Hysingla & Zohydro: Same church different pew?

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pewsSame church different pew you ponder?  It’s not that simple.  Almost a year to the day since the availability of Zohydro ER (hydrocodone Extended release, manufactured by Zogenix), there is now another kid on the block; Hysingla ER (hydrocodone Extended release, manufactured by Purdue). Nobody can deny that Zogenix paved a pretty hefty path to bring and keep this on the market.

Along the way was a pretty disheartening road.  But no matter how many unearthed faults were found in the path, they were minuscule compared to the faulted rhetoric among media sensationalists and politicians. With one road block after another, it became clear that politicians were more interested in saying something (anything) for the attention than they were about the truth. In fact, their futility and sensationalistic journalism promulgated numerous blogs here.  On the one hand I suppose that was cultivating for this site and our readers, but unfortunately it was on the backs (perhaps literally) of legitimate pain sufferers that might otherwise benefit from an extended release formulation of hydrocodone.  Rehb.com provides some interesting infographics that break down nationally and by state, various permutations of how “Admissions to treatment facilities has been steady or rising for the past 20 years, yet it seems elected officials spend less and less of their time on the floor of the House and Senate talking about it.”steam roller

The indisputable facts are that since Zohydro ER release in March 2014, there have been over 50,000 prescriptions filled (almost 3 million capsules dispensed) yet an extremely low incidence of abuse, misuse, and diversion reported in the surveillance databases.  Do note however that because schedule II drugs are not allowed automatic refills, each Rx is considered an initial fill, so the 50,000 prescriptions does not equate to 50,000 patients. I imagine we will see similar safety and surveillance data for Hysingla ER in the months ahead.

So, you ask, what are the differences?  On the surface it seems simple; 1) Hysingla ER is once daily dosing and Zohydro ER is twice daily dosing; 2) Hysingla ER has an FDA label as “abuse deterrent” and Zohydro ER does not (yet);  and 3) Hysingla ER is a tablet and Zohydro ER is a capsule.

Let’s break this down, because ultimately it really should be about the patient.

History tells us that once daily or twice daily intended dosage forms sometimes require twice or three times daily dosing respectively.  Third party payers have notoriously used this as an excuse not to pay. By way of example, OxyContin (oxycodone extended release) is indicated for every 12 hour dosing, but it is not uncommon to see it appropriately prescribed every 8 hours instead of every 12 hours. The same is true for Avinza (morphine extended release).  Avinza is indicated for every 24 hour dosing, but it is not uncommon to see it prescribed every 12 hours instead of once daily. The best example where reality, practicality, and just plain good medicine flew in the face of the original package insert is brand name Duragesic, fentanyl transdermal (TD).   

The original package insert required every 72 hour changes of the patch.  Some patients didn’t receive adequate analgesia for that period of time – the manufacturer recommendation therefore was to raise the patch dosage to the next highest strength.  Sure, this would therefore raise the overall serum levels thus extending the therapeutic blood levels perhaps into the third day, but was it clinically the best thing for the patients and did it adhere to basic therapeutic principals?  The answer is no!  We always want to give the lowest effective dose.  If that could be achieved by remaining on the same fentanyl dose and changing it more frequently, then that is the proper approach.  See Medscape, Can Fentanyl Patches Be Replaced Sooner to Improve Pain Control?

To address point #1 above, the once daily practicality and convenience of Hysingla ER is of course a wonderful thing.  For a caregiver that can only get to the home once daily, it is a Godsend.  But, although it is a nice option for many, some patients might be better off on a lower overall 24 hour dose by using the every 12 hour dosage form of Zohydro ER.

To address point #2, abuse deterrent technology (ADT) is a wonderful thing too (kudos to Purdue), but ADT is not the be all and end all of substance abuse; it is simply another option.  To read more about that, see the Pharmacy Times article Abuse-Deterrent Opioid Formulations: Purpose, Practicality, and Paradigms. For the record, Zogenix ER has received FDA approval for their new abuse deterrent formulation.

And finally to address point #3, Hysingla ER is a tablet and Zohydro ER is a capsule.  From experience, it is clear that some patients are better able to swallow one compared to the other.  For some, the fear of swallowing a tablet (a form of phagophobia) is insurmountable.  For those that cannot swallow a tablet, I do prefer a capsule and the patient is told to sit or stand straight, place the capsule in their mouth, sip a mouthful of water, and look down towards the table or floor.  The capsule floats to the back of the throat – now swallow.  Although this often works, some might do better with a small tablet.

Hysingla ER is available by tablet in milligram strengths of 20, 30, 40, 60, 80, 100, and 120.

Zohydro ER is available by capsule in milligram strengths of 10, 15, 20, 30, 40, and 50.

