Earlier Onset While Driving Requiring Early Oxycodone Dosage

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EdSoFlo
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Joined: Tue Jan 06, 2015 4:44 am

Earlier Onset While Driving Requiring Early Oxycodone Dosage

Postby EdSoFlo » Fri Jul 06, 2018 11:47 am

Hi all -

A few months back I began to experience a mid-afternoon onset of symptoms while driving in traffic, and pretty severe ones at that. As in, literally wanting to get out of the car and start running down the shoulder! I take (and have for going on a decade) 10-20 mg oxycodone IR per night, once before dinner and once right before getting into bed, which immediately upon being prescribed it years ago almost completely resolved my severe refractory RLS, and does to this day. I’ve now found myself requiring an early afternoon dose of 5-10 mg depending on severity and where/how much driving I’m doing on a particular day. I drive a lot, and every day, as I’m an antique/vintage dealer and well, the stuff isn’t going to find itself! I’m trying to figure out why this has only kicked in now, and 1) I drive a LOT more now since moving to the almost incomprehensiblly sprawling Atlanta area, and if you’ve ever driven here, you know what the traffic’s like (as in terrible, I’m a Los Angeles native and this place may actually be worse). So I’m sitting behind the wheel for probably 3-4 hours every day. I also just turned 51, and maybe it’s just a function of aging. I’m very fortunate in that my doctor understands and has added an additional 5 mg per day to my dosing, but quite honestly it takes 10 mg to really get on top of it and keep it under the intolerable threshold, so that is a conversation I’ll be having my next appointment which is this coming Monday (it’s caused me to run low on this prescription especially as I just took a long road trip over the 4th, so I’m looking forward to not a particularly restful weekend!)

My question is, has anyone experienced anything similar? Did you find age was a factor? Did anything in addition to medication help (massaging seat pad, etc?) Also, I’m very curious as to people’s experience with the longer release oxycodone vs the IR. I’m thinking it might be beneficial to me to switch to ER with one dosage evening and one early afternoon.

I’d appreciate any thoughts as always. Thanks & Cheers!

ViewsAskew
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Re: Earlier Onset While Driving Requiring Early Oxycodone Dosage

Postby ViewsAskew » Fri Jul 06, 2018 6:03 pm

I cannot comment about the Oxy - I don't use it. I typically use methadone - have tried shorter acting drugs and find that I do not get enough coverage and have to take them too frequently. My guess is that an ER Oxy would be better based on my experience. With methadone - and its very long half life - I can usually dose once a day and be covered. When I have to work early and drive a lot, that becomes two times.

It isn't uncommon for symptoms to increase over time. It likely is just that. But since you are taking an opioid, I can imagine some potential nervousness at asking for more or a change. If not, sorry for bringing it up!
Ann - Take what you need, leave the rest

Managing Your RLS

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

legsbestill
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Location: Dublin Ireland

Re: Earlier Onset While Driving Requiring Early Oxycodone Dosage

Postby legsbestill » Sat Jul 07, 2018 4:00 am

The stress of the driving could itself be exacerbating the rls if I understand your message to be that the hours of driving have recently increased.

I took er oxycodone (OxyContin) for awhile. I had to take 30mg in the evening for my symptoms when I was using it alone and I definitely had withdrawal effects the following day. I think by about 12 or 1pm but can’t remember precisely. Dr. Buchfuhrer told me that there were law suits pending concerning misrepresentation about the length of efficacy of OxyContin and according to him typically it only lasts about 6 hours.

I believe this is one of the reasons why methadone is the opioid of choice for rls.

There are some substances that are supposed to potentate opioids. Agmatine sulfate is highly recommended on Reddit. Paracetamol can apparently also be good. I have also heard that cannabis can do it. Maybe these would extend the life of your oxycodone or enable you to take a slightly lower dose in the evening to free up some for the following day.

