone, as they know it's the drugs and not really me. Many families fail to deal with this early on and as a result do not make it.Constipation and urination problems are another - they'll be with you as long as you're taking it in any form. My solution is chocolate pudding or ice cream. Lemonade will go through you as well.It's important to keep your kidneys and liver healthy as well to ensure your body is filtering it out of your system. Cranberry juice is great for that, or just a lot of water. Keep yourself hydrated.The longer you're dependent, the longer it will take to end your dependence if at some point you're able to down the road. The key is to drop your opiate level slowly over a period of weeks or months, using oral doses in smaller quantities to help deal with the withdrawals. At some point though, you'll need to deal with withdrawals in force, and it's not fun. Anti-anxiety and anti-nausea meds will help, as well as a sedative. I spent most of this past year lowering my levels from 200mcg fentanyl and my usual 4-6 Percocet 10/325's daily (for the past 9 years), and a total of about 4 weeks of withdrawals to get off of my patches. It takes the body about a month to recover, so if you can do it, make sure that you've got someone around who can help, and that your schedule is clear for the duration. Opiates alter the brain's perception of not only pain, but your own strength. If you're weak physically at the time, you'll be pretty weak as it leaves your system, but eventually you'll bounce back as your system recovers.In the end though, it comes down to quality of life, and I resigned myself long ago to the possibility I'd require opiates for the rest of my life. We're all on a journey toward death anyway - how we get there, and what we're able to do in that time is the important thing. If it takes opiates to do it, then so be it.

Side effects of using Fentanyl patches are pretty common. Mood swings (typical with most opiates), urination (you won't feel it until you're ready to bust), respiratory problems (if you're not tolerant to the drug - if it happens at all call your doctor immediately), euphoria for first time users (until you get used to it). 25mcg is a pretty low dose, but if you're not that tolerant, increased body heat can increase the dosage delivery to the bloodstream. In such cases it can lead to confusion - as a 200mcg patient myself, it's happened to me several times over the years. You literally feel like you're stuck in a loop you cannot get out of. If you ever feel this way, remove the patch immediately (you can put it back on - just don't let it get stuck to itself. See my answer on keeping patches applied). Opiates are Vasodilators, meaning they open the blood vessels wider. As long as your body heat is higher from exercise or moving around, the drug will continue to be delivered at a higher rate, and if you're not that tolerant it will affect you adversely. It is difficult to realize what is happening to you, harder still to do anything about it until your body heat returns to normal. You should alert family and friends about what to do if they find you in a confused state and it's apparent you're overheated. Tell them to get your patch off and get you cooled down. Fentanyl takes several hours before you'll feel any withdrawal symptoms at all, and you should be well recovered before then. If you have specific questions about side effects you can email me at my WA email listed on my Supervisor bio page. After nearly 10 years, there aren't many side effects I haven't experienced from it. Additionally, nausea can be a major problem. As a 300 mcg patient, I lost 40 lbs. in 3 months. Zofran helped, but Marinol worked best .

Having used Fentanyl (Duragesic) patches for over 10 years, I can say that of course opiate dependence is the primary effect. As I write this, I am going through my second voluntary withdrawal in the past few months, the need for it no longer exists. It is not easy at all - I've been steadily dropping my dependence levels for 6 months, and from dosages of 200mcg (2 100mcg patches) and up to 150 Percocet 10's per month. To say I've been catching up on my Supervisor work here at WA is an understatement, as the mental distraction really helps. Other than dependence and the increased tolerance level it brings, if you tolerate opiates well there aren't any real other problems I've incurred, aside from the occasional bout of constipation, but any opiate patient learns to deal with that. I will say though, that one thing that surprised me was that it was hard to realize when I fully recovered from my last spinal surgery (check my bio page for the full skinny) that the pain I was having was actually from withdrawal and not my back. This second period is longer than the first one - previously, I was only able to go 5 days before requiring another patch, the hold was just too much. This time, I've gone over a week now and believe I've made the switch back to pills, which are much easier to get off of. I've cut down my Percocet to 5mg and 2.5's so that I can do gradual reduction. Fentanyl in any form is a wonderful drug if you absolutely require it, but it should only be used in a Quality of Life decision. For myself, there was no other option until 3 years ago and until now. However, with it comes responsibility and essentially slavery to the drug and the system - as a Schedule 2 opiate, you're required to get new prescriptions every month, and only 30 days worth.

