Switch from Oxycodone to Methadone? Whatcha think?

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Joanie60
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Joined: Thu Mar 15, 2012 2:48 pm

Switch from Oxycodone to Methadone? Whatcha think?

Post by Joanie60 »

Hey Peeps,

I have been on 5mg Percocet three times a day for the last several years. I am inching up towards 20mg (couple times a week I need a fourth pill in the middle of the night). My doc is concerned, she has very few patients who require 20mg. (BTW, I have tried every med, including iron infusion and long acting Oxys but this is only thing that helps without unbearable side effects). I am leaving for two months in Germany and when I get back, she would like to switch me to Methadone.

What are your thoughts???? I am a bit apprehensive about leaving behind the Percocets cause they are the only things that work. But I live with varying levels of symptoms 24/7. Only a couple hours a day when I don't think about them. So it seems to make sense to try the Methandone, but I would like to hear what you guys have to say.

On a side note, I went in for routine colonoscopy and had to tell the anesthesiologist about RLS/WED and the fact that I am on Percocet for it (I have had breakthru symptoms while in surgical twilight sleep) . After frowning and shooting looks of extreme judgement at me, he freaking asked if my doctor knew I was taking Percocet???? Ummmmm, are you for REAL??? I am putting my very life into your hands for this surgery and you think I am scoring opioids on the street?? What the HECK. Fortunately, I had a lovely nurse anesthetist for the actual procedure and never saw the "horse's ****" after that first consultation. Pissed me off, in case you can't tell lol.

Anyway, I'd love to hear your stories about oxycodone v methadone :-)

Hugs and here's to a great weekend!

Joanie

ViewsAskew
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Re: Switch from Oxycodone to Methadone? Whatcha think?

Post by ViewsAskew »

All I can say is that I'd take methadone ANY day over oxycodone. But, that's because the oxy makes me very tense and angry. I have almost NO effect from the methadone. All other opioids cause me to be angry, annoyed, and feel tense and uptight. So, easy choice here!

That said, since some of us do have problems with tolerance, if I were new to opioids, I'd never want to take them without knowing that tolerance can happen to some of us and having a backup plan in place. It sounds as if you may also have tolerance issues. I stayed at 25 mg for almost 4 years, but during 2 of that, I used pramipexole every third day in place of the methadone. It was GREAT...until the side effects from the pramipexole became too much to tolerate. After two years of every day use, the 25 mg has long stopped working for me and every night I'm up and down multiple times.

To me, we all have to have a way to keep that dose down - I just don't like the options. For people such as yourself (or me), there seems to be only one option - to stop taking it every so often and be miserable without anything. Doesn't make me happy to do that!
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.

Joanie60
Posts: 194
Joined: Thu Mar 15, 2012 2:48 pm

Re: Switch from Oxycodone to Methadone? Whatcha think?

Post by Joanie60 »

How long would I have to stay off the Oxys to "re-set" my brain??? I can't even begin to imagine the hell that that would be.

Oxys do not make me angry or tense or annoyed. In fact, the opposite. They seem to make me MORE tolerant and upbeat. But maybe that is just because they alleviate the symptoms for a time. The deep deep DEEP aches just drive me nutty during the day. The dancing limbs drive me nutty at night. Hmmmm. Without the several hours after each pill of relief, I would probably not be fit to live or work with :-)

Since I will not be working while in Germany, perhaps it would be a good time to take a "drug break"..assuming a brief break would "re-set" things

Thanks~Joanie

ViewsAskew
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Re: Switch from Oxycodone to Methadone? Whatcha think?

Post by ViewsAskew »

I am not sure. I know that when I took methadone daily, I had to increase my dose approximately once a year. When I took it two days on, one day off, I never had to increase it.

So, do we take a break, say a weekend, ever other week? Every week for 1 to 2 days? I wish I knew. I just know I do NOT want to do it!!!!!! As you noted, I know I wouldn't be fit to live or work with!
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.

cornelia

Re: Switch from Oxycodone to Methadone? Whatcha think?

Post by cornelia »

FYI: when 10 mg of the Oxy's (short and long lasting) didn't help me anymore and after that having tried to lower the dose and supplement with Ropinirole like Ann did I switched to 5 mg of methadone and very soon to 10 mg's. I lived with that for another year. Dr B always says that methadone works better than all other opiates and I must agree. However it is possible that just rotating these opiates made things better because opiate rotation is used with pain patients; they don't have to up their dose that quickly doing that.

I think you might be pleasantly surprised after the change.
Corrie

badnights
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Re: Switch from Oxycodone to Methadone? Whatcha think?

Post by badnights »

I also have heard that opioid rotation works similarly to holidays. IT could be an option for you.

