Restless Legs Syndrome (RLS) Discussion Board

1. Anyone have the Methadone sedation go away with time (how much time)?

2. Anyone have experience changing to oxycodone from methadone and avoiding withdrawal?

All experience welcomed.

I can't help with your first question because I get opioid-induced insomnia and so I have to take them mid-day rather than in the evening.

As for your second question, last fall I switched from methadone to Tramadol ER due to side effects from the methadone. I went through a bit of withdrawal because I didn't get the Tramadol in time, but otherwise the transition was fairly seamless. As for methadone withdrawal, the only issue that I had for the first 24 hrs was that I didn't sleep at all that night and wasn't the least bit sleepy. I was out walking around my neighborhood all night long, which I attributed more to untreated RLS than withdrawal.

1. Clarification: I can also often have the evening "alertness" from the methadone, but during the day I take two or. three naps and feel drugged. I wonder if that might go away with time?

When my dose is higher, I have daytime tiredness and evening alerting. When my dose is lower, I just have the evening alerting. I try to keep mine at 50% of what I would take if I only took it. I use pramipexole to cover the other 50% of symptoms. Every few months, I stop the pramipexole completely for a few weeks, take only methadone, then go back to the 50/50 split.

That is the only way I have come up with to deal with the side effects of both. Alone, they both have issues. Together, it is manageable.

I did try three other opioids about ten years ago. I switched between them easily - no withdrawal at all.

I asked about the withdrawal because I just went through it when switching from Belbuca/Suboxone to Methadone, and really hope to avoid that if I do decide to try Oxycodone.

I tried three things from methadone. Didn't have an issue. I am not yet awake enough to remember all three. One was as Steve did - Tramadol. Another was hydromorphone...so that sort of leaves oxy as the last, since there aren't too many others and I haven't used Fentanyl.

Did those of you who switched just go from methadone one day to a corresponding amount of oxycodone the next?

And did you ever switch back to methadone seamlessly as well (I always plan for failure)?

yes, that is what I did. There are dosing charts. I did find that some of them never worked as well, so I had to take more than it indicated, though.

MEU comparisons for dosing of opioids can be a bit off when it comes to methadone. Most of the other opioids have to be taken every 4 to 8 hrs. Since methadone has such a long half life and usually lasts for more than 24, it is very hard to get a good, accurate comparison.

6mg. of methadone works for sleeping through my PLMs. I would keep taking it except for the sedation and depression.

I have been working with primary care doc and he seemed freaked by the amount of oxycodone that was "equivalent" to 6mg. of methadone when I suggested the change, and it made me nervous. (But then the methadone has kind of turned me into a nut case.) Nervous as well because I see the oxycodone as my last chance and I am worrying even that won't work.

wantok wrote:I have been working with primary care doc and he seemed freaked by the amount of oxycodone that was "equivalent" to 6mg. of methadone when I suggested the change, and it made me nervous. (But then the methadone has kind of turned me into a nut case.) Nervous as well because I see the oxycodone as my last chance and I am worrying even that won't work.

You might only need 3/4 of a equivalent dose but with Methadone it is complicated.

What dosage for Oxycodone did you or your primary care doctor calculate?

6 mg Methadone is not a very high dose, even when you took it for a long time.

Why does the doctor suddenly freak out but prescribing Methadone is okay? As long as the dose is equivalent, what does it matter?

Most likely Oxycodone will be able to manage all relevant physical RLS symptoms but Oxycodone is known to cause insomnia, even in patients who do not have RLS. I've had this problem for a long time and the only solution back then was to switch to Hydromorphone and later to Morphine. But keep in mind that all opioids can cause insomnia and that this might force you to take additional drugs.

Methadone is a bit of weird opioid. It is fully synthetic and has some additional analgesic properties compared to the classic opioids like Oxycodone however Methadone can impact quality of life in a way that it does not make sense to continue with Methadone.

So opioids alone never offered enough relief for me. They do an awesome job when it comes to the restlessness part but they only deal with 40 to 60% of the pain symptoms. So for that I use additional antiepileptics (Oxcarbazepine) and medical Cannabis in the form of an THC / CBD 1:1 spray and natural Cannabis flowers.

Don't give up!

And keep in mind that because of the additional analgesic properties of Methadone you might need a higher Oxycodone dose than calculated.

I would say a reasonable dose to start would be between 10 - 15 mg Oxycodone per day. A calculator I used says 16 but I would not be surprised if you end up needing 20 to 30 mg.

Don't give up hope. I've invented many strange and outright bizarre solutions for my sleeping problems. It is all very well documented in this forum if you are interested in reading about it. There are so many drugs on the market that you can often find some solution. The bigger problem is that most of them often only work a few weeks or months. However some of them worked for up to 3 years for me.

So we gotta keep trying.

Also consider using medical Cannabis. It is an easy way to keep the opioid dose and tolerance low and it can help a lot against insomnia.

Edit: I forgot, Methadone is famous for causing depression and impotence. That are two of the main reasons why people in opioid replacement therapy ("drug addicts") stop taking Methadone and return to Heroine or other opioids sold on the street.

Should Oxycodone not work for you, you can always try some of the other classic opioids like Morphine, Hydromorphone, Hydrocodone and if you live in the U.S. Oxymorphone. Morphine in the end worked best for me but because of tolerance issues I now take a combination of Morphine and Oxycodone and sometimes even Hydromorphone. I know, it sounds bad but I am also a really severe case. Access to opioids was always the least of my problems.

Thank you so much for taking the time to answer.

I think primary doc freaked out because he doesn't usually prescribe opioids and I was going on about the sedation side effect (prescribed norcan right away). Fortunately there is an opioid specialist here I will be seeing in a week. Primary doc didn't prescribe the oxycodone because for a couple of days the depression (not the sedation) lifted and I was hoping my body was adjusting (wrong!). I took percocet and percodan decades ago for Crohn's pain (when they used to do that) and I had no alerting effect (I do get that with hydrocodone--also with methadone but I take it 5 hours before bedtime) at that time so hopefully that won't happen. The downside of the opioid specialist is he doesn't have any experience with RLS, although I think since I am asking for such a small amount he didn't seem to blink at trying to help me. He also didn't seem to like it when I had terrible anxiety with Suboxone and I didn't want to tough it out for a while and see if I adjusted. I vaguely remember taking 5 mg. of percodan for pain and that did seem like a lot, but my memory about dosage from decades ago is hardly accurate. I have tried lots of cannabis varieties and dosages and never got it right. Need to take THC and I just ended up getting stoned which I don't like (again because of anxiety response). I am hoping the IR oxycontin may help with the hangover? I am dying to get off the methadone but I am having a cardiac ablation on Monday and can't really deal with this for a bit...which seems like forever. (I now know the answer to the question docs ask about "have you ever been depressed?" Yes, now I know what depression is. If local doc fails, I am flying to LA to see an RLS "expert". Yes, it is not an option to quit. I am really hopeful about avoiding a terrible withdrawal from the methadone which I had when I tried the Suboxone failed experiment. (Lost 10 pounds in a week from diarrhea.)

Many thanks again.

I thought that the dosage used for pain was more than RLS dosages usually?

wantok wrote:I thought that the dosage used for pain was more than RLS dosages usually?

I take almost 200 mg Morphine (or 100 mg Oxycodone) daily. The individual doses depends on the individual needs of the patient.

But is it true that most RLS patients need lower opioid doses than the average chronic pain patient.

Also I'm taking opioids for 7 years now. So tolerance is a factor, too after so many years with really severe RLS.