NOTE: These posts were split from another post to keep a topic on topic.
Ann wrote: "One of the RLS docs told me that as long as we take it once a day, stopping it should not be a problem."
With full respect, I'm not sure if I believe this. There was a posting, about a month ago, from doety who had gone on her vacation and forgot to bring her methadone. She experienced a night of hell for not taking her one 10 mg evening dose.
If I'm wrong, then please correct me. But I don't think you "just stop" any of these drugs if you're taking them only once per day over a period of time. The body develops tolerance and, along with it, expectation. When it's unfulfilled, then there are problems.
And that's the case with opiates, benzos and even beta blockers.
tunes
Methadone, dependence, withdrawal, and more
I can stop methadone from as high as 15mg sustained daily doses. The withdraw for me is minial aching.
However, the RLS will go untreated and THAT is what tends to put us through hell and misery, when we miss a dose.
The only people I have heard horror stories about getting off methadone from, were Heroin addicts, for whatever reason. However they also take doses up into 100's of milligrams. Even after they've been titrated down to 1mg, stopping cold turkey can be hell because they are so used to any amount of the drug in their system, and also I think another reason is that their pain threashold is forever altered by all the drugs people have potentially done.
However, the RLS will go untreated and THAT is what tends to put us through hell and misery, when we miss a dose.
The only people I have heard horror stories about getting off methadone from, were Heroin addicts, for whatever reason. However they also take doses up into 100's of milligrams. Even after they've been titrated down to 1mg, stopping cold turkey can be hell because they are so used to any amount of the drug in their system, and also I think another reason is that their pain threashold is forever altered by all the drugs people have potentially done.
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ViewsAskew
- Moderator
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I hope Doety comes by to explain, but I am almost positive that it was the RLS that was driving her crazy, not the methadone itself.
What I didn't say above, is that there is a problem when you stop methadone, and maybe even other opioids. For methadone, while there should be little if any physical withdrawal from the methadone, there often is a huge increase in RLS, sort of like augmentation from the DAs. My guess is that this is what many opioid (including herion) addicts go through when they get RLS for the first time when they finally go off the methadone or other opioid.
I felt exactly as you did, Tunesmith - I heard this at an RLS conference and then later emailed the doctor to make sure I'd heard it correctly. He verified that this is what he did say.
That said, this doc doesn't treat everyone. He can only go on what happens in his practice. He was adamant that he has never had a withdrawal issue if the person was taking one dose a day. Now, is that ten people? Twenty? I don't know, but probably not hundreds. And, it may be that some people are more sensitive and will have problems. This doc certainly felt confident enough to tell me that at an RLS conference, with other people around, so I am guessing he thinks it is true for the majority if not all. The last caveat is that this was two years ago. It's possible that he's seen something else since then.
One of our members here had a lot of difficulty getting off methadone...she was taking it 3 or 4 times a day, IIRC. So, it can definitely be hard. I don't know what happens with two doses, say split 12 hours apart. Methadone does have a longer half-life than many opioids, so 12 hours may be close enough to cause problems. Josh would know if he were around.
I've forgotten my methadone for many hours past my dose (supposed to be at 8 PM, but I've forgotten it as late at 2 AM)....no issues except that the RLS comes roaring back and then it's worse for a few days and I need a slight increased dose to get the RLS under control.
What I didn't say above, is that there is a problem when you stop methadone, and maybe even other opioids. For methadone, while there should be little if any physical withdrawal from the methadone, there often is a huge increase in RLS, sort of like augmentation from the DAs. My guess is that this is what many opioid (including herion) addicts go through when they get RLS for the first time when they finally go off the methadone or other opioid.
I felt exactly as you did, Tunesmith - I heard this at an RLS conference and then later emailed the doctor to make sure I'd heard it correctly. He verified that this is what he did say.
That said, this doc doesn't treat everyone. He can only go on what happens in his practice. He was adamant that he has never had a withdrawal issue if the person was taking one dose a day. Now, is that ten people? Twenty? I don't know, but probably not hundreds. And, it may be that some people are more sensitive and will have problems. This doc certainly felt confident enough to tell me that at an RLS conference, with other people around, so I am guessing he thinks it is true for the majority if not all. The last caveat is that this was two years ago. It's possible that he's seen something else since then.
One of our members here had a lot of difficulty getting off methadone...she was taking it 3 or 4 times a day, IIRC. So, it can definitely be hard. I don't know what happens with two doses, say split 12 hours apart. Methadone does have a longer half-life than many opioids, so 12 hours may be close enough to cause problems. Josh would know if he were around.
I've forgotten my methadone for many hours past my dose (supposed to be at 8 PM, but I've forgotten it as late at 2 AM)....no issues except that the RLS comes roaring back and then it's worse for a few days and I need a slight increased dose to get the RLS under control.
