methadone vs buprenorphine/naloxone
Posted: Thu Dec 15, 2022 8:56 pm
Hello all.
I am in the "fortunate" <snicker> position of being offered either methadone or Suboxone (buprenorphine/naloxone) for my refractory RLS. I have been taking a very low dose of methadone --1/4 of a 5mg tab once daily--for only 3-1/2 weeks and I fall asleep quickly and sleep uninterrupted about 5 hours and then wake up and feel restless and unable to get back to sleep. Also my RLS symptoms (involuntary twitching) start to come back around 4 AM and bother me all morning until early afternoon. But my main problem is still extreme tiredness and cognitive dullness, as well as worsening anxiety and depressive symptoms. For most of the day I do very little and I often feel too impaired to drive.
I related the above to my RLS doctor via the patient portal and he wrote back, "if you think the cognitive issues are related to the methadone, rather than sleep deprivation or mood disorder, then it makes sense to try switching to buprenorphine/naloxone."
The problem is, I don't know if the cognitive, and mood, problems are due to the methadone or not. I tend to think not, since the main reason I have been seeking help for years is the extreme tiredness and cognitive dullness due to poor sleep, and just recently with intense anxiety and depression which I feel is secondary to the RLS and poor sleep rather than primary (I never had any anxiety or depression until my sleep deteriorated). I also understand methadone can cause or exacerbate depression, and depression in the elderly (i am 62) can cause "pseudodementia" with impaired memory and cognition.
So it's just clear as mud.
My thought right now is initially to stick with the methadone and try increasing to 1/2 a tablet daily and see if I get better (more sleep, less restlessness) or worse (methadone side effect), and then get back to Dr. Winkelman.
Any thoughts? Personal experiences?
Also, even if the methadone wasn't "causing my cognitive issues", if one could choose either medication, is there a good reason to choose one over the other?
Thanks in advance for any input.
Paul
I am in the "fortunate" <snicker> position of being offered either methadone or Suboxone (buprenorphine/naloxone) for my refractory RLS. I have been taking a very low dose of methadone --1/4 of a 5mg tab once daily--for only 3-1/2 weeks and I fall asleep quickly and sleep uninterrupted about 5 hours and then wake up and feel restless and unable to get back to sleep. Also my RLS symptoms (involuntary twitching) start to come back around 4 AM and bother me all morning until early afternoon. But my main problem is still extreme tiredness and cognitive dullness, as well as worsening anxiety and depressive symptoms. For most of the day I do very little and I often feel too impaired to drive.
I related the above to my RLS doctor via the patient portal and he wrote back, "if you think the cognitive issues are related to the methadone, rather than sleep deprivation or mood disorder, then it makes sense to try switching to buprenorphine/naloxone."
The problem is, I don't know if the cognitive, and mood, problems are due to the methadone or not. I tend to think not, since the main reason I have been seeking help for years is the extreme tiredness and cognitive dullness due to poor sleep, and just recently with intense anxiety and depression which I feel is secondary to the RLS and poor sleep rather than primary (I never had any anxiety or depression until my sleep deteriorated). I also understand methadone can cause or exacerbate depression, and depression in the elderly (i am 62) can cause "pseudodementia" with impaired memory and cognition.
So it's just clear as mud.
My thought right now is initially to stick with the methadone and try increasing to 1/2 a tablet daily and see if I get better (more sleep, less restlessness) or worse (methadone side effect), and then get back to Dr. Winkelman.
Any thoughts? Personal experiences?
Also, even if the methadone wasn't "causing my cognitive issues", if one could choose either medication, is there a good reason to choose one over the other?
Thanks in advance for any input.
Paul