It depends entirely on the individual. Fentanyl stays in the system for a lot longer than acute meds do, so you've got several hours to either put a new patch on or swap the old one. Ideally, you want to put a new patch on a couple of hours before the old one is supposed to expire, but it's important to note that the normally prescribed 72 hour mark doesn't apply to everyone, and isn't fixed in stone, something that a lot of pain doctors have trouble understanding. Fentanyl transdermal patches regulate the dosage by body heat - this means if you're engaged in physical activity or anything else that raises your body temp, the dosage delivery is increased, and the expiration time is decreased. Also, a small percentage of the population (myself included) require a 48 hour change rather than 72. It's more typical of high-dose opiate patients like myself. The problem lies in that for many years, Janssen Pharmaceuticals' literature on Duragesic had 72 hours as the effective dosage period. However, they knew that some people didn't get that much. Though they finally changed the literature about 4 years ago to say that 48-72 hours, a lot of doctors don't keep up with those kinds of minor changes, and a lot of pain patients don't understand the proper way to communicate with their pain doctors. The real problem is that if you're getting patches based on a 72 hour dosage rate, and you're falling shorter, you'll wind up having less patches for your monthly prescription. In those cases, keeping an accurate Pain Diary is essential in showing your doctor that his prescription isn't right for your particular case and needs to be adjusted. If you're a fairly new Pain Management patient, or have an idiot for a pain doctor, it can be frustrating. Where you place the patch is important as well. I've always used my biceps in the 10 years I've been using them, since it's easy to add them and the skin doesn't flex as much as it does in other areas. Even during the times when I've had to increase to 200mcg (2x100mcg patches), I still use both arms, taking on patch off for a few hours to let the skin breathe, clean it, then put a new one on, and then do the same with the other one. As I said, if you overlap the patches (put a new one on in a new location as the other one is about to expire) you'll have no withdrawals to deal with. It takes a couple of hours for the new patch to ramp up to full delivery, so as the old one is getting weaker the new one is slowly catching up. The result helps to keep your overall maintenance dose fairly steady.

It depends on the exact problem, severity of pain, location, and if it's really chronic (24/7/365).Having just started my 11th year in formal Pain Management, and after 3 major spinal operations, I've been using Duragesic patches for primary pain and Percocet 10/325's for breakthrough. My Duragesic dose is 1 100mcg patch, every 48 hours (most people get 72 hours), Percocet is PRN, but I average about 120/150 per month depending on the time of year. I use more in the winter because cold weather and lower barometric pressure hurts me more. I also use 100mg Demerol tabs and 30mg MS Contin tabs when the need requires it, in addition to my normal meds. But that's not very often, and when it is, I'm usually looking at another surgery.For primary chronic pain, either Duragesic or OxyContin are the main drugs of choice. I used OxyContin for about a year, but it only lasts 12 hours and has a steep drop-off point (the point where it starts to wear off). Duragesic (Fentanyl Transdermal patches) by virtue of lasting so long, takes much longer to wear off. The biggest plus is that you get effective pain control for 2-3 days, not just a few hours. Breakthrough meds are usually prescribed as well, for those times when your activity causes pain to increase to the point where your primary med isn't controlling the increased pain level.In order to use Duragesic, you must be opiate tolerant - in other words, you must either be using an opiate now or have used opiates in the past without problem. Depending on any opiates you may be using now, there is a direct conversion chart that's used to determine the initial starting dose (12.5, 25, 50, 75 or 100mcg). Patch dosed can be mixed/matched to achieve whatever dose is required. I've had to increase my patch dosage in the past to 200mcg (2 100's), and I've known of cancer patients (terminal) who