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.
I'm certainly not going to argue with you on this, Ann. You have an exceptional amount of experience and the doc said what he said.
Once, I asked Dr. B about the similarity in RLS (as a disease) and RLS (apparent in withdrawal). His answer was that there was no similarity at all.
Could have knocked me over with a feather!
I've had RLS (for over thirty years) and I've gone through withdrawal (after taking opioids following surgery, years ago) and they both feel exactly the same to me. RLS is RLS, I thought.
In fact, I believe that many opiate addicts are simply RLS patients who are self-medicating, oblivious to the fact that they have a bona fide disease.
So, I don't know who's right on this, but I do know if I were to decide that I no longer want to take opioids for my RLS, that I'm in for a very long taper, along with the suffering that comes when my primary RLS isn't being treated.
I know that "just stopping" isn't an option.
tunes
Once, I asked Dr. B about the similarity in RLS (as a disease) and RLS (apparent in withdrawal). His answer was that there was no similarity at all.
Could have knocked me over with a feather!
I've had RLS (for over thirty years) and I've gone through withdrawal (after taking opioids following surgery, years ago) and they both feel exactly the same to me. RLS is RLS, I thought.
In fact, I believe that many opiate addicts are simply RLS patients who are self-medicating, oblivious to the fact that they have a bona fide disease.
So, I don't know who's right on this, but I do know if I were to decide that I no longer want to take opioids for my RLS, that I'm in for a very long taper, along with the suffering that comes when my primary RLS isn't being treated.
I know that "just stopping" isn't an option.
tunes
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mackjergens
- Posts: 406
- Joined: Sat Jul 21, 2007 5:10 am
I have had RLS for over 34 yrs and yes RLS is RLS, but there are different degrees of RLS, some nights mine starts our very mild, same symptoms, but just not so strong, IF I do not get meds taken, I can assure you my RLS will become stronger and stronger to the point its very very hard to handle.
I personally have taken hydrocodone for many years and took it every night for several of those years, then switched to Ultram(tramadol) with NO ill effects, now I rotate the two and have no problem.
I do not have RLS 24/7 mine is mostly at night(every night), with a mild case at times during the day.
I personally have taken hydrocodone for many years and took it every night for several of those years, then switched to Ultram(tramadol) with NO ill effects, now I rotate the two and have no problem.
I do not have RLS 24/7 mine is mostly at night(every night), with a mild case at times during the day.
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mackjergens
- Posts: 406
- Joined: Sat Jul 21, 2007 5:10 am
Info on didaudid hydromorphone
Moss,
I copied/pasted this info from www.rlshelp.org/rlsrx.htm (which is the So. CA RLS support group web site.
Listed below are all the pain meds used to treat RLS.
Dilaudid hydromorphone is discussed in this listing, Hope this will be of some help to you.
___________________________________________________________
3) Analgesic (pain-killing) Medications - Opiates/Narcotics
These medications are very helpful for treating RLS. Many patients will get relief from this class of drugs. Many physicians have significant fears about patients getting addicted to these mainly narcotic derived drugs (derived from opium, hence the term opiates). This generally does not happen if the medications are used to just blunt the majority of the RLS symptoms, rather than increasing the dose to completely eradicate all symptoms and possibly "overshoot" using more drug than really needed. Intermittent use and drug holidays (using other medication in place of the narcotic for a few days) can often insure that no tolerance/dependence will occur. In patients who use the opiates daily and cannot stop them, keeping them at the lowest dose to relieve most of the symptoms should greatly reduce the chance of addiction. There are many patients who have been using these medications daily for years without problems. A recent study (Walters, A.S. et al, Long-term follow-up on restless legs syndrome patients treated with opioids. Mov Disord 2001;16:1105-1109) which found the narcotics to be very safe even when used for long -term use in RLS patients.
Constipation can also occur with this class of drugs. This may limit the use of this class of medication, but adding fiber (Metamucil, for example) may help this problem. Nausea can also be a significant problem and can be overcome by adding an anti-nausea pill before taking the opioid.
Below is a chart comparing equianalegesic doses (doses that have the same pain relieving effect) of the different narcotic pain medications. These doses are calculated for the relief of severe post-surgical pain and may not be accurate for their effect when used to treat RLS. The combination drugs (Propoxyphene, Codiene, Hydrocodone, and Oxycodone) have considerably more effect for post surgical pain due to the added aspirin or acetaminophen. Since aspirin and acetaminophen have no effect on RLS, these drugs are less potent than listed when used for RLS treatment. This chart is just a rough reference guide to the potency of the narcotics.