For the benefit of media sensationalists and political mouthpieces, let me save you the trouble and embarrassment this time around, because if tempted, I will call you out publically again.  Hysingla ER 120mg is not 3 times more potent than Zohydro ER 40mg. They are equipotent because hydrocodone is hydrocodone is hydrocodone as explained in the previous post here, ZOHYDRO: What weighs more – A pound of feathers or a pound of hydrocodone?

Kudos to the two companies that fought to bring these new options to market for patients that can truly benefit from a single entity extended release dosage form of hydrocodone. 

As always, comments are enthusiastically welcomed!


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82 thoughts on “Hysingla & Zohydro: Same church different pew?

  1. I have taken both Zohydro and Hysingla. I was on Zohydro 30mg twice daily and asked to try the Hysingla since it is only 1 pill to remember and was told it is the same. IT IS NOT! I even looked up graphs of 7.5mg hydrocodone being stronger than the 3pmg hysingla. I’m not sure why people say these are the same, but blood serum levels look about half of Zohydro. I have taken both and am waiting to switch back to zohydro. I am stuck in bed in severe pain until then.

  2. I am getting off of all opioids. I was on Hysingla for about 5 years. My max dose was 40mg. When I complained about lidido issues to my PCP she ran testosterone levels. I had bascially zero. Hysingla warns of low testosterone, but does not play up that fact. Also, I had no idea that low testosterone in men meant no longer maintaining the bone you have nor building new bone. I had seeing spinal surgeon during the course of treatment and had numerous x-rays and MRI’s of my spine. He said wit a year or two and get surgery. Well in those 2 years my spine went to swiss cheese of bone.What was supposed to be one surgery will now be three and 2/3 of my spine will be solid rose (8 fused vertabrae in total!) If you are a man and on ANY kind of opioids get a baseline testosterone level after talking to your PCP and keep a periodic check on it. Even when my docs knew my Testosterone level hit the toilet and I was using testosterone gel, they did not take me off the Hysingla. Any of these long acting things cause one issue, there is a period of time that men manufacture testosterone (early morning ). The pain managemnet doctors know they messed my spine up horibly. They are changing many procedures about how they treat men on opioids as well as one doctor both appologizing and crying for all the damage she had done.

  3. For years I tried to get by only taking a 10mg Hydrocodone tab and a muscle relaxer at bedtime (treating a very bad back). I finally gave in and went to a pain management doctor, when I finally just could get any sleep. To start with he put me on Zohydro ER 30mg with 10mg Hydrocodone 4x daily for breakthrough pain. This was not giving enough relief and my insurance was upset about the price, so I was changed to Hysingla ER 40 and the 10mg Hydrocodone 4x daily (breakthrough). It was a little better, but it definitely did not last 24 hours (I would guess around 19 hours max).

    As my care continued I found myself taking Hysingla ER 80 with the same breakthrough pills and it was allowing me to control my pain levels (keeping me around a 3), what a relief. Then my insurance company stepped in again and refused to cover the Hysingla. I really don’t understand insurance companies.

    Now I am on Zohydro ER 50 2x daily and my breakthrough pills are not working (I am not sleeping again). I told my doctor that I could live with the pain levels through the day, but at night I was waking up repeatedly with excruciating pain in my lower back and radiating down my legs. As a result, the doctor decided to increase my breakthrough medicine to Oxycodone TAB 15mg (generic Roxicodone) 4x Daily for breakthrough pain. In addition he prescribed a muscle relaxer Tizanidine TAB 4mg (generic Zanaflex) 1tab every 8 hours for muscle spasms.

    Ok my question. Is it safe to take the Oxycodone 15mg and the Tizanidine 4mg at bed time in addition to the Zohydro 50mg? I have never been one to take pills (heck I didn’t even like taking aspirin), now I am taking what seems to me to be a lot of medication, will it affect my breathing while I sleep? I talked with my doctor and he assures me I will be fine, just a little worried.

  4. I take Zohydro ER 50mg 3x a day… but my insurance company (blue cross) decided I can’t take 3 a day, I must take 2 a day and now I am not getting enough pain relief and am waking up in the middle of the night in pain! Who do these insurance companies think they are, that they know better than my doctor??

  5. Dear Dr. Fundin,

    I would like to know if any studies have been attempted in regards to the “opioid crisis” as to how many of the people who were prescribed originally due to an injury while active duty military, who were later ALSO treated by the VA and who subsequently OD’d.
    Also, how many overdoses were prior service, Veterans or medically separated personnel between 2002-2016. It really seems to me that this “crisis” wasn’t a crisis until the Obama Administration decided to start downgrading our Military. As someone who has witnessed some pretty horrific injuries first hand from 2004 to 2010, and also witnessed the amount of pain these people were in, and the amount of pain meds given to Soldiers and Marines who were blown up, burned, electrocuted, etc, (due to the inability of ANYTHING to control their pain) in Iraq and Afghanistan, it’s not surprising that the number of prescriptions have gone up since 2003. This is a bit of a no brainer.