If you did take a holiday, btw, you would have to cover symptoms with a DA or something else, not just tough it out - that would be unnecessary torture.

You should not be on Percocet. You should be on straight oxycodone without acetominophen. why has your doctor allowed you to take an unnecessary drug (acetominophen) all these years? It's extra stress your body does not need to break down and eliminate the acetominophen.
Beth - Wishing you a restful sleep tonight
Click for info on WED/RLS AUGMENTATION & IRON
I am a volunteer moderator. My posts are not medical advice. My posts do not reflect RLS Foundation opinion.

Joanie60
Posts: 194
Joined: Thu Mar 15, 2012 2:48 pm

Re: Switch from Oxycodone to Methadone? Whatcha think?

Post by Joanie60 »

We did try straight oxycodone. Had terrible nausea, constipation, and exhaustion. Which I don't have on Percocet. Go figure, I sure can't.

badnights
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Re: Switch from Oxycodone to Methadone? Whatcha think?

Post by badnights »

Oh! That's something I haven't heard of. Interesting!
Beth - Wishing you a restful sleep tonight
Click for info on WED/RLS AUGMENTATION & IRON
I am a volunteer moderator. My posts are not medical advice. My posts do not reflect RLS Foundation opinion.

Joanie60
Posts: 194
Joined: Thu Mar 15, 2012 2:48 pm

Re: Switch from Oxycodone to Methadone? Whatcha think?

Post by Joanie60 »

Very annoying, cause it is much easier to take a long-lasting pill than a short acting one. But from what I have read, methadone is longer acting than Percocet so maybe I'll have the best of both worlds. I am hesitant to switch, as nothing has worked as well as Percocet, but my doc is really really trying to find relief for me. And for that, I am grateful!

badnights
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Re: Switch from Oxycodone to Methadone? Whatcha think?

Post by badnights »

I use the long-acting version of hydromorphone, called hydromorph contin. It has been very effective for me with almost no side effects.

There are a number of other potent opioids (besides oxy, hydromorph, and methadone) but they are not as common. Oxymorphone is one, the fentanyl patch is another.
Beth - Wishing you a restful sleep tonight
Click for info on WED/RLS AUGMENTATION & IRON
I am a volunteer moderator. My posts are not medical advice. My posts do not reflect RLS Foundation opinion.

QyX
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Re: Switch from Oxycodone to Methadone? Whatcha think?

Post by QyX »

I can't see why taking 20 mg of Oxycodone is an issue and considered "a lot" or "much".

I take 16 mg of Hydromorphone (8 mg twice daily/every 12 hours) which equals 60 mg of Oxycodone and 120 mg of Morphine.

The first potent opioid I tried was Oxycodone. I started with 10 mg per day, 5 mg twice daily and after 5 months I was taking around 60 mg and then on some days up to 80 mg. I even tried 100 mg Oxycodone per day but there was no improvement. Since August 2013 I am stable on a dose who equals 60 mg of Oxycodone. I have to say that my feeling on Oxycodne was that I have some kind of small tolerance issue there.

My feeling was that there was no such issue on Morphine and for sure not on Oxycodone. I always was taking long acting pills and I had to take 3 doses of Oxycodne per day. Same with Morphine, every 8 hours. Hydromorphone was working much better. Here I benefit the full 12 hours.

Some people just need more. Finding the right dose for long term treatment is a very individual thing. I would raise the dose as long as it necessary. Of course there are some limits. Lets say if you reach 100 mg per day and you still need to raise the dose every 4 weeks, I would consider adding a 2nd drug to support the opioid. For example I take Carbamazepine. This really improved things. I was on 16 mg of Hydromorphone but still had pain here and then and other unplessent feelings in the legs. I tried higher doses of Hydromorphone but again, there was no benefit. It was the same when I tried higher doses of Oxycodone.

When you need opioids the whole day, I would try finding a extended release version. You said you had problems with extended Oxycodone. You could try extended release Hydromorphone, Morphine and Oxymorphone. It is just much more convenient. Here in Germany with even have a 24 hour Hydromorphone version. I might try this pill. I find it annoying to take a pain drug every 12 hours. The pain comes back when the drug stops working and often I am lazy to look for a pill or stand up, go upstairs and take a pill. And often I wake up when the Hydromorphone stoped working. So I have to open these nasty safty packages which sometimes can be a tricky thing and take a pill ... and then it takes 10 minutes until they work and before I can continue sleeping.

Taking short term Hydromorphoe really would annoy me.

