Methadone Users
AARgh. Well, I guess the appt went OK. He was very concerned about my sleepiness behind the wheel and did not want to increase the methadone. Since I was not comfortable at this dosage, he wanted to switch me to a fentanyl patch 25 micrograms/hour. However, I thought the fertility doc would freak out with fentanyl so I said let's go with hydrocodone and see if it works (to to 30 mg/day - 10 mg, 3 times per day,but can increase to 4 times per day if needed).
I called teh fertility doc and they were ok with hydrocodone but not fentanyl. I called teh neonatologist and they were ok with either drug - said nearly all the opiates are the same - no birth defects just possible withdrawal syndrome for baby. I called the fertility doc back to tell them that what the neonatologist said about fentanyl but I haven't heard back. The neurologist really feels lthat fentanyl is the best option for me - you only have to change the patch every 3 days - so I really WANTED to do that, to feel better, you know? but I still want to try for that baby and my husband and inlaws really want it too. I know I shouldn't feel pressured by that but it does sit there in teh back of my mind. SO, here we go on another medication trial period . . . Best part was that he gave me lots of options to deal with the constipation . . . I didnt know it was oK to take constipation remedies every day - I was always told that was bad - but neurologist said that lots of folks have to because of their medical situations and it was fine. Yay.
I called teh fertility doc and they were ok with hydrocodone but not fentanyl. I called teh neonatologist and they were ok with either drug - said nearly all the opiates are the same - no birth defects just possible withdrawal syndrome for baby. I called the fertility doc back to tell them that what the neonatologist said about fentanyl but I haven't heard back. The neurologist really feels lthat fentanyl is the best option for me - you only have to change the patch every 3 days - so I really WANTED to do that, to feel better, you know? but I still want to try for that baby and my husband and inlaws really want it too. I know I shouldn't feel pressured by that but it does sit there in teh back of my mind. SO, here we go on another medication trial period . . . Best part was that he gave me lots of options to deal with the constipation . . . I didnt know it was oK to take constipation remedies every day - I was always told that was bad - but neurologist said that lots of folks have to because of their medical situations and it was fine. Yay.
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ViewsAskew
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Helen, it sounds like there is a bit of conflict here...hard to please everyone, isn't it?
I don't know you...and what I'm about to type may come across as insensitive - it's not meant that way. I hear some ambivalence in your post and am trying to explore that. Maybe not my place...so just tell me it's not if that's the case.
What do you, in your heart of heart, want? Is one child "enough" for you? If not, are you willing to explore other ways to bring children into your life other than biological conception between you and your husband? Do you want to go through this?
You are the most important person in this equation - you feeling well and being able to be a good, happy, able mom.
I don't know you...and what I'm about to type may come across as insensitive - it's not meant that way. I hear some ambivalence in your post and am trying to explore that. Maybe not my place...so just tell me it's not if that's the case.
What do you, in your heart of heart, want? Is one child "enough" for you? If not, are you willing to explore other ways to bring children into your life other than biological conception between you and your husband? Do you want to go through this?
You are the most important person in this equation - you feeling well and being able to be a good, happy, able mom.
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.
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.
Well, To be honest if the methadone was not holding you over properly, I don't see how Hydrocodone possibly could.. You may even find it very difficult to adjust to it.. At least I seem to have had a hard time in the past when I had to step off methadone for short periods.. 8 a day was barely holding me over and I was still getting ansty movements and pain during that week I had to wait with only the hydrocodone.
I hope this doesn't happen to you though.. Yeah all opiates are probably the same, but I would be concerned about the amount of tylenol.. A Fentanyl patch may be a good solution.. But I don't know much about fentanyl or the kind of dose necesarry for RLS relief - you have to keep that in mind.. I doubt its less than safe to just slap 2 or 3 patches on at the same time, and being that it is distributed in such a small amount per hour, I'm guessing its extremely powerful.
