Methadone sudden failure efficacy

[Tinabuglaw]

So about 5 months ago I was put on methadone 5mg. It was a miracle. No RLS symptoms at all!

This week, I've had symptoms. They have become increasingly worse and worse, starting just in the afternoon when I take a nap and now all night again!

What does this mean?? Bad batch? Tolerance? Based on what I know, I can't imagine it's tolerance.

[Neco]

Are you on 5mg per day, in a single dose? That's seems a little on the low end, from my previous experience. I'm not sure why the efficacy would suddenly drop like that, I suppose its always possible the batch was bad.

have you tried splitting your 5mg in half and taking 2.5mg in the morning then 2.5mg in the evening? Outside of that, if it continues, adding a second 5mg may solve the problem, if its not quality-control related.

I had tolerance issues with methadone and the way I controlled it was adding an extra dose for a couple days, randomly, then dropping back down to normal. However if you are only on a single 5mg dose that doesn't give you much to play with.

[QyX]

It is probably tolerance ... 5 mg of Methadone is a relatively low dose for RLS, especially when given over 5 months without any changes in dose.

[ViewsAskew]

I had tolerance in about 6 months. Now, I know most of us aren't supposed to get it....but there are always outliers - I seem to be one of them! .

[QyX]

I had tolerance in about 6 months. Now, I know most of us aren't supposed to get it....but there are always outliers - I seem to be one of them! .

I think it is not correct that RLS patients are not supposed to develop any tolerance at all. If we would not develop any tolerance effects at all, that would be very weird.

The way I see it is that for us RLS patients tolerance is not that much of an issue as it would be with "classic" chronic pain, like back pain where opioids often stop to be effect after several months and major tolerance problems can occur with patients taking several hundred mgs of Oxycodone in just a few months.

In my case, I am now stable on approx. 180 mg of Morphine for about 4 years but to avoid tolerance issues, I have to take additional medication and use opioid rotation to avoid developing more serious problems related to tolerance.

Coming back to the Methadone:

5 mg is a starting dose. I think it is still a pretty good sign that 5 mg was working so good for so many months. There a lot of room to increase the dose further before you need to be really worried about tolerance issues. But it is wise to be prepared and think about what to do when this problem is going to occur.

What I do from time to time is to cut my opioid dose by 1/4 to 1/3 for about a week and deal with the additional symptoms by using other medication or simply accepting the symptoms. Then after a week, I can increase the dose again but not up back to my original dose. This does make opioids work great again for several months. Then I simply repeat the procedure. I've done it plenty of times now.