Methadone to Tramadol?

[Maria]

Recognizing that almost anything one might try has some kind of fall out, I am wondering if switching from methadone to Tramadol might ameliorate the persistent drowsiness I continue to experience with methadone.
If anyone could share experience with tramadol, what have you found?
What has been an effective dosage?
What side effects have you encountered?

If one transitions from methadone, what are some guidelines?

I currently take 10 mg. methadone in the late evening. By midmorning I am dozing over my keyboard. I’ve taken it earlier – in the late afternoon -- but have the same effects.

I almost always awaken at midnight, sometimes with symptoms, sometimes not. If I have symptoms I take an additional 2.5 mg and am able to return to bed after 45.”
I’ve tried taking all 12.5 mg before bed and still awaken at midnight – though without symptoms.

So— I’m wondering if it’s time to try another avenue…

[Neco]

This is tough..

I've made the transition from Methadone to Vicodin before, and it just barely held me over, taking 5mg x 8 a day. Mostly I am guessing was withdrawal pain creeping through.

With Tramadol though I'm not sure how much stronger or weaker it is considered vs hydrocodone. You may find yourself using the maximum 400mg/day or may not. It depends on how effective it is.

A few people have reported it has anti-depressive effects and can give you a bit of an energy boost. I don't imagine it would make you tired like the Methadone though.

Have you tried discussing the problem with your doctor, and asking if there isn't something you could take along with the Methadone, that would keep you more awake / energetic?

I think someone around here has taken something for that.

[Polar Bear]

Hi Maria, I use the tramadol to supplement requip, but only use total of 150 mg tramadol per day. Symptoms are still not fully relieved, and I don't think the tramadol on its own would be sufficient for me unless at a much higher dose than I am taking.

I use the cocktail of the two drugs rather than a very high dose of one particular drug.

[runkrun]

Maria, I'm doubtful Tramadol will cover you enough after being on Methadone.

[Neco]

And I think its worth saying. I know you want to keep your medication regime as simple as possible - but sometimes this just isn't going to happen, especially with RLS.

I suppose it comes down to what you feel most comfortable with. I certainly wouldn't want to be taking something for a side effect of something else, and then something else to cover other side effects, ad nausea...

However if its only a matter of one additional medication, it may just be worth it to stick with what is working. It all comes down to personal choice, but many of us have been or still are on polydrug treatments because they are simply the most effective way to manage it.

[Maria]

"polydrug"! I love that - it sounds kind of Willy Wonka-ish.

So do I hear you saying that methadone may be a one-way trip?

Maria

[ViewsAskew]

Most of us who are on methadone got there because NONE of the opioid drugs that pack a lighter punch worked for us and the DAs and other drugs weren't effective.

So, it's hard to go back, I think. If the RLS was "bad" enough to need this level of drug, it's going to be difficult to find something else that is less effective to cover the symptoms.

Now, if the methadone was used prior to trying some other stuff or a "cocktail" of things, then you might have luck.

So, guess it depends on how you got here, if that makes sense.

[Neco]

True,

Many people who are on Methadone are on it because even if lesser things worked in the beginning, it would become ineffective or require such large doses of lesser strength drugs that it would draw undue attention from the authorities, or their doctors may not have been comfortable with the amount needed.

Although in my case I ended up there, to try and deal with my opiate addiction, I still would have likely ended up on it at some point.. The main problem with the weaker meds is not that they necesarrily don't take care of RLS, but that they are short acting medications that would eventually wear off too fast and require constant redosing, increasing the frequency of raising the overall dose because of tolerance building faster than someone with less severe RLS and dosage needs.. Methadone, even though it is a short acting med, is very successful due to its long half-life - but that is a double edged sword for people with side effects like fatique or tiredness.

However, adjusting back to lower strength opiates should be entirely possible, it just isn't an easy process for most people. Methadone by nature has an extremely high affinity for opiod receptors and will compete with other opiates for binding privileges. The reason it is so successful as drug maintenance for Heroin, etc is because it will keep those opiates from binding (there is a sliding scale of effectiveness where you can overcome the blocking effect though) or if they are already present, promptly kick them off your receptors so they can bind instead.

The long half-life makes withdrawal a long period, and it is not necesarrily the amount of pain which makes Methadone withdrawal horrible, but the duration of the withdrawal. Kind of like stopping Requip or Mirapex and having to wait a few weeks for your RLS to calm back down.

