Can methadone augment??

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mudslide
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Can methadone augment??

Postby mudslide » Thu Oct 16, 2014 3:32 pm

Here goes with a third thread. Sigh. I'd been doing pretty well sleepwise with methadone for two, maybe three months. Dosage varied between 5 and 10 mg; thought I'd gotten stabilized on 7.5. Just took it before bedtime. Side effects were dry mouth, constipation, and random overheating plus drenching sweats when exercising. The side effects were getting pretty old, so I asked for and received a scrip for the Neupro patch. It worked like a charm for the RLS but I only took it four nights because it turned out to cause insomnia. Over those four nights I reduced the methadone to 5 mg, 2.5, zero, and zero -- except that the last two nights I ended up taking off the patch around midnight and dosing with methadone to get to sleep; don't remember the doses then.

So ever since then, the methadone's been acting as if it were augmenting, although Dr. B. advised me that opioids don't augment. I've had symptoms in the afternoon, which hadn't happened since I got off Mirapex; I have to take additional doses during the night because of waking with sx; and in the morning I have to get up because of sx even if I haven't slept long enough. I've cut the pills into not just halves but quarters to try to keep the doses as low as possible, because I have learned the hard way (no pun intended) that constipation can be a real problem even with Citrucel on board. (TMI: I have pooped like a champ all my life and am not used to fretting about BMs.)

I'm getting the impression that at the very least, methadone does not like to have its doses tinkered with too much. (The day after my trial with the Neupro patch ended, I was overheating constantly for no good reason.) But this really does feel like augmentation. Does anyone out there have similar experience, or can you otherwise shed light on what's going on here? On Sunday I'll be leaving on a 10-day trip that involves 7-hour plane flights out and back, and I know you can relate to the anxiety I'm feeling about that prospect.

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Neco
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Re: Can methadone augment??

Postby Neco » Thu Oct 16, 2014 8:04 pm

Did you stop the Methadone while trying the Neupro? Were you on other opiates before Methadone?

If so that might have something to do with it. Coming off long-term opiates (and maybe even short term?) you will go through a period of increased symptom intensity. When I came off opiates altogether I went through a horrible period of just over 2 weeks where my symptoms were very bad and then they started to calm back down. They're still worse than they were back when I was diagnosed but I chock that up to natural progression of the disease more than anything.

For the 4 years I was on Methadone it was great, I usually took staggered dosages a few hours apart, up to 20mg daily. One thing you can try is taking some in the morning and some in the afternoon or evening, and seeing if that stabilizes things at all.

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Re: Can methadone augment??

Postby ViewsAskew » Thu Oct 16, 2014 8:12 pm

I think you may have made too many changes at once.

Neupro works by keeping a steady stream in your system. Taking off your patch isn't a good thing to do - it would increase the likelihood of augmentation. It's the steady stream that reduces the likelihood of dependence.

As Neco said, stopping opioids often causes increased symptoms that are very similar to, but essentially different from, WED, as I understand it. On the message boards, everyone calls it WED/RLS, but the doctors assure me it is a withdrawal symptom that is different. I honestly do not know much about it other than what I've read. If it isn't really WED, it may not respond to WED treatment (ie the patch). So, you might have to completely withdraw from methadone, take a week or two to stabilize, then try the patch again.

Or, try the gabapentin option and see if that solves the insomnia and leave the patch on. Might work.

Dr B is right - you cannot augment with opioids. You can, however, become tolerant. But, I don't think that is what's happening. I'd vote with opioid withdrawal.
Ann - Take what you need, leave the rest

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mudslide
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Re: Can methadone augment??

Postby mudslide » Thu Oct 16, 2014 11:39 pm

Thanks, Ann and Neco. Let me describe the situation in a slightly different way, with some added info. I have been taking the methadone a little longer than I originally estimated -- it's been 4 months. (Before that, while I was quitting Mirapex, I gave oxycodone a try. That lasted maybe 2 or 3 weeks.) So on the 4 nights when I was trying the Neupro patch, I reduced the methadone dose as follows (in conjunction with using the patch): 5 mg, 2.5 mg, and then 2 nights without any methadone to begin with. However, on those nights the insomnia was clearly going to keep me totally sleepless; that's when I removed the patch and took some more methadone, which eventually let me sleep. So I am not "coming off" the methadone. At worst, I took one dose outside the low end of my range, the night I took 2.5 mg. My doses have generally been between 5 and 10 mg. Any higher than that and the drowsiness gets troublesome.

