Long-range Refractory RLS post medication adjustment

[tea4one]

Been on my original therapeutic dose of 10mg methadone for two weeks after lowering methadone and increasing gabapentin to assess tolerability. I continue to experience daytime symptoms. They aren’t as intense as the prior weeks, but they remain.

Why does efficacy of the previous therapeutic dose take so long to manifest? Why weeks and not days?

RLS is such a strange condition.

Thanks


JZ

[Rustsmith]

The half life of methadone is very long compared to many other meds (several days for some). Therefore, it can take you a while for the methadone to work its way out of you system when doing a "small" decrease from 10mg to 5mg. Even if you were to completely stop, it takes a while for it to completely clear out of your system.

[tea4one]

Thank you for the reply. I can understand why someone may have symptoms when reducing their med, but why would someone continue to have symptoms over two weeks after going back to their usual dose and going up on gabapentin? It seems I’m just about through the worst of it, but weeks? Man, this condition is awful.

[Rustsmith]

Half life works both ways, but up and down. That is why your doctor probably didn't originally start you off on the "final" dose of methadone. They want you to become "stable" at the small dose before getting to the target dose. If it is taking you this long, you are probably one of the people on the tail end of the curve who has a very long half life when it comes to methadone.

But, the good news is that you seem to getting back to a stable treatment level with decent control of you symptoms.

[tea4one]

Hi Rustsmith,

It took over 6wks to get back to baseline after going back up to the original dose. I continue to have sx in the late mornings when attempting to get back to sleep, but nothing like I experienced during the previous weeks.

Thanks,

J