EdSoFlo
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Joined: Tue Jan 06, 2015 4:44 am

Re: Earlier Onset While Driving Requiring Early Oxycodone Dosage

Postby EdSoFlo » Sat Jul 07, 2018 11:10 am

Much thanks to you both. I’m actually (since November last year) in the happy position of being treated by Dr Rye at the Emory Sleep Center and I feel we have a free and open line of communication and he’s fully versed and supportive of opioids usage when indicated. Trust me with my last Dr in Florida I would not bring it up...any talk of dosage increase etc had him threatening to boot me to a dreaded pain clinic which are nothing more than rackets in FL but that’s another topic. On that topic actually it amazes me that a Dr could behave in a way that literally destroys trust and humiliates the person with a very serious condition they’re supposed to be treating but I guess that’s where we are as a society. It actually is a scarring experience and made me gun shy initially to speak freely with Dr Rye but luckily I knew right away that’s not his routine and our Dr/patient relationship would be based on trust and finding the best results. It helps I imagine that he’s in the RLS club as well, so he’s fully aware of what we all deal with. Also quite luckily as well for me is my local Walgreens out here in the Atlanta burbs is great. No weird looks, no ‘let me see if we have it’ BS (now that they know me) etc. and they actually treat me as an appreciated customer. Unlike every pharmacy in Palm Beach County I assure you lol...

I plan to bring up both methadone and the ER version of the oxycodone. I’ve actually always wanted to give methadone a try as it really does seem to be for most the most effective choice, but have always figured if it ain’t broke don’t fix it, etc. I really feel it’s a matter of changing body chemistry and the heavy increase in driving time in stop-and-go traffic. I’m about 30 miles north of downtown Atlanta and if it gets to around 2:30 and I’m there or south of there I’m looking at at LEAST an hour in grinding traffic and my legs just aren’t having it after an already long day of driving. I’ll let you know what happens, and thanks again for your input!

ViewsAskew
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Re: Earlier Onset While Driving Requiring Early Oxycodone Dosage

Postby ViewsAskew » Sat Jul 07, 2018 5:51 pm

Good luck. And, yes, you are very lucky! Dr Rye has always been one of my favorite RLS docs (of those I have met through the Foundation).

As someone who has used methadone for about 12 or 13 years, I have long wished for a combo approach. A small amount of methadone for what it does, and a small amount of a shorter lived opioid so that I have less of the "hangover" I often have in the morning. Many people do not get it - I always have. I could sleep 12-14 hours at times - which was great initially, but as time went on, not so much!
Ann - Take what you need, leave the rest



Managing Your RLS



Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

2BassetMom
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Location: Idaho

Re: Earlier Onset While Driving Requiring Early Oxycodone Dosage

Postby 2BassetMom » Sat Jul 07, 2018 7:07 pm

EdSoFlo, I find your post really interesting as I take an OxyContin CR 15mg at bedtime and 1 oxycodone 7.5 at midday. This barely takes care of the rls. I usually take the night time dose around 8pm and wake up twice during the night. 4:30am is when I awaken with severe rls in my legs and hip pain. I'll have at least 2-3 episodes during the day. The dosage of opioid was suggested by Dr. Poceta, a quality care center doctor. He is great and I find him very easy to talk too. The problem is that he is far away from where I live. I flew to the San Diego area to see him from my home in northern Idaho. My PA at the pain management clinic I go to seems willing to go along with his suggestions. I think we need to tweak the dosage or time but am hesitant to ask. I feel like I am on a tight-rope and if I use the wrong words or ask the wrong question I will fall off. And this, with a good relationship with the PA. I do have a suggestion for the rls while driving. Realizing that we live in very different climates I will still offer this: I use a heating pad that plugs into the power outlet for phones and lay this across my lap and it seems to help. Often when we make the 45 minute drive to and from the nearest big town I need it to calm my rls. I used it yesterday when we had a hot day for us, 89'f, and with the A/C on it wasn't bad. Thanks so much for sharing your story.

EdSoFlo
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Joined: Tue Jan 06, 2015 4:44 am

Re: Earlier Onset While Driving Requiring Early Oxycodone Dosage

Postby EdSoFlo » Sat Jul 07, 2018 9:23 pm

ViewsAskew wrote:Good luck. And, yes, you are very lucky! Dr Rye has always been one of my favorite RLS docs (of those I have met through the Foundation).

As someone who has used methadone for about 12 or 13 years, I have long wished for a combo approach. A small amount of methadone for what it does, and a small amount of a shorter lived opioid so that I have less of the "hangover" I often have in the morning. Many people do not get it - I always have. I could sleep 12-14 hours at times - which was great initially, but as time went on, not so much!