have used up to 600mcg's (6 100mcg patches). Keep in mind that the conversion chart is on the conservative side and is usually lower than an actual direct conversion to be safe. It also means if your doctor believes it to be a 1-1 conversion, you're going to have withdrawals out of the gate. So adjust the dose a little higher if you're already using opiates on a regular basis.Keep in mind that Duragesic and the other drugs I've mentioned here are for severe chronic back pain, not just a sciatic episode or something similar that doesn't last but a few days or weeks. These drugs are used for people like me who have major spinal/back problems and severe pain all the time, and will have that pain for the rest of their lives. It is not for muscle, joint, arthritis and similar types of pain.TSD -RAVEN- Category Supervisor

You can always ask your doctor for Suboxone, which is a withdrawal easement drug. However, since I deal with them daily as a longtime opiate patient, I use other methods when needed. Your best option is to reduce your current dependency level to one that doesn't give you withdrawals. OxyContin has a steep drop-off when it wears off - when I used to take it I literally had to take a couple of Percocet to boost my opiate level a bit and then lay down for an hour until the OxyContin got my level back up again. The easiest way to deal with the short term drop-off withdrawals is to either use an acute drug like Percocet or Vicodin, or note the effective hourly time of effectiveness you get from the OxyContin, and then take it an hour prior to when it wears off so you don't experience any withdrawal. If you're having withdrawals because your dependency level is higher than your dosages, then you need to lower your level to the point where you're comfortable again. You can do this by what I call Incremental Dosage Reduction. I've had to do it several times over the past 11 years, as I've had to significantly increase my opiate level, and then drop them back down again afterward. This is the text of a procedure I did for Ehow a while back that explains how to do it. Keep in mind that OxyContin is a chronic pain drug like Duragesic when reading this - it just doesn't last as long, nor is it as strong. When starting this, it's always best if you can begin on a long weekend or during a holiday. If you can take time off, it's even better. There will be times where it's desirable to sedate yourself. If you have no prescription drugs that will do that, Valerian Root may help. The time it takes to accomplish, and the overall difficulty of opiate Incremental Dose Reduction (IDR - my term) for each person depends on a number of different factors - the person's tolerance to the opiate, the strength of the opiate taken, how long it's been used, how big the patient is, length of dependency, dealing with withdrawals, etc. All are factors in lowering your dosage intake of any opiate or opiate analgesic. All opiates are Controlled Substances, classed under 1 of 5 DEA Schedules, with Schedule 1 being illegal drugs (Heroin, Cocaine, etc.) Schedule 2 being Morphine, Oxycodone, and others of similar strength; Schedule 3 contains Vicodin (Hydrocodone), Schedule 4 has drugs like Darvon/Darvocet, and Schedule 5 contains analgesic syrups and suspensions with small amounts of Codeine and the like. The most common prescription drugs are from Schedules 2 & 3 for moderate to severe pain - patients using these drugs normally have pain that is chronic (long lasting), and is the reason dependency is common this group. Some, like myself, will be required to use them for the rest of their lives. Schedule 4 drugs are for mild pain, and the potential for dependency, while possible, is unlikely given the small amounts of opiates present. If you are using Duragesic (Fentanyl Patches) - Duragesic dosages can be reduced fairly easily, and I will cover that separately. OTC MEDS AND THEIR USES The OTC meds I've noted as being optional can be used to help in the reduction process and the easing of withdrawal symptoms. Their specific use and advantage: Bayer Back and Body Aspirin - For easing withdrawal pain. Good when using an analgesic containing a high amount of Tylenol and not wanting to add more Tylenol to the the dose. Examples - Percocet, Darvocet. Tylenol Rapid Release Gel-Tabs - For easing withdrawal pain. Good when Tylenol component is low or drug isn't