Codeine

[Agw0006]

I was recently prescribed codeine (30 mg) nightly due to the refractory nature of my symptoms. I have been on it for about a month and have a follow-up appointment with my sleep specialist in 6 days. I know that he will ask me how the codeine is working. Some nights it works great, some nights it helps significantly, and other nights it is not very effective. I am curious if others who are taking opiates have had the same experience (i.e., inconsistency from night to night). Is this normal, or should I try another opiate? Increased dose (60 mg)? Anyone else using codeine? I am very interested in others' experience - especially if anyone has tried several opiates before finding one that helps on a consistent basis.

[Rustsmith]

I just ran a calculation with a Morphine Equivalents Calculator to see how your dose of 30mg codeine compares with the starting dose of 5mg of methadone (which is the smallest dose available unless you break a pill in half). 30 mg of codeine is 25% of the methadone dose. Codeine is also the weakest of the opioid medications.

Personally, I am not surprised that such a low dose of codeine is providing mixed results. On your "good" nights it works well but when your RLS is acting up, it probably isn't strong enough.

Further, in the document that the link in my signature takes you to, 30mg of codeine is listed as the "starter" dose with 60-180 mg shown as the "usual effective daily dose".

[Agw0006]

Hi Steve, Thanks for the reply. I greatly appreciate the reference. It seems that methadone may be the way to go - or at least now trying 60 mg codeine. Should opiates work most every night in your experience? That is, on a consistent basis - or is it common for the benefit to be inconsistent in your experience?

[Polar Bear]

I have been a sufferer for 40 years and if untreated I would have rls pretty much 24/7. I am prescribed cocodamol 30/500 x 2 by 4 times daily. Mostly I only take it 3 times. Occasionally taking one during the night. I am also prescribed pregabalin 300mg twice daily for neuropathy and this has the benefit of also treating my rls.
There was a long time when it was very inconsistent but this past couple of years it has been much more steady. I believe that changing my nightly dose of pregabalin from bedtime to 7pm has contributed to this improvement.
Since December 2023 I have been prescribed the anti depressant Sertraline. ADs are generally considered a trigger for rls but I have been fortunate to not have had any obvious negative effect and indeed I am sleeping better. Not always great but very much better.
I have never tried any other opiate.

[Agw0006]

Thanks Polar Bear. I am also taking 800 mg Gabapentin for neuropathy associated with Rheumatoid Arthritis, along with the codeine. It sounds like my sleep specialist started me off on a low dose of codeine (30 mg) - which appears to be common. I suspect that when I go back and see him this week he will increase the dosage - but we will see. From what I am learning it seems that methadone is the go-to drug prescribed by many physicians. Thanks again for sharing your experience.

[Polar Bear]

I am in the UK and my Dr nearly had a fit when methadone was suggested. I'm fortunate that the cocodamol at max dose works for me.
Bear in mind that medication for rls works best if taken in advance of symptoms.

[Rustsmith]

From what I am learning it seems that methadone is the go-to drug prescribed by many physicians.

There is nothing all that special about methadone when it comes to treating RLS. The other opioids work just as well if prescribed in equivalent doses. The reasons why methadone is "preferred" are that it is a once a day med, so it is more convenient for the patient who doesn't have to take a second dose during the middle of the night like many of the shorter acting meds and second, it is very inexpensive compared to some of the others (such as buprenorphine and tramadol).

Some doctors are starting to also prescribe buprenorphine, which is a lower schedule med (3 vs 2) and therefore has less red tape involved. However, the Suboxone form of buprenorphine can cause dental problems since it dissolves under the tongue and the pill and patch forms are either much higher doses or are very expensive (especially compared to methadone).

[ViewsAskew]

And here is some general info about Suboxone and dental issues (and ways to prevent problems - or at least limit).

https://www.bicyclehealth.com/suboxone- ... t-my-teeth

[Agw0006]

Thanks for the replies. My doctor just this week switched me from codeine to methadone. I am starting at 2.5 mg and going to try that for a month. Last night it worked pretty well for me.