Thanks! I’m really leaning toward giving it a shot. And as someone who’s lived on a sleep deficiency of some kind probably since college, a few nights of 12-14 hours sounds amazing! :lol:

EdSoFlo
Posts: 20
Joined: Tue Jan 06, 2015 4:44 am

Re: Earlier Onset While Driving Requiring Early Oxycodone Dosage

Postby EdSoFlo » Sat Jul 07, 2018 9:34 pm

2BassetMom wrote:EdSoFlo, I find your post really interesting as I take an OxyContin CR 15mg at bedtime and 1 oxycodone 7.5 at midday. This barely takes care of the rls. I usually take the night time dose around 8pm and wake up twice during the night. 4:30am is when I awaken with severe rls in my legs and hip pain. I'll have at least 2-3 episodes during the day. The dosage of opioid was suggested by Dr. Poceta, a quality care center doctor. He is great and I find him very easy to talk too. The problem is that he is far away from where I live. I flew to the San Diego area to see him from my home in northern Idaho. My PA at the pain management clinic I go to seems willing to go along with his suggestions. I think we need to tweak the dosage or time but am hesitant to ask. I feel like I am on a tight-rope and if I use the wrong words or ask the wrong question I will fall off. And this, with a good relationship with the PA. I do have a suggestion for the rls while driving. Realizing that we live in very different climates I will still offer this: I use a heating pad that plugs into the power outlet for phones and lay this across my lap and it seems to help. Often when we make the 45 minute drive to and from the nearest big town I need it to calm my rls. I used it yesterday when we had a hot day for us, 89'f, and with the A/C on it wasn't bad. Thanks so much for sharing your story.


My pleasure, our sharing stories, insights etc is one of the things I love about the Foundation. And ditto. I find the combo approach you’re using interesting as well. Have you seen the latest Mayo Clinic opioid for RLS guidelines created by Dr Silber? Up to 30 mg/day is within the guidelines, so that may be helpful if you feel the need to increase. I think I’m going to request a methadone trial and see how that goes, nothing to lose. Thank you for the tip on the heating pad I’ll give that a try. Cheers and best with all.

ViewsAskew
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Location: Chicago

Re: Earlier Onset While Driving Requiring Early Oxycodone Dosage

Postby ViewsAskew » Mon Jul 09, 2018 8:43 pm

EdSoFlo wrote:
ViewsAskew wrote:Good luck. And, yes, you are very lucky! Dr Rye has always been one of my favorite RLS docs (of those I have met through the Foundation).

As someone who has used methadone for about 12 or 13 years, I have long wished for a combo approach. A small amount of methadone for what it does, and a small amount of a shorter lived opioid so that I have less of the "hangover" I often have in the morning. Many people do not get it - I always have. I could sleep 12-14 hours at times - which was great initially, but as time went on, not so much!

Thanks! I’m really leaning toward giving it a shot. And as someone who’s lived on a sleep deficiency of some kind probably since college, a few nights of 12-14 hours sounds amazing! :lol:


Oh, it was! Until it wasn't, lol. But, it didn't get to be a problem for at least a year :-). I LOVED it for quite awhile.
Ann - Take what you need, leave the rest



Managing Your RLS



Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

EdSoFlo
Posts: 20
Joined: Tue Jan 06, 2015 4:44 am

Re: Earlier Onset While Driving Requiring Early Oxycodone Dosage

Postby EdSoFlo » Wed Aug 01, 2018 7:54 pm

I realize I never followed up on this. In the end we added a small afternoon dosage to deal with the earlier/while driving issues. I discussed both methadone, and ER oxy. I didn’t realize but they consider methadone the ‘big gun’ to utilize if other opioids aren’t working, as it’s so potent apparently. I had no idea. And decided to stick with regular release oxycodone as I don’t have any issues through the night when I take my bedtime dosage (if it ain’t broke...) and I guess the ER is more restrictive to prescribe (why, I have no idea). In any event it’s working fine. Would I say perfectly? No. But I think part of what I’ve incorporated into my journey with dealing with this disease is that it’s a ‘management to within livable standards’ type thing, and that tolerating some days of my afternoon dose not fully knocking the feeling of my wanting to jump out of the car and run down the road when stuck in traffic I’ll just have to tolerate! :D I’ll admit I’m still curious to see what a trial of methadone might do differently (especially given all I’ve read/heard that it’s the best opioid for RLS) but it’s off the table for now which is fine.

ViewsAskew
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Re: Earlier Onset While Driving Requiring Early Oxycodone Dosage

Postby ViewsAskew » Thu Aug 02, 2018 6:37 am

Yep - management to within livable standards is as good as it gets (and better than for many).
Ann - Take what you need, leave the rest



Managing Your RLS



Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.


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