DRUG APPROXIMATE EQUIANALGESIC ORAL DOSE
Morphine 30-60 mg every 3-5 hours
Morphine, controlled-release (MS Contin) 60-120 mg every 12 hours
Hydromorphone (Dilaudid) 7.5 mg every 3-4 hours
Levorphanol (Levo-Dromoran) 4 mg every 6-8 hours
Meperidine (Demerol) 300 mg every 2-3 hours
Methadone (Dolophine) 20 mg every 6-8 hours
Propoxyphene (Darvon, Darvocet N-100, etc.) 270-300 mg every 3-4 hours
Codeine (with aspirin or acetaminophen) 180-200 every 3-4 hours
Pentazocine (Talwin) 150-170 mg every 3-4 hours
Hydrocodone (Hycodan, Lorcet, Lortab, Maxidone, Norco, Vicodin, Vicoprofen, Zydone) 30 mg every 3-4 hours
Oxycodone (OxyContin, OxyFast, OxyIR, Percolone, Percodan, Percocet, Roxicodone, Tylox,) 30 mg every 3-4 hours
Oxymorphone (Opana IR or ER) 15-20 mg every 4-6 hours
Fentanyl (Duragesic patches) 50 mcg/hour patch
Darvon (Propoxyphene)/Darvocet-N, 50,100
Darvon is the weakest drug in this class of medication. It comes in several forms. Darvon comes in a plain form with 65 mg of Propoxyphene hydrochloride (this is equal to 100 mg of propoxyphene napsylate) and as a compound (Darvon Compound-65) combined with 389 mg of ASA and 32 mg of caffeine. Darvon-N has 100 mg of propoxyphene napsylate, Darvon-N 50 has 50 mg of propoxyphene napsylate with 325 mg of acetaminophen, Darvocet-N 100 has mg of propoxyphene napsylate with 650 mg of acetaminophen. The drug has a rapid onset of action (less than 30 minutes) and will last hours.
The dose Darvon, Darvon Compound, Darvocet-N 100, or Darvocet-N (all of these have about the same effective amount of propoxyphene) is from 1 to 8 tablets per day taken on an as needed basis of 1-2 tablets every 4-6 hours. The average daily dose for patients with significant RLS is about 3-4 tablets per day. The choice of the various forms of Darvon will depend on trial and error and intolerance of the additives (for example patients with ASA/aspirin intolerance should not take the Darvon Compound). For regular daily usage, the compound with Tylenol or ASA are best avoided to lessen the chance of side effects from a second drug.
This drug may also decrease the arousals from PLMS, but does not seem to decrease the amount of PLMS.
Codeine/Tylenol with Codeine No. 2, 3, or 4
This is the next in potency at its lower dose formulation (15 mg). At the higher doses, it may be just as potent as the other narcotic agents. Codeine comes in 15 mg, 30 mg, and 60 mg tablets. Tylenol with Codeine has 3 strengths each in combination with 300 mg of acetaminophen; No. 2 has 15 mg of codeine, No. 3 has 30 mg of codeine, and No. 4 has 60 mg of codeine. It has rapid onset of action (less than 30 minutes) and will last 3-6 hours.
Codeine doses range from 15 mg to 240 mg per day. The medication can be given at 15 mg to 60 mg every 3-6 hours. For regular daily usage, the compound with Tylenol is best avoided to lessen the chance of side effects from a second drug.
Warning: Some of the SSRI antidepressants (Paxil, Prozac, and Luvox) can cause a decrease in the effectiveness of codeine. These drugs inhibit the O-demethylation of codeine to its active form of morphine. The pain killing effect of codeine can be significantly decreased if you are taking one of the above antidepressants. This problem does not occur with other pain killers on this list.
Talwin/Talacen (Pentazocine)
This medication comes in a 50 mg tablets. This is equivalent to a codeine dose of 60 mg. The dose range is 50 - 200 mg per day, taken at 1 tablet every 3-6 hours as needed. The onset of action is 15-30 minutes and lasts 3-6 hours.
NOTE: There is a new formulation of Talwin called Talwin Nx which contains pentazocine and naloxone which is an opioid antagonist which can worsen RLS. This drug may help RLS at first but chronic users may need larger doses and develop tolerance to the drug and experience renewed symptoms.
Vicodin/Lorcet/Lortab/Tylox/Zydone/Norco (Hydrocodone)
Vicodin and Lorcet are trade names for the same drugs. Vicodin and Lorcet HD each contain hydrocodone 5 mg and acetaminophen 500 mg. Vicodin ES and Lorcet Plus each contain hydrocodone 7.5 mg and acetaminophen 750 or 650 mg respectively. Lorcet 10/650 contains the highest dose with hydrocodone 10 mg and acetaminophen 650 mg. Lortab comes in 3 strengths, each combined with acetaminophen 500 mg; and hydrocodone 2.5 mg, 5 mg, or 7.5 mg.
