oxeyneo

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mapleleaf
Posts: 27
Joined: Thu Oct 11, 2012 5:22 pm

oxeyneo

Post by mapleleaf »

I have been using oxeyneo the slow release for more than a year . 20mg at 6am and 20mg 6pm... 1.25 of miraprex ....than I started using 5mg oxycodone for breakthrough about 3 times in 24 hrs. My dr. thought I should up the oxyneo to 30mg 2x a day. That eventually also needed breakthrough 5mg oxycodone. 2 weeks ago I went to 30mg of oxyneo every 8 hours. it really helped but then I started to get breakthrough pain in my shins and calfs!! So my dr. told me to cut the oxyneo back to 20mg 2 times a day. WELL talk about with drawls the first day... the seocond day went back to 30mg 2 times a day and some 5mg of short acting oxycodone. It is day 5 and I still feel crappy, maybe a little better. I am going to take 30 mg of oxyneo at 6am, 20 mg at 2pm and 30 mg at 6pm....after a week I will then try to go to 70mg of the oxyneo in 24 hr. period.

My pharmacist asked why I don't change opiods like using a patch? Im from Canada so it all my seem different than the states. Can anyone give me an idea of what to try? been suffering with RLS/WED for more than 16 years.
Also would going to a place like "' The John Hopkins Restless Leg Medical Center " or a place like that worth while?

Please help ...all of you sufferers know how desperate things can get.....thank you for your answers....

ViewsAskew
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Joined: Thu Oct 28, 2004 6:37 am
Location: Los Angeles

Re: oxeyneo

Post by ViewsAskew »

May I ask if you're still using pramipexole? If you are, and at that dose, it's likely many of your extra symptoms are caused by it.
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.

mapleleaf
Posts: 27
Joined: Thu Oct 11, 2012 5:22 pm

Re: oxeyneo

Post by mapleleaf »

so the pramaperxeral is the cause...I guess I should ween off of that....and that will be a hard one to ween off right?

mapleleaf
Posts: 27
Joined: Thu Oct 11, 2012 5:22 pm

Re: oxeyneo

Post by mapleleaf »

My dr. has suggested that many times....will just the oxyneo and oxycodon control my legs?

badnights
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Joined: Tue Mar 10, 2009 4:20 pm
Location: Northwest Territories, Canada

Re: oxeyneo

Post by badnights »

Mapleleaf, does your doctor have experience treating augmentation? It would be best if you could work with an experienced doctor, but if that's not possible , you can still work with an inexperienced doctor who is open to learning about it.

Some of the basics: pramipexole can (usually will) cause augmentation, that is a worsening of symptoms. Usually, they start earlier in the day, spread to the arms or other parts, and grow more intense. Increasing the dose helps for a time but ultimately just adds fuel to the fire - the augmentation gets even worse. The only solution is to get off the pramipexole. Most WED/RLS specialists now recommend not returning to any of the dopamine medications even after you've cleaned it out of your system; the best course is to replace it with a different class of medication, or combination of classes (eg. anti-convulsants or opioids). Some specialists are still keen on rotigotine, however, which is a dopamine agonist in long-acting patch form.

Coming off the dopamine agonist medications involves a further worsening of symptoms. This withdrawal phase is a period of intense agony without the possibility of sleep for a number of days. Most people can snatch an hour or two here or there after the first day, and begin to see a light at the end of the tunnel after 3 days, sometimes after 5 days. It is still a tough slog for a total of a week, at least, and possibly up to 3 or 4 weeks but usually under 2. It helps immensely if:
1. your doctor prescribes a potent opioid - in your case, ups the dose - to get you through the withdrawal period, and
2. you don't expect anything of yourself for the first 5 days - take leave from work, remove all social obligations from your calendar.

Tapering is not a good idea unless you're on a high dose (eg. 4 mg or more), in which case you might have adverse medical events if you quit cold turkey. If you're 1 mg or less, stopping cold turkey should be safe but you would have to confirm that with a medical professional. The reason tapering sucks: full-blown withdrawal starts as soon as you start tapering. So get it over with by going cold turkey if you can. Don't expect to cover off all your symptoms or even most of them during withdrawal. Hang on for three days and you'll see it get better day by day after that. Other people have done it, you can too.

Once you have gotten over the withdrawal, your symptom severity will be down at your new baseline - probably higher than when you started the pramipexole, but lower than your current augmented symptoms.

Opioids like the slow- and fast-acting oxycodone formulations that you're on are the most effective medications known for controlling WED/RLS, so yes, by themselves they will be just fine. It's a good idea to rotate the type of opioid you take, eg. switch from oxycodone to hydromorphone for a month, if you can tolerate those other types, in order to prevent tolerance and dose creep. It would also be good to try to keep the overall opioid dose low by supplementing with an anti-convulsant, if you can tolerate those.

Please take the plunge and see if you can work with your doctor on this - once you're off the pramipexole and stable on your new meds, you'll feel like you've been granted a new lease on life. It will be sooo much better! You will have a life again!

Some resources to give your doctor if he's not familiar with treatment of WED/RLS augmentation:
- Click the link under my name below. The page that opens has a number of references that deal with augmentation and the role of iron in augmentation. Any or all of the first four would be good to bring. I recommend the Foundation's handout on augmenation (2nd item) and Buchfuhrer's paper (3rd one).
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.

ViewsAskew
Moderator
Posts: 16571
Joined: Thu Oct 28, 2004 6:37 am
Location: Los Angeles

Re: oxeyneo

Post by ViewsAskew »

mapleleaf wrote:My dr. has suggested that many times....will just the oxyneo and oxycodon control my legs?


Smart doctor! As badnights wrote, it won't be fun, but it's worth it. Everything she wrote was excellent info. To recap,

1. Work with your doctor to stop the pramipexole - if you're at 1.25 mg, you should be safe just stopping it, but check with your doctor.
3. Use the opioids to help get through the next few days after you stop - it might be tough, but you can do it - many of us have.
4. After 3 to 6 days, most people are feeling better, and by day 10-18, things should be much better.
5. Once you are off the pramipexole, either rotate opioids to prevent tolerance and increasing your dosage, or try one of the alpha 2 delta drugs, such as gabapentin or gabapentin encarbil.
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.

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