  6. I have RSD/CRPS, I was on oxycodone 10, two every four to six hours as needed for the pain, which didn’t even touch it for most days. A new pain mgt dr changed my meds and started me on Hysingla ER 20mg along with 5mg oxycodone every four hours, which I was on for a month, and didn’t help. On my recent visit, yesterday, I was put on Zohydro ER 10mg, which I was originally told I would take twice a day, but the RX was filled for once a day, along with the 5mg oxycodone every four hours. So far, this like the Hysingla ER has done nothing to control the pain. Does anyone have any suggestions

  7. Hi, I’ve been prescribed Hysingla 40mg, n Percocet 10’s for break thru 2x a day. I’m SCARED to try the hysingla, was on Zohydro, highest mg, so dr trying this. I’ve got bad anxiety n terrified to try it, honestly, have had it for 2months n not taken it, I’m that scared!!!

    1. Love the hysingla & I had hydrocodone 10’s for break through. You have to give your body a chance to balance. I take 80mg & it’s probably the best thing thats helped me in years. Most of the time 800 mg ibuprofen is all I need to go with it.

  8. Hi, I’ve been prescribed Hysingla 40mg, n Percocet 10’s for break thru 2x a day. I’m SCARED to try the hysingla, was on Zohydro, highest mg, so dr trying this. I’ve got bad anxiety n terrified to try it, honestly, have had it for 2months n not taken it, I’m that scared!!!

    1. I have a number of chronic pain issues and was on morphine for years. Went to a new doc he prescribed hysingla 30mg it worked well along with the shots but didn’t last the whole 24 hrs. So he gave me zohydro today to try. I have cirrhosis so few meds will work but I like both. Give it time

  9. I have been on Norco for 5 years. First on 5 mg and then increasing to 7.5 4 times daily. My doctor switched me to Hysingla 30 mg for 2 weeks and then increased to 40. I can also take 1-2 of the 5 mg Norco a day for breakthrough pain. I take the Hysingla at 4 pm and it doesn’t start working until 11 pm. Then it starts wearing off already by noon the next day. So I’m really only getting 12 hours of pain relief. The Norco used to work but now when I take them for breakthrough I barely get any relief.

    Any suggestions for a different dosing schedule that would give me more relief? I really want my peak relief to be at night so that I can sleep and then through mid afternoon so I can get things done. I also feel like I’m having withdrawal symptoms. I never took more Norco than prescribed and I only take the 1-2 break through pills now. I’m experiencing increased pain but also anxiousness and a jittery feeling. Even when I was on the Norco I never had this feeling even if I was overdo to take a dose. I did experience increased pain but nothing like this and definitely not the anxiousness etc.

    1. I’m a pharmacy technician. Maybe I can help. So before switching to Hysingla ER you were on 30mg Hydrocodone/day. Then your Dr gave you the Hysingla 30mg and went to 40mg. I would suggest trying Zohydro ER instead of Hysingla ER. It’s very very hard for 1 tablet of Hydrocodone to last a full 24 hours. Zohydro ER is the exact same ingredient (Hydrocodone Bitartrate) as Hysingla, except it’s dosed once every 12 hours. So your Dr could start you on Zohydro 20mg every 12 hours and continue to take the Norco 5mg for breakthrough. Also, Zohydro is the ONLY extended release opioid that maintains a steady state plasma level with NO peaks or troughs. So if you take it in the morning at 8am, you’ll maintain a steady blood level of Hydrocodone until 8pm. It takes about 3 days for your body to experience peak pain relief. The drug takes a little time to build up. I definitely think switching from Hysingla ER every 24 hours to Zohydro ER every 12 hours will make you feel much better. Also, I don’t know what your insurance is like but Zohydro ER is also cheaper than Hysingla, and insurance companies usually prefer one over the other. My insurance covers Zohydro but not Hysingla.

      1. I’m also hearing that zohydro 20mg. Is no longer being manufactured. How could this be? How does one wean off when a middle dose is not made anymore?