But hopefully you will find something that works.. However all opiates are going to give you side effects such as tiredness, nausea, etc that you either will or will not get used to.. So any one of them could be better or worse than methadone.. Time release sounds like a great option in your case as you have had a lot of difficulty.. So I hope you get a chance to try the patch and I hope it really works out for you
http://www.fda.gov/fdac/features/2006/206_fentanyl.html
You REALLY need to read this page, and ask your doctor if this is safe for you, because this is unlike anything I've ever read.. I suspected it was strong crap, but the investigations about improper instructions and resulting deaths makes me nervous... As does the requirement you be taking 60mg oral morphine, or other narcotics equivalent to that dose before using it..
Don't want to scare you.. I think controlled meds are great, but I question the use of this particular one in your case.. Given the explicit warnings of proper usage on that page
I hope this doesn't happen to you though.. Yeah all opiates are probably the same, but I would be concerned about the amount of tylenol.. A Fentanyl patch may be a good solution.. But I don't know much about fentanyl or the kind of dose necesarry for RLS relief - you have to keep that in mind.. I doubt its less than safe to just slap 2 or 3 patches on at the same time, and being that it is distributed in such a small amount per hour, I'm guessing its extremely powerful.
But hopefully you will find something that works.. However all opiates are going to give you side effects such as tiredness, nausea, etc that you either will or will not get used to.. So any one of them could be better or worse than methadone.. Time release sounds like a great option in your case as you have had a lot of difficulty.. So I hope you get a chance to try the patch and I hope it really works out for you
http://www.fda.gov/fdac/features/2006/206_fentanyl.html
You REALLY need to read this page, and ask your doctor if this is safe for you, because this is unlike anything I've ever read.. I suspected it was strong crap, but the investigations about improper instructions and resulting deaths makes me nervous... As does the requirement you be taking 60mg oral morphine, or other narcotics equivalent to that dose before using it..
Don't want to scare you.. I think controlled meds are great, but I question the use of this particular one in your case.. Given the explicit warnings of proper usage on that page
http://www.globalrph.com/fentconv.htm
Here is a Fentanyl conversion chart.. It seems there are two and I'm a little confused.. one suggest 15 - 44mgs of Methadone is enough to switch to the 25mcg/hr Patch.. but the top-most chart suggests 20 - 44mg Methadone to 25mcg/hr Fentanyl..
Either way based on some of the numbers for Oxycodone its probably safe at your dose of Methadone to switch to Fentanyl at 25mc/hr
However the short period where you are Hydrocodone would be concerning as your tolerance would drop off, and even a couple days can make a difference.. If you have any methadone left, you may want to suggest to your doc taking 5mg 4x a day of Either Methadone or Oxycodone for a couple days then switching to Fentanyl 25mcg/hr Patch.
It is important to work your tolerance up before taking Fentanyl, because unlike other pill forms, you can break anything in halves or quarters like you could with Methadone, etc when first starting out.
PLEASE do read the FDA link I posted, because there are things you can NOT do under any circumstances with Fentanyl.. Alcohol and benzo's or other tranqs or sedatives obviously.. But heating pads, multiple patch application, heating blankets, heated water beds, very hot water all=NO NO NO
Here is a Fentanyl conversion chart.. It seems there are two and I'm a little confused.. one suggest 15 - 44mgs of Methadone is enough to switch to the 25mcg/hr Patch.. but the top-most chart suggests 20 - 44mg Methadone to 25mcg/hr Fentanyl..
Either way based on some of the numbers for Oxycodone its probably safe at your dose of Methadone to switch to Fentanyl at 25mc/hr
However the short period where you are Hydrocodone would be concerning as your tolerance would drop off, and even a couple days can make a difference.. If you have any methadone left, you may want to suggest to your doc taking 5mg 4x a day of Either Methadone or Oxycodone for a couple days then switching to Fentanyl 25mcg/hr Patch.
It is important to work your tolerance up before taking Fentanyl, because unlike other pill forms, you can break anything in halves or quarters like you could with Methadone, etc when first starting out.