You can try Methadone. There is no real extended release of Methadone. It just generally works longer and accumulates when you take it for some days. It also possible to add Oxycodne to the Methadone when you need extra relief during the night but my guess is most doctors will be reluctant to prescribe two different opioids. I still don't really see what the issue with the extended Oxycodone was. You might wanna try a different generic version or the original Oxycotine ... or Hydromorhpne. I never was happy with Oxycodone. Morphine was much more stable but it still only worked 8 hours. So I tried Hydromorphone and it is really the best for me.

Have to say that I never tried Methadone. I read a lot in discussion boards were opioid addicts describe their treatment with Methadone and most of them are not happy with it. In my estimation 80% would prefere Morphine or Oxycodone/Hydromorphone. Methadone is well known to cause insomina and loss of libido/sex drive. This might be different when you have RLS but I don't really know. The only RLS patients I know who take Methadone write here on the board and this are not enough to tell how Methadone is likely going to work for you.

I tried 55 different drugs and alone 6 different opioids. Experimenting with different opiods wont hurt and isn't that complicated when you are already used to opioids. It is a trial and error thing. Taking only short term working opioids might be factor for development of tolerance.

Neco
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Re: Switch from Oxycodone to Methadone? Whatcha think?

Post by Neco »

I would opt for the Methadone if you have a doctor willing to prescribe it.

Methadone can generally give you 24/7 relief if dosed properly. You just have to nail down how much you need at one time, and at what interval you need repeating doses.
When I was on Methadone (I got forced off it by an idiot who took over the practice, and now I take nothing) I was on 15 - 20mg daily for 4 years straight without any real issues. I usually took my doses over a staggered time period of 4 - 6 hours (do not suggest this to doctor as it may throw up a red flag), and then I was golden until the next day. In a lot of cases I could go longer than 24 hours before truly needing to re-dose. i.e working late and not being home for my usual dosing schedule or something like that.


Start low and go slow. 2.5mg (break a 5mg in half) and see what that gets you and for how long. The only real issue I had was hot flashes which either came from not dosing early enough, or from the medication itself as it began to work in my system. I was never able to figure out which it was though. But it was a small price to pay for no RLS.


I've noticed a rise in people asking about Methadone over the past year or so, and all I can say is I wish I lived where you people did so I could find one of these doctors willing to prescribe it.

Joanie60
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Joined: Thu Mar 15, 2012 2:48 pm

Re: Switch from Oxycodone to Methadone? Whatcha think?

Post by Joanie60 »

I'll let you guys know how it goes! I am getting hot flashes now anyway hahah (I am 54, it is about damn time) so a few more won't hurt. They don't really bug me that much.

Once I ran thru the usual set of meds (Requip, Gabapentin, etc) my doc wanted to start me on Methadone but knucklehead that I am, I too have a hard time with the name of that med. So I asked if Percocet was ok and she said yes. Percocet has served me well, and if I have to go back to it, that is ok too, but I would love to have a 12 block of relief...that seems like nirvana right now :-)

Thanks for your thoughts QyX..not sure any doc around here would prescribe Dilaudid for RLS but it sounds like it is working for you!! I do wonder if the tolerance has been caused by only using short-acting opioids?? That is an excellent question, one I do not have the answer to. Wish I did.

I am determined to go for an entire month without bugging my doctor once I start on methadone. I will just complain here about any side effects and give them time to wear off. I really want this to work and like Neco says, I am one lucky gal to have a doc willing to prescribe it!

Happy New Year!

Neco
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Re: Switch from Oxycodone to Methadone? Whatcha think?

Post by Neco »

Not buggins the doctor is an admirable goal. But you probably want to keep in touch with them for the first week. i.e if the amount you are prescribed turns out to not really be enough, etc.
Typically though 15mg (5mg 3x a day) seems to be a good level for a lot of people.


The only thing you may notice, is fatigue/tiredness. I forgot to mention that. It was not unusual for me to take a nap in the middle of the day when it was possible to do that. But aside from insomnia here and there, being on Methadone was the most drastic change that helped me get on a proper, permanent sleep schedule. Going to bed at night was usually not much of a problem - and I've had insomnia since childhood so it was a great 4 years in that respect.

Joanie60
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Joined: Thu Mar 15, 2012 2:48 pm

Re: Switch from Oxycodone to Methadone? Whatcha think?

Post by Joanie60 »

Thanks for the hope! I have no idea of what dose Doc plans to start me out with, but guessing it is lowest that is made lol. I won't hesitate to ask her to up the dose some, but my pattern is to throw in the towel too quickly. I really really want this to work! My husband and I have our own business and work from home office, so I can take a nap if necessary. For the last year or so, despite LOVING naps, I have not been sleepy enough to take one, no matter how little sleep I get at night. Weird I know :roll:

Joanie

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