So… I'm still puzzled by what's going on. However, I think I have to stick with the methadone until I return from my trip. Today my doc wrote me a prescription for gabapentin, so I could see if it fixes the insomnia caused by the Neupro. But it seems too close to departure time for me to be starting an unfamiliar drug that could cause daytime sleepiness. I have a 3-hour drive to the airport.

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Re: Can methadone augment??

Postby Rustsmith » Thu Oct 16, 2014 11:58 pm

I would like to possibly cast a different light on your experience with Neupro and insomnia. I have been on Neupro for about 5 months now and had started a low dose of gabapentin for a different reason about a month before that. When I switched from pramipexole to Neupro, I also started experiencing more insomnia. When I asked my doctor about this, he increased my night time gabapentin dose. I think that what was happening was that the Neupro was treating the urge-to-move part of WED but because the dopamine levels at night are lower than I had with pramipexole, I was not getting any benefit for the insomnia (note that I change my patch first thing in the AM). The role of the increased gabapentin at night is therefore to treat the insomnia side of the WED. My "proof" of that has to do with the fact that I have been waking up at 4AM sharp every morning (I haven't sent an alarm for months) and that includes the nights when my WED breaks-through the Neupro so that I don't get to sleep until 1AM. Interestingly, 4AM represents almost exactly the half life of gabapentin from the time that I take it at night.

As for daytime sleepiness, mine hasn't been anything that a cup of coffee won't fix.

And, good luck on your trip. I hope you arranged for an aisle seat in both directions. The extra leg room and the knowledge that you are not trapped can be of immense help.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

ViewsAskew
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Re: Can methadone augment??

Postby ViewsAskew » Fri Oct 17, 2014 3:10 am

Methadone has a LONG half life. It can take up to 4 or 5 days to feel the full effects of stopping it. You never went that long.

The insomnia is separate from the increased symptoms. THAT is the patch, most likely as we discussed in another thread yesterday or the day before. And, that Steve is agreeing with above. We suggested you try gabapentin to deal with the insomnia.

The increased symptoms have to come from somewhere. It's not likely augmentation from the patch, though it could be. It's most likely to be related to stopping the methadone. You never were off of it completely for at least 3 or 4 days. That would tell the full story.

I easily could be wrong - I'm not a doctor. But, that's how I hear what you're saying.

If it were me, I'd do the following:

Get some gabapentin - it's the least expensive of that class.

Try the patch with it.

Reduce the methadone more slowly. Say 2.5 mg every 3 to 5 days.

You WILL likely have something happen that you don't like. Just try to deal with it. Once you've completely stopped the methadone for 3 to 4 days, reassess. It could take several weeks at that point to stop any withdrawal symptoms, if there are any.
Ann - Take what you need, leave the rest



Managing Your RLS



Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

pjmccoy1
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Re: Can methadone augment??

Postby pjmccoy1 » Fri Mar 06, 2015 3:00 am

Mudslide,
Based on what I've read everywhere here opiates are not suppose to augment. However, this was my concern when first started methadone, that being, tolerance then withdrawal RLS symptoms. Of course withdrawal RLS symptoms are not exactly the same as primary RLS it's still very uncomfortable. I had to stop methadone (very low dose) Tuesday evening and by Wednesday afternoon I was not only feeling nauseous and overall malaise. Anyhow, we may not augment on methadone, but in my short 4 month trial of methadone until other issues developed, I was experiencing tolerance and withdrawal RLS within 12 - 14 hours of my dose. (I only took one dose in the evening. It was usually almost exactly at the 12 hour mark first flare up would occur then would settle and then again 3 - 4 hours later. Anyhow, how are you doing now? And if I may ask, what are you using for RLS treatment now?
PJ, Heaven Bound


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