PLEASE do read the FDA link I posted, because there are things you can NOT do under any circumstances with Fentanyl.. Alcohol and benzo's or other tranqs or sedatives obviously.. But heating pads, multiple patch application, heating blankets, heated water beds, very hot water all=NO NO NO
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SquirmingSusan
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Helen, my pain doctor talked with me about the fentanyl patch at one point, but I was able to just increase the methadone and get enough relief. But it can be an excellent option, especially if you're having problems all day long. I guess my RLS had settled back down to being "just" maybe 12 out of 24 hours, too.
I have skin reactions to everything, too, so that was another consideration for me.
Really, you need to fight for what you think is best for you. For me, the hydrocodone just wasn't really an option anymore because I only got about 2 hours of relief , and I was building tolerance very quickly.
I have skin reactions to everything, too, so that was another consideration for me.
Really, you need to fight for what you think is best for you. For me, the hydrocodone just wasn't really an option anymore because I only got about 2 hours of relief , and I was building tolerance very quickly.
Susan
OK. I am pretty worried now. I don't want to switch off the methadone. (although, the doc says the methadone is what is making me twitch - have you experienced that? I stopped twitching pretty much in the month before I reached 7.5 mg).
I am afraid the hydrocodone won't be enough. If it turns out it is not enough, I can just switch back to the methadone, right? Or do I have to start all over again at 2.5 mg and work my way up again?
If I can control my anxiety, I think I will do much better. That is my goal right now is to get tha tunder control. If only I could take benzos I'd be in great shape I think. Today my RLS was well controlled by the methadone until I was hit with an anxious situation at work).
I definitely am terrified now that fentanyl will kill me or my son. I have a back problem and I NEED my heating pad. Also, how hot a shower is too hot?
Ann- thanks for your concern regarding what sounded like ambivalence in my post. I unequivocally want to have another child. I want my son to have a sibling. I even want to be pregnant again! I just want to do it comfortably (as comfortably as pregnancy can be--knowing that it is challenging even in the best of circumstances). My husband will not consider adoption and we can't afford surrogacy. Once in a while I try to convince myself that we don't need to try for a second child but I'm only convinced for a few hours. I think I'm going to have to keep trying to make this work until it is irrefutably clear that it won't. Sometimes I think I would be a calmer mother if I could convince myself not to pursue this, but I don't know if I would succeeed at that. It's definitely a can of worms.
Thanks everyone.
I am afraid the hydrocodone won't be enough. If it turns out it is not enough, I can just switch back to the methadone, right? Or do I have to start all over again at 2.5 mg and work my way up again?
If I can control my anxiety, I think I will do much better. That is my goal right now is to get tha tunder control. If only I could take benzos I'd be in great shape I think. Today my RLS was well controlled by the methadone until I was hit with an anxious situation at work).
I definitely am terrified now that fentanyl will kill me or my son. I have a back problem and I NEED my heating pad. Also, how hot a shower is too hot?
Ann- thanks for your concern regarding what sounded like ambivalence in my post. I unequivocally want to have another child. I want my son to have a sibling. I even want to be pregnant again! I just want to do it comfortably (as comfortably as pregnancy can be--knowing that it is challenging even in the best of circumstances). My husband will not consider adoption and we can't afford surrogacy. Once in a while I try to convince myself that we don't need to try for a second child but I'm only convinced for a few hours. I think I'm going to have to keep trying to make this work until it is irrefutably clear that it won't. Sometimes I think I would be a calmer mother if I could convince myself not to pursue this, but I don't know if I would succeeed at that. It's definitely a can of worms.
Thanks everyone.
As I said, it wasn't my intention to scare you.. Also, I think if you put the patch on your arm for instance, or an area away from the heating pad you might be OK.. You could make a list of questions to go over with your doc.. But I am also worried how it will affect your baby, especially when it is born and has to withdrawal.. I imagine the methadone would be difficult for it, but I would think Fentanyl being so much stronger would probably be even worse.. The good news about opiate withdrawal is while it can be excruciating depending on what you withdrawal from, it is never fatal.. You get flue like symptoms and hurt all over at the most..