  10. I certainly hope everyone on these heavy hitter narcotics are being careful. My mother went to one of those “Dr. feel good” pain management Quacks and wound up getting hooked on very high dose regiments of several different drugs. So money pain management doctors are nothing but connections for the druggies. No good greedy bottom feeders. I know this based on my experience with approximately 18 different pain management physicians. I would see other “patients” stumble in to see the doctor for a few minutes and come out with the script. They looked more pathetic than the damn drunks down on skid Row. I know there’s a legitimate segment of the population that need these medications or they’re basically bedridden and still in pain. But there’s an even greater number of filthy dopers who visit irresponsible doctors who’s only concern is the money rolling in from a bunch of skid row looking suburban middle class drug addicts. And doctors to get patients hooked on meds so that they’ll continue to come back and pay for follow-up visits to support their habit are No-Good Sons of Bitches. My mother was suffering from back pain because of two failed surgeries and she was in terrible pain. However the pain management drug regimen was over-the-top overkill. They continued to titrate up her medication doses. It was getting ridiculous AND her 2 doctors that she went to did nothing. She was literally blasted during her appointments so these clowns saw her obviously way overmedicated. Yet they did nothing but continue to write scripts without reassessing her pain. They would see her and ask her if she was out of pain. It’s a good thing those assholes weren’t detectives; she was obviously off the rails and couldn’t even walk straight or carry a conversation. I could go on. I just want to say that it is possible four people to get hooked on these medications or find themselves getting into trouble even when all they wanted to do was to ease chronic pain, even legit intolerable pain . I have two good friends and I have spoken to several others where this has been the case. My point is simply… Ask questions and talk about all treatment options with your doctor. And for heaven sake, don’t potentiate your medications with alcohol or anything else. it’s amazing what can happen, I would’ve never believed it if I hadn’t seen so much.

    1. Post script: please excuse all my errors in syntax and spelling. My phone’s grammer/spellcheck program makes changes on its own. I also hope that everyone here who is dealing with chronic and debilitating pain is able to get the relief they need. This includes the safe yourself narcotic medications.

    2. Where are her Dr’s.at? I’m sure after your Promotion of Pain Clinics or the abundance of Clinics & Dr’s. your comments will seek abusers. Is your Mother complaining? My take on this is that the Pain Dr’s. Are much more qualified than ever before. My Son is a Member of the Pain Clinics Association.PCA
      His Dr. Is the real deal. He is Sharp. The qualifying of being a Patient in a Pain Clinics is monthly Visits and his Dr. reads the Journal of my Son’s Drug history and the amount of Visits to his Neighborhood Rx.

      1. You are dead on Alan. I have to take pain meds but limit them. I have a very astute and capable dr.
        Are you the singer? I love your music and would love to see your car collection. I’m Dusty Ray Vaughn of The CayJays. If you’re not already familiar with our music, give us a google and a like and we’ll return the favor. Thanks, Dusty

    3. My mother’s pain doctor got her hooked on oxy and it took 4 yrs but she stopped eating and starved herself to death because of the pain meds.
      I am also on pain meds for a number of health issues, but I’ll never let myself be my mother. RIP mom, I love and miss you

    4. If your Mother was in severe cronic pain,then what is the big deal of being medicated to ease her pain and give her the chance to get out of bed and tie her shoes? All you people with your opinions Do Not have the Right to put people in Pain down, Untill it’s Your turn to try and get out of bed with a wore out Spine from Years of Back Breaking Work.

  11. Hi…I was just prescribed Hysingla 30mg. I have read through the thread and still had a question, and was wondering if someone may be able to help. I work afternoon shift, 2p-10p, when would be the best time to take the hysingla so it reaches its peak while I’m at work-and is most effective there? I can’t quite figure out the timing. Thank you. 😉

  12. Just started taking Hysingla 20mg and still have 5x daily 15mg oxycodone for breakthrough pain. The first three days Hysingla was a Godsend! I have not felt that good (pain free) in years. It consistently worked all day, and did not provide any low’s or high’s. The delivery method of the medicine was spot on. After day 3 it’s like I am not even taking it; I am having to use my IR oxycodone all day, and it is barely working.

    I asked my pharmacist if I was crazy, and what happened with the Hysingla? She looked up the tritration period, and it said 3-5 days. She suggested I call my Dr. and see if they can increase the dose. She was surprised it was at that time frame. According to the conversion chart on Hysingla’s website for oxycodone to Hysingla dosing I should be on 40mg per day instead of 20mg. I am waiting for the Dr’s office to call me back.

    1. my wife was like that when she 1st got hysingla and then it stopped helping so they up her MG and it’s not working again so good luck.