Obviously tapering to the lowest dose possible is not an option as we would have no beneficial RLS coverage during the taper. So switching to Hydrocodone, Tramadol, or Oxycodone, would require an initially much higher dose to help cope with withdrawal for a week or two, and keep the pain at bay. However after a couple of weeks, I believe it should be possible to begin tapering your new opiate down to a reasonable dose, and withdrawal should be minimal or a non-issue as long as the taper is done properly and gently.

The big thing here is convinving a doctor to do something like that. Usually when you start a new opiate, you start at the lowest dose possible, although when tapering from strong to weak the process is obviously somewhat reverse. If you suck at explaining the idea to a doctor they'd probably think you're nuts or just want to get high or something, without taking into account the end result of a lower dose than you started with.

There is also the risk that, your RLS may be unmanageable as you begin to lower the dose.. It depends on several factors, all of which I don't know I'm sure.. But if your RLS has progressed in severity (unnoticed because of the strength of the Methadone) and you try to get by on a lesser opiate, you may only notice it then..

In terms of tolerance and a lower strength opiate "not cutting it" because you were on Methadone - I don't think this is a big issue. Methadone is supposedly good for recovery as it allows your receptors to "heal" from burnout and whatnot, and allow you to produce natural endorphins on your own again (and all of us on opiates are likely dependent on them for endorphins as we have to take them every day and the body doesn't produce what is being given in ample supply from an outside source).

Hope none of this is confusing or scaring you.. Just kind of rambling trying to explain the big picture.

There's no reason not to try tapering down to a lower strength opiate, but given that you're on Methadone already, and it works, sometimes we just feel like its easier to add an additional medication to deal with something. It all comes down to personal choice and risk vs reward vs quality of life.

[Betty/WV]

Zach, you amaze me. You are a perfect example of what my new neurologist said, He said, "You know more about RLS than I do, because you have it and research it".
You seem to know so much about RLS and the drugs used to treat it. I'm learning!!! I would love to hear you (being a little fly on the wall) discuss this subject with my doctor. I've learned so much just reading your posts, and others also. And it all makes so much sense.
For years I knew nothing about this weird ailment that I was afflicted with. And I didn't know anyone else experienced the same misery.
Boy, the things I've learned. And I thank you all for helping me on this journey.

BETTY/WV P.S. Even though my new doctor seems young and inexperienced, I'm going to stick with him because he is really trying to help me and I think he is learning along with me. And he is doing the research also.

[Maria]

Zach, you do bring such clarity to this issue – your “rambles” have much more the character of a 400 meter sprint in the way you focus on what works and why. I ramble; you elucidate!

[Neco]

Praise makes me nervous, or maybe that is just the guilt complex I've carried around forever, I don't know..

I like being able to help others and explain things to them, but I always encourage everyone to do their own research.. Even if I get one thing wrong, if someone acts on that wrong piece of information, or uses it as part of a justification for going ahead with a decision, and bad things happen, then I will feel bad too.

But, you guys can be just like me too. Just read, read about whatever interests you to do with RLS, and you will see things jump out in a sentence that interest you too, and cause you to do more research and so on..

It's kind of shameful to admit, but most of my knowledge about pharmaceuticals and other drugs comes from both an interest in reading about them, reading experience reports, and through some of my own experiences with experimentation. Because I just find it fascinating to read about and in some cases, try for myself.

The big hurdle is overcoming the fear of writing big drawn out posts like mine. I have the confidence that I am informed in what I'm saying, and that's the only reason I do it (plus I like to explain what I am saying in clear terms).

But sometimes I don't post things because I am not sure either.. And sometimes I still get corrected, but anyone can do this!

[ViewsAskew]

Zach's point is well taken. Sometimes he's not right, as he's pointed out. Sometimes I'm not right. Sometimes someone PMs me to tell me when I goof, sometimes I figure it out and correct it, but I bet sometimes I don't know and there it is for anyone to read and think the wrong thing.

No matter which one of us says something, ALWAYS verify any drug information either through your own research, a call to a pharmacist, etc.

We are not doctors, more importantly, we're not perfect. We think erroneous things, we type things wrong, we out and out are wrong sometimes.

So, please be careful.

[Polar Bear]

Zach and Ann, your comments are noted, but please continue as you have been doing.

We all appreciate your efforts, and we all know that they are your own personal comments - and not those of a doctor etc.