Going back to Methadone after a couple day on Hydrocodone probably isn't going to hurt you much, if at all.. The week I spent on 40mg over 24 hours didn't seem to hurt me at all. I went straight back to 15-20mg + (this was when I still controlled my med rations)..
Yes, the ticks are normal. My doctor told me he had a cancer patients family ask the same thing. I also suffer from ticks, still do actually about its been 6 months. However they aren't life threatening or interfering with driving or anything serious. So I don't mind. My ticks have decreased slowly over time and I am hoping they will fade entirely within a year or two. I think my tramadol/luvox induced seizure is playing a part in the severity and frequency though.
I have to reiterate again.. I think you will find a lot better relief if you split your doses up 3x a day at 5/7.5 - 10mg per dose.. I know tiredness seems to be an issue for you... Maybe you should ask the doc about a medicine to keep you more alert, IF it will be safe for your baby.
Aiken had problems with tiredness and he is on a combo of Hydrocodone/Methadone and says it is a lot better now than with just Methadone. Perhaps he can give you some dosing insight and maybe you can discuss the combo with your doctor.
In the end there is always Oxycontin if you can afford it.. You were offered Oxycodone before, right? Oxycontin is controlled release over 12 hours, so potentially one or two 20mg pills a day is all you'd need (20mg is the lowest dose I am aware of)
I just can't recommend Fentanyl in good concience after doing some research, and I think you should print that stuff out and show it to your doc so he knows why you don't want, period.. I would use it as a last ditch option only
Going back to Methadone after a couple day on Hydrocodone probably isn't going to hurt you much, if at all.. The week I spent on 40mg over 24 hours didn't seem to hurt me at all. I went straight back to 15-20mg + (this was when I still controlled my med rations)..
Yes, the ticks are normal. My doctor told me he had a cancer patients family ask the same thing. I also suffer from ticks, still do actually about its been 6 months. However they aren't life threatening or interfering with driving or anything serious. So I don't mind. My ticks have decreased slowly over time and I am hoping they will fade entirely within a year or two. I think my tramadol/luvox induced seizure is playing a part in the severity and frequency though.
I have to reiterate again.. I think you will find a lot better relief if you split your doses up 3x a day at 5/7.5 - 10mg per dose.. I know tiredness seems to be an issue for you... Maybe you should ask the doc about a medicine to keep you more alert, IF it will be safe for your baby.
Aiken had problems with tiredness and he is on a combo of Hydrocodone/Methadone and says it is a lot better now than with just Methadone. Perhaps he can give you some dosing insight and maybe you can discuss the combo with your doctor.
In the end there is always Oxycontin if you can afford it.. You were offered Oxycodone before, right? Oxycontin is controlled release over 12 hours, so potentially one or two 20mg pills a day is all you'd need (20mg is the lowest dose I am aware of)
I just can't recommend Fentanyl in good concience after doing some research, and I think you should print that stuff out and show it to your doc so he knows why you don't want, period.. I would use it as a last ditch option only
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ViewsAskew
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Reading this thread, it could easily be construed that we were doctors or pharmacists...I just wanted to remind everyone that we are not. While we have a lot of knowledge and sometimes we may know more about RLS meds that other docs, what we don't have is the comprehensive knowledge that many years of medical school provides.
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.
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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cornelia
That's cool...
Ann, I was thinking about this yesterday too.. I had an imaginary fight with my doctor.. lol.. I think it is important to remind everyone we are not doctors, etc..
But I also think its important to recognize, that you don't need years of school and a fancy piece of paper to certify that you are knowledgeable.. That's my defense any way. Obviously I'm not running a clininc or I'd probably be rich or something, lol.. But I think because of the situation with RLS recognition and difficulty getting treated it forces many of us to become, as many have said before, better experts than our doctors.
I think everyone should always consult their doctor, though.
