Opioid Combinations

[lhoff12085]

I'm having some trouble w breathing the longer I'm on methadone (10mg/day). I'm wondering if I switched to some combination of opioids if this would lesson. How prevalent is being on 2 opioids for RLS and what are they? Thanks, Laura

[QyX]

Could you specify the problems you have with breathing?

And why do you think a combination of 2 opioids would be better than taking one (strong) opioid?

If you don't tolerate Methadone for whatever a reason, the recommendation would be to switch to one other potent opioid. In most cases doctors probably would select Oxycodone. However Hydromorphone or Morphine should work equally well.

There are not many scenarios when doctors combine two different opioids. The most common is probably when one patient takes a long acting formula of an opioid and then a short acting opioid for breakthrough symptoms like Oxycodone retard every 8 to 12 hours and Morphine solution or immediate release tablets for breakthrough symptoms when the base dose of Oxycodone is not enough.

I take a combination of 3 different opioids: Morphine is my main opioid, Hydromorphone I take in the morning and Oxycodone at night together with Morphine. I take opioids for 7 years now and ran into tolerance issues after about 4 years. Combining different opioids helps me avoid tolerance issues.

I can't see any reason why it would be necessary or helpful to combine different opioids. And in your scenario, your doctor would probably reduce the Methadone to 5 mg before switching to another one.

Methadone accumulates in the body and so a fixed dose taking over a longer period of time will become "stronger" until you reached steady state.

[lhoff12085]

Hi QyX! I take rigorous exercise classes (aerobics, weights) and find it's tougher to catch my breath. Doesn't really make sense to me that this would get worse over time so maybe I'm just recognizing it more. I do find that even when walking, I sometimes can't talk and walk at the same time bc I need to catch my breath. I didn't have this before being on methadone 2 years ago. Maybe all opioids have this side effect? I want to continue on opiods bc I've tried all the other options and they become ineffective after 2 years or so. I have a doctor's appt in a few weeks and wondered if I should ask the doctor to switch me or add something. ?

[QyX]

So you are taking Methadone for two years now and you developed this "being out of air and having to catch your breath" problem just recently like in the past couple months?

What makes you so sure this problem is connected to Methadone?

There could be plenty of reasons for the symptoms you are describing.

Respiratory depression is a common side effects of opioids for people who are new to opioids haven't developed a tolerance yet. Respiratory depression can also happen when the dose of opioids is suddenly significantly increased.

However, what you describe is not respiratory depression in my opinion. If you suffer from respiratory depression, you would not really notice that you have to catch your breath.

Still, what you describe can lead to serious medical issues. So I would say you contact your doctor as soon as possible. But again: if you are taking Methadone for 2 years and only recently became aware of those issues, I would suspect something else is going on. But without closer investigation and in person examination it is impossible to say what is going on.

10 mg of Methadone per day is a dose that is even tolerated by people who do not have a opioid tolerance yet or are naive to opioids.

If opioids would be cause for your symptoms, something would be really wrong. And yes, just to exclude the Methadone it can make sense to switch to a different opioid. However without knowing the cause for your symptoms, it is not possible to tell if additional medication is necessary.

I will do some research however to see if similar problems are documented in connection with opioid therapy.

[lhoff12085]

I noticed it when I first started taking it but it seems to be worse lately. I will go see my primary doctor though. Appreicate your advice! Will let you know.....thanks again.