combined with it. Delsym 12 hour Cough Syrup - The active ingredient in Delsym is sometimes used by doctors to augment opiate effectiveness. Used as directed for cough, it can ease withdrawals by augmenting the lower dose. I used it for about 2 years with OxyContin prior to switching to Duragesic. Valerian Root - Natural sedative sometimes used as an herbal replacement for Valium and other sedatives. Can be used to help sedate yourself when prescription sedatives or muscle relaxers aren't available. Use sparingly and exactly as directed. Note any drug interactions. It is important that you read and understand all OTC usage instructions carefully. You are potentially using them to help lower your opiate dosage, not create another problem or make you sick. INCREMENTAL DOSAGE REDUCTION (IDR) - OPIATES IN PILL FORM It is helpful to maintain a Diary while you go through this process. Note the date, time of dose, total amount taken, any OTC meds used, and withdrawal symptoms and strength. Also note how strong the pain you're taking the drug for is. You don't want to lower the dosage to the point where you're no longer getting any pain relief. Note your average required dose, and whether it requires 1 or 2 pills to achieve. What you will be doing is cutting one of your pills (if using more than one to achieve normal dose) in half or in quarters, depending on your initial attempt. You will be reducing your dose initially by what it tolerable to you as far as withdrawals are concerned. There is no way to completely avoid withdrawals, but they can be minimized. 1. If you are only using 1 pill, cut it in half with the pill splitter or razor blade. Some pills come with scoring marks on them to make them easier to break. You can also score/break if you find cutting is crumbling the pill. Cut one of the halves in half, leaving one half and 2 quarters of the original pill. 2. When your next dosage time approaches, instead of taking a full dose, take only 3/4 of your dose - the half of the pill you split up plus one of the quarters. If you're using 2 pills, take one whole pill and one half and one quarter of the other. This lowers your dose by 1/4 overall. 3. At the same time, take 1 or 2 of the Bayer Back & Body Aspirin or the Tylenol. If you're like me and using Percocet, use the Aspirin will probably help better. Try each to see which works best. 4. Note how you feel as your withdrawals begin to take hold. If it's tolerable and you can continue with your daily routine unaffected, then continue. If not, try cutting one of quarters in half and drop your dose by 1/8 instead of a quarter, or using the Delsym to augment the lower dosage - it may help you tolerate the withdrawals easier. 5. Continue with the initial reduction for 1 week, then attempt another reduction in dose by another quarter or eighth. Again, see how well you tolerate the withdrawals. If it's too much, then go back to the previous reduction in dose and continue for another week. Repeat the process on a weekly basis until you can tolerate another dose reduction. Increase the amount by 1/8 or 1/4 when you can tolerate the lower dosages and withdrawal symptoms. Keep repeating the process of IDR over time, noting results in your diary. If withdrawals become too uncomfortable, you can sedate yourself if you have the time and that option to ease your symptoms. I've found that the ability to sedate yourself helps tremendously when withdrawals are too uncomfortable, or you're trying to lower your dosage by halves rather than quarters. Prior to my 3rd spinal operation, the pain induced from my L3 disk collapsing and the L3 vertebrae slipping forward onto the L4 vertebrae (bone-bone contact, Spondylolisthesis) was excruciating to the point where I had to double my Duragesic dose, increase my Percocet intake, and add Demerol and MS Contin. After surgery, my dosages were: Duragesic 2 x 100 mcg (200mcg) Percocet 10/325 - 8-10 per day Demerol 100mg - 1 - 3 per day, down from double that prior to surgery MS Contin - discontinued after surgery Over a 6 week IDR period several months later, which included a lot of sedation and withdrawals, I was able to return to my longtime original doses of Duragesic 100mcg and Percocet 10/325, 3-6 per day as needed. For sedation I used Flexeril as it's the only drug that will effectively sedate me anymore.


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