Ann, I was thinking about this yesterday too.. I had an imaginary fight with my doctor.. lol.. I think it is important to remind everyone we are not doctors, etc..
But I also think its important to recognize, that you don't need years of school and a fancy piece of paper to certify that you are knowledgeable.. That's my defense any way. Obviously I'm not running a clininc or I'd probably be rich or something, lol.. But I think because of the situation with RLS recognition and difficulty getting treated it forces many of us to become, as many have said before, better experts than our doctors.
I think everyone should always consult their doctor, though.
The way I have been instructed to switch from methadone to hydrocodone is this:
Days 1-3:
5 mg methadone am
1 5mg/325mg hydocodone apap am
1 5mg/325mg hydocodone apap afternoon
5 mg methadone evening
1 5mg/325mg hydocodone apap eveining
Days 4-6:
2 5mg/325mg hydocodone apap am
2 5mg/325mg hydocodone apap afternoon
5 mg methadone evening
2 5mg/325mg hydocodone apap evening
Days 7-9:
2 5mg/325mg hydocodone apap am
2 5mg/325mg hydocodone apap afternoon
2 5mg/325mg hydocodone apap evening
Then, if needed, increase to 2 pills 4 x per day
However, I left a message asking him if we can reconsider and find a way to keep me on the methadone. Every personal account I read seems to say that hydrocodone won't help if methadone is not doing the job.
That said, in December, 1.5 hydrocodones were covering me OK for 5 hours, so maybe it could work . . . still nervous.
Days 1-3:
5 mg methadone am
1 5mg/325mg hydocodone apap am
1 5mg/325mg hydocodone apap afternoon
5 mg methadone evening
1 5mg/325mg hydocodone apap eveining
Days 4-6:
2 5mg/325mg hydocodone apap am
2 5mg/325mg hydocodone apap afternoon
5 mg methadone evening
2 5mg/325mg hydocodone apap evening
Days 7-9:
2 5mg/325mg hydocodone apap am
2 5mg/325mg hydocodone apap afternoon
2 5mg/325mg hydocodone apap evening
Then, if needed, increase to 2 pills 4 x per day
However, I left a message asking him if we can reconsider and find a way to keep me on the methadone. Every personal account I read seems to say that hydrocodone won't help if methadone is not doing the job.
That said, in December, 1.5 hydrocodones were covering me OK for 5 hours, so maybe it could work . . . still nervous.
It can be real hard, especially when you're trying so many things in a short span of time... I can't imagine how annoyed he might be with the back and forth, but that's not really your fault..
I think you should use the methadone and hydrocone like prescribed, except don't taper the methadone out.. Find a methadone/hydrocodone dosing schedule that doesn't make you tired and balance them both.
See what he says about that? Is it primarily in the afternoon commute that you get problems with drowsiness?
You could take 5mg Methadone in the AM, then cover until the evening with 5mg Hydrocodone a couple hours apart, but no more than two doses during the afternoon, and then take 5mg methadone in the evening before bed ?
As an aside... next time you speak to, or leave a message.. just throw in a "I'm sorry if I'm annoying you, it's just been so difficult with the drowsiness" - if leaving a message make sure to tell them to specifically tell him that too.. Sometimes its nice to hear that when someone is frustrating you, even if its not theirs/your fault.
I think you should use the methadone and hydrocone like prescribed, except don't taper the methadone out.. Find a methadone/hydrocodone dosing schedule that doesn't make you tired and balance them both.
See what he says about that? Is it primarily in the afternoon commute that you get problems with drowsiness?
You could take 5mg Methadone in the AM, then cover until the evening with 5mg Hydrocodone a couple hours apart, but no more than two doses during the afternoon, and then take 5mg methadone in the evening before bed ?
As an aside... next time you speak to, or leave a message.. just throw in a "I'm sorry if I'm annoying you, it's just been so difficult with the drowsiness" - if leaving a message make sure to tell them to specifically tell him that too.. Sometimes its nice to hear that when someone is frustrating you, even if its not theirs/your fault.