      1. Embeda 50mg ER its a time release morphine, I myself have problems with morphine but I have a couple of friends that swear by it and it is covered by medicade

    2. You should be on the 40 or 50mg, the charts are crap. I went from 8 reg hydro a day to 80mg hysingla, and worked for awhile 3 or 4 months but now except no withdrawls my pain is like I’m not taking anything

  13. I am being switched from oxycodone 10mg, 4x/daily to hyslinga 30 mg 1x/daily. For one reason only. Pressure from the federal gov’t to doctors to immediately discontinue writing prescriptions for narcotics. I have been a cronic pain patient since 2007 which was the 2nd x I broke my back. When I broke my back the 3rd x and had rods installed pain. Meds were the only treatment that allowed me to have any quality of life.
    I am grateful that a new doctor was willing to take me on as he realized that people just can not be dropped from care as a result of pressure from the gov’t.
    I found this site very helpful and hopeful for the new 1x/daily time release medication. The questions on the best time of day for taking the pile and the information on the Meds peaking was very helpful. Other site did not address these concerns at all.
    Responsible people are not taking narcotics to “get high,” but seeking some normalcy and quality of life that w/o research and progress in this area is not obtainable.
    I do hope my insurance covers what appears to be a wiser choice of medication treatment and the pill is not too large to swallow as I have a hard time with large chalky pills.
    Thank you everyone for your feedback on this medication.

    1. Sorry to hear about your problem, Joanne.
      Don’t feel bad!The government is always on the tax payers back for one reason or the othr.
      I have Trigeminal Neuralgia. I am one of the “lucky” ones. I do not have it 24/7. I get it every so often,maybe once every 3 or 4 months.When I do get a sudden attack, I am down the river for a few days.Usually for 4or 5 days. Then it slowly goes away.
      My MD cannot just fill out an RX and get me some more pills. I got tired of screwing around because of DEA.What I do, when I get an attack, is take one of my hydrocodone and a shot of whiskey.Seems to work for me.Doc does not like it, but I am sick of hurting.Try it. It may help you.
      BTW I am a 75 year old white male and been having this problem since my early 30s.
      Good luck!

    2. I’m trying the hysingla for the first time today but confused on what time of day to take it, 20mg plus 10/325 for breakthrough pain, I really need the hysingla to last through the night for my pain & to get through the day, really confused at this time but guess it’s going to be like trial and error, any suggestions, please help.

  14. I was wondering will two pills will really be enough throughout the day. Usually it is what they say until a few months later and I needed more. I am really hoping this is the breakthrough I have been needing. I really need something that will help me with my pain without needing anything more. I have been enjoying reading most of the comments that others have written. I am so tire of the ups and downs with pain medications and sometimes running out prior to time because I have not had the relief that I need during the month. Could this really be a God sent pain medication that many like me have been waiting on. I am in dire need of finding something that will give me the confidence to go to work on a professional job and to do my best without feeling I am not competent enough to do my job. I have a job whereas people and especially children are relying on me preforming my very best due to their mental help and issues that will mean the difference of a meaningful life. I must be at my best at always and need the best medication possible to help me to do my best for others. Please let me know if this could be the true breakthrough medication.

    1. I’m going to follow your comment as I’m interested in the same response, hopefully we can get some more answers on others experiences, thank you

    2. No, it stops working after 3 or 4 months. And they will only give you the break through pain meds for a month or two due to DEA

  15. Why is zohydro not covered by insurance and what do I do to get it covered? I am a 34 yo female whom has been in pain management for ten years due to endometriosis, Adenomyosis and PCOS. I also have three herniated discs in my lumbar and thoracic areas along with severe TMJ and bone loss in my jaw. I am at my wits end with pain and hate living like this. Pain is always waking me up at night and it’s getting harder to function as a human being, let alone as a mother to three and wife. Help, I can’t take this. I had a hyst for the female problems, but my jaw is worse than ever. My teeth, jaw and ear are a cause of severe pain. Any ideas?

    1. Dr. put me on Hysingla ER 20 mg due to the fact the Zohydro ER is getting very hard to find. My pharmacy in Wisconsin tried everywhere and their wholesaler did not have in stock and could not order. We also checked Minnesota and had the same problem. Zohydros with my hydrocodones worked so well together ! Hate the idea of something new….

    2. Your Dr has to try all alternative medications first then insurance will cover it. He will have to show them that he’s tried other medications and they didn’t help.