A new medication is Zydone which has a lower amount of acetaminophen at only 400 mg combined with 5, 7.5 or 10 mg of hydrocodone. Another newer preparation of the medication is Norco, which also has lower doses of acetaminophen at 325 mg combined with either 5 or 7.5 mg of hydrocodone.
The daily dose ranges between 5 mg to 40 mg of hydrocodone per day. The drug will last and should be given every 3-6 hours as needed. The onset is rapid with effect noted in less than 30 minutes.
Percodan/Percocet/Percolone/OxyContin (Oxycodone)
This drug is amongst the strongest of this class of medications. It comes in 5 mg tablets combined with ASA 325 mg (Percodan) or with acetaminophen 325 mg (Percocet). It also comes in a smaller dose of 2.5 mg called Percodan-Demy. It also comes in a 7.5 mg tablet with 500 mg of acetominophen and a 10 mg tablet with 650 mg of acetaminophen. You can also get pure oxycodone in the form of Percolone at 5 mg tablets without any additives.
The dose range is 2.5 mg to 20 mg per day divided into doses every 4-6 hours. The average dose was 16 mg per day in one study. This medication works very well for RLS but also may have some benefits for PLMD. Some studies have shown decreased PLMD, and even decreased arousals from the existing PLMS.
OxyContin is a potent 12 hour duration medication that is used mainly in patients with severe pain (like cancer patients). It come in 10, 20, 40 mg, and 80 mg tablets which can be taken on a twice daily basis. It is a slower acting drug and will not be active for at least one hour. It has potential benefits for RLS patients who are taking other narcotic agents at high doses every 3 to 6 hours (by being in a more convenient 12 hour preparation and it does not contain acetaminophen (Tylenol)), but experience in RLS with this medication is minimal, and for now this drug should be reserved for severe pain patients.
There is also a quick release formula called OxyIR which contains 5 mg of oxycodone and can give immediate relief for pain or RLS discomfort.
Dilaudid (Hydromorphone)
This drug is a very potent narcotic pain killer. It is on a par with the strongest narcotic medications and has similar side effects. It comes in 2 mg, 4 mg, and 8 mg tablets. Its use in RLS has been limited, but it is an option for difficult RLS cases. Some RLS specialists have found this drug to be very effective for severe RLS patients.
Demerol (Meperidine)
This drug is very frequently used by intramuscular injection but can be used orally with a significant decrease in effectiveness. The amount of this decrease is not well established. 60-80 mg of Demerol (given by intramuscular injection) is roughly equal to 10 mg of Morphine.
Demerol causes less constipation and depression than equal pain killing doses of Morphine. Demerol comes in 50 mg and 100 mg tablets and can be given every 4 to 6 hours for pain/RLS relief. Its use in RLS is quite rare and really no data is available.
Duragesic Transdermal Patches (Fentanyl)
This is another potent narcotic, but with a unique delivery system. Instead of a pill, a patch is placed on the skin which contains the active drug and slowly, but steadily releases it over 3 days. There are four different patches named by the amount of the drug released per hour; 25 ug, 50 ug, 75 ug, and 100 ug.
These patches are used for patients with chronic pain syndrome such as cancer, arthritis, etc. We have seen a few patients who have been on Duragesic patches for RLS with some success, but its use in RLS has been quite limited so far. As with all narcotics, the smallest dose should be tried first, and increased only if necessary.
Dolophine (Methadone)
This drug is actually very effective in RLS. Most physicians will not prescribe Methadone due to its association with drug dependency treatment. Many patients may get relief from this drug when other ones in this class have failed. It should be reserved for when patients fail the other narcotic drugs.
Methadone comes in 5 mg and 10 mg tablets. The dosage range is from 5 mg to 30 mg per day. When given for pain relief, the drug lasts 3-4 hours. In RLS, many patients report much more prolonged duration of effect, often up to 6-12 hours.
Morphine
This is the one of the most potent medication in this class. Because of this, and its reputation as a potent narcotic, Morphine is seldom used in the treatment of RLS.
Morphine comes in 15 mg and 30 mg tablets. These should be used in the smallest dose necessary to achieve relief of about 90% of RLS symptoms on a 3-6 hour basis. There are two 12 hour sustained release forms of Morphine, called Oramorph SR and MS Contin. They comes in 15 mg, 30 mg, 60 mg and 100 mg tablets dosed every 12 hours. This might be a useful medication for severe RLS if used carefully, but we do not yet know of much experience with this sustained release form of Morphine.
Levo-Dromoran (levorphanol tartrate)
Levo-Dromoran is a synthetic analgesic that is as potent as morphine. It can be used by injection or by tablet and is as potent by either route. This drug is a narcotic and has an addiction potential equal to morphine. The drug should thus be given all