  16. I have been in pain management for nearly 10 years. In the beginning, I was put on a cocktail of methadone, soma, adderol, and kolonopin. This combination saved my life. It also nearly ended it. After months of therapy, my doctor.increased my methadone.to 120/mg daily. Combined with kolonopin (and 3 beers) sent me into hypotension and the ER. I spent two years titerating off of methadone, which was replaced with a 25micro gram Butrans patch. My tolerance to pain medication must be unreal. Butrans made the slightest difference, for the first two weeks anyway. I was and am reluctant to get back on high powered narcotics, but I really have no choice. I cannot live with the increasing pain I feel, in my body and mind. I was put on Hysingla 20s with 3/norco 10s daily, because I reacted very well with norco. However, I no longer get the same type of releif I used too. Even having been increased to Hysingla 30 with norco 10s/4x daily. I am beginning to think the hysingla has somehow nullified the effectivness of norco, which has created a domino effect with other meds. Still taking kolonopin and vyvance (replaced adderol) The only med I stopped completly was Soma 350, which I had been taking for years. I am truly at a loss, as to what I can.do about this. I had very high hopes for this medicine, but now I feel as if it has made everything worse. I will not be able to afford this medication once the new year hits, not that I want to stay on it, and I need to find.something that works quickly. These past three months, trying to see if I could get the dose right, has been awful. I stay so tired, and even the smallest trip to the store absolutly wipes me out. Any suggestions?

    1. Well sorry to hear this! Ive just been given hyslinga not read yet for pickup.been on norco 10 fr 11 yrs so dont work much.shes letting me keep norcos adding hysingla er 30 to start.ive had fusion sugery l5 to l1.fibro and ra on top that.back surgeon said all my discs are bad. On disability as got laid off 3 yrs ago.wasting my days in bed.one trip to store if i get a burst of energy wipes me out for the day.was hoping this new er without acetaminophen might help feel normal again.every 4 hr deal is roller coaster all day and still cant function a simple days activity.i mean er and no acetaminophen which is killing my stomach should be perfect right!?! I hope all these posts on bad reactions or no effect at all maybe ill get lucky? Doubtful. Im dissapointed and havent even tried it yet.govt and ins makes u ho thru all these steps though.i know straight oxy prolly work great for me but u dont dare ask for it.geez this is 4th new med now.none have worked. 20 yrs with this bsck i am so at my ropes end now.sure hope you find your perfect combo as u have been thru hell as well.its hard life to endure.ppl dont have any idea how hard it is.esp the doctors!

    2. Maybe drug interactions, I’m also taking omeprazole 20mg twice a day but hopefully will not lesson the the effect of my hysingla, just starting on hysingla today for first time so I guess we’ll see, I’ll report my experience.

  17. I’m a chronic pain patient and have tried all of the time release as well as conventional narcotics and can testify hysingla is effective and helpful. I think those who want to abuse the drug will find regular lortabs a whole lot more of a high effect. I don’t experience that side effect with hysingla at all. Makes me wonder what all the fear was about.

    1. I was on Norco in for at least 7 years. I woke in the morning unable to move.I took my norco and muscles relaxers and in an hour I was out of pain but also high and had no incentive to move off the couch.I gained 50 pounds and lost all contact with friends and family. Hysingla once a day saved my life. I am out of pain but no high and my will to participate in life is returning. I don’t know how I did not overdose before. It takes away the high associated with pain relief. Cervical fusion 2 lumbar fusions nerve cut in my leg was going in for my 3rd lumbar fusion.lost 2dress sizes. The only problem was getting CVS in town to stock Hysingla but went through mail order with no problems. The pharmacist gave me such a bad time as Hysingla is new and she would not stock it. Saved my life.I wake up in no pain

      1. I hope works for me too! With all negative reviews glad see one positive.i strat 30mg once day next week to start.then to 40 twice day if first month works out.along with norco 10 fourx day.i just want be able move do simple things have energy again.just vegging now due to constant pain.yep thats me in morning.hobble to bathroom get meds.grab coffee and sit for hour waiting.have maybe 2 hrs between dose time and wearing off 3 hrs for any tasks.then i wear out so easy.no strength left do anything strenuous att all.just laundry is hard to manage.i sure hope i can get my life back.yeah they dont tell u before surgery what hardware does to you.too scared for surgery to remove it.plus fibro and ra in all joints anyways. At almost 60 trying live on disability check isnt easy but meds not working on the pain for yrs at a time making life impossible. Tried so many meds.must have high tolerance now.sure hope this new one works for me too.glad hear its helped you! Maybe there is a light at end of this horrible tunnel

        1. I am so happy to hear at least one positive response, as I am to start the medicine when my pharmacist (who also gave me a hard time) orders it.
          I am a 63 year old woman with fybro DDD, osteoarthritis, a triple fusion in cervical spine and on treatment for breast cancer. I am praying this helps me as I haven’t been keeping up with cleaning shopping and cooking etc. I feel guilty like I’m lazy, but don’t feel good enough to do anything. So glad to hear it helped “someone” after hearing so many negative comments.

  18. My pain management physician suggested I think over Hysingla instead of Hydrocodone 10/325, 4-5 daily. He pointed out that’s 40-50mg\day. I willing to try but worried may not work. He also suggested pain patches and Hydrocodone 3/day as alternative. What say you? I’ve been on pain med school over 3 years.

    1. I too was on 4-5 10/325 a day (was 5-6 a day) and just started Hysingla ER 60mg today. I’m actually trying to completely wean myself off the painkillers altogether. Just like you I was very concerned that it wouldn’t be effective, I think that comes from my desire to have the ability to increase dosage as I see fit throughout the day. But, I wasn’t always the best at judging exactly what I needed and sometimes even rebounding off the medicine resulting in migraines or burning through my medication before th end of the month, But with Hysingla i just let the slow release do its job all day long. So far, pain is in check, no “high” feelings, sleepiness is almost nonexistent, no itchyness, etc. Then again, it sounds like it can take a few days to stabilize. But if all goes well, I will use Hysingla to decrease dosage each month and stop taking these stupid painkillers. From forums like this, I can see that there are people with far more pain than I that truly need relief. I have no idea if Hysingla will be a good solution for them, but if you’re like me and you’re looking for an exit strategy, I think Hysingla could be a solution.

    2. good luck my wife is taking hysingla and it doesn’t work like it did when she 1st got it and they even up her MG of hysingla.

  19. I take Hysingla 40mg in the morning and it is very effective for pain relief. I also had success on Lortab 10/325 and Norco but doctors became less willing to write the scrip though I had no issues and I am a chronic pain patient. I do find it makes me a little itchy at night. My doctor doesn’t seem concerned but it is irritating and Benadryl doesn’t help much. Plus, isn’t the point to take less medication? Also, warnings say alcohol is very dangerous. Can a girl not a have a couple of glasses of wine or a Guinness or two? I am not a heavy or even frequent drinker but I haven’t had alcohol since starting this med. Any thoughts?

    1. Krista, I also take 40mg in the morning for the past 2 months and love it! I don’t experience any itching though. Do your research regarding Hysingla and “dose dumping.” The concern with extended release tabs and alcohol is that the alcohol can cause a rapid release of the medication all at once. However Hysingla testing shows that it does not react this way in the presence of alcohol (either does OxyContin). Just google hysingla and dose dumping and you will come across articles that state this.. However, hysingla will increase the CNS effects If combined with alcohol like all narcotics.. May make you more sleepy, etc…
      Best of luck!

    1. I take 40mg around 6am.. The drug peaks around 14-16 hours later so I find if I take it at 6 am it peaks around 9:00 and helps me sleep.. I have been on it for 2 months now and love it..

  20. I didn’t see a reply to the question as to when the best time is to take the Hysingla 20mg each day.

    1. Jim, It depends on the individual situation and on what other medications are prescribed and when. If no sleep aids are used, I generally suggest that it be taken in the evening.

      1. Does the use of the natural sleep aid called Melatonin 10mg. Prevent taking Hysingla Er 20mg in the evening? I use to take 1 Hydrocodone 10mg each night around 6 or 7 pm and then the Melatonin around 10pm…does taking the Hysingla prevent ANY alcohol like an evening cocktail?

        1. Jim I take mine in the evening usually at sametime 7pm. I was told by one Dr its best to take in evening. Which works out great because I have bedtime meds it doesn’t interfere with any. I take a higher dose and have never felt an extra boost at anytime. As with most pain meds your not supposed to drink alcohol with them but have asked and was told an occasional drink is ok wouldn’t heavily drink on it because it can cause more of a messed up feeling. I absolutely love it has helped tremendously and I’ve tried a variety of ER meds. I have no side effects and don’t feel messed up.

      2. I found this website by a google search asking this very question regarding when the best time is for taking this med. can you explain why u recommend evenings with the half life being 7-9 hrs im curious and need to know the why’s. Appreciate your board here for helping everyone. Thank you!

          1. Thanks for info. I have bene on this now for 3 wks and it has made a lot of difference for the good w the steady level snd not tsking meds 5 times a day and feeling like on a roller coaster all the time.
            I will tske it now 6am and switch to night time to ight see how i do now that level is leveled out for me. I tried a night dose on day 3ish when i read this post and it did not fo well but im betting due to not having it in me but a couple days. I do take a break thru med. but i fo next wk for her to raise the dose. She was gettinf me on slowly to see how it went.

            Constant and severe constipting is deiving me up the wall. I also have crohns ans have had episodes back to back for days now. Up ALL night this past night drom the gut wrenching pain and sterood did not touch it ans they always helped n past. Increased urination and never able to empty bladder right. Seems like maybe the med is effecting my crohns ue to constipation is this possible?? Im concerned Swear its like my guts and colon want to fall out. When i see her tue i will be letting her know. But wondering id u have seen or heard of other guys w crohns javing issues w this med?

            Sry for so long a msg. I appreciate your feedback and shares knowledge to us all.

            Thx!!- Taylor

  21. You won’t hear anything bad about Hysingla from me. I have been on it for a month now and am only taking Hydrocodone for breakthrough pain. Most days once a day, some twice. My daytime alertness is much better, general feeling better and pain is same to maybe a bit less than taking Hydrocodone in much higher quantities.

    1. Hi Jeanne, I was just prescribed Hysingla ER and was wondering what time of day is best to take the medicine.I read somewhere that the medicine peaks or something like that. I am so un sure what the peak thing means so wasn’t sure if I should take before bed or in the morning. Any insite you might have would be great! Thank you in advance.

    1. My script of Hysingla 20mg did not help any. My doc prescribed 30mg single scripts for two months. The fourth script insurance will not cover. The medication left me with severe dry mouth and constipation. I need help. Would Zohydro help?

      1. Elihu, It’s hard to know for sure. If yo tolerated short-acting hydrocodone, Zohydro may be worth a try because the peak blood concentrations are a bit lower compared to Hysingla.

  22. HHHMMM ,
    I’m happy I don’t have phagophobia , a term describing the fear of swallowing, usually developed in young children as a result of being force-fed medicine. Wouldn’t want to be force – fed false information from the Media, Sensationalists and Politicians that Zohydro ER is 10 times stronger than Hydrocodone.
    If you think about this statement , 10 x stronger than hydrocodone , then you know who shouldn’t be playing doctor or what kind of medication will or will not be sold in that politicians state.

    The BEST way to keep your chronic pain under control and keep your pharmacist, doctor , insurance company etc.. happy is stay at the lowest dose possible and you still have a life worth living.
    After 28 years of suffering with chronic pain I found the secret to being somewhat pain free and keeping everyone including yourself happy . What a ride this last year has been.

    Thank you Dr. Fudin for another excellent blog , please let the first person speaking out bad about Hysingla ER how certain people stuck their own foot in their mouth about Zohydro ER and scared the dickens out of everyone for no good reason. I don’t think we will have that problem this time around but we never know who might want to make a name for themselves and take that chance.

  23. All I can say is this article is superb! To all of those uninformed “the sky is falling” alarmists, I hope you have learned your lesson. Somehow I doubt it! Thanks for being spot on.

  24. Another great blog, oh wise one. 😉 You failed to mention that Zogenix’s incredible risk mitigation platform is the reason why Zohydro has been so minimally abused. Will this be true of Purdue’s platform for Hysingla? Time will tell. We also have the issue of progressively more insurers refusing to pay for ADFs/TRFs, resulting in too many people receiving high dosage oxycodone IR. Lynn Webster and I are just finishing up a scathing editorial review on the topic, which we’ll publish in the Journal of Pain Research. Although the last time we published a scathing editorial in J Pain Res., didn’t someone threaten to sue us? 😉

    1. Michael, You do crack me up! On this Valentines day, you deserve a kiss for these comments. You will note that I took the Switzerland neutral approach on this one! I’ll be looking forward the the article by you and Lynn. And yes, I agree – Zogenix has been quite proactive with their risk mitigation strategies and they deserve much praise for their efforts! Its shameful that we see no media attention given to that!

      1. I am a chronic pain pt.I have been on fentanyl patch for 10 yrs 150mcg per 48 hrs but last 2 yrs got myself down to 75mcghr per 72 hrs..?? My doc wants to switch me from the patch to 100mg of hysinglahr …I’ve already been suffering awwwful withdrawels symptoms. .I’m in horrible pain..I’ve never had a problem with the fentynal patch but have severe itching..feeling low of breath and tired on hysinglahr..I’m just curious if the cost of the fentanyl patches is more than hysinglahr? I guess I’m curious why some health professionals are wanting to put everyone on it when I had no problems withere the fentynal patch?

      2. Will start my Hysingla ER 20/mg 1x/day on the 31st. I also will be taking my regular pain medication oxycodone 10/325 4×/day. Have been reading over the comments and have noticed many saying the medicine only works for about 3 months and their break through medicine seems to also at that point not be working? This scares me! So anyone on the Hysingla ER doing okay past this time frame? What in this medication if any would cause the break through medicine to stop doing as it always has? Last anyone that went through the medication not working after 3 4 months. What are you doing now? Sorry thats a real concern for me! I have to be able to be active and the relief I receive from my medication now isn’t keeping me at a good level of pain, but it works better than nothing! Hope someone can answer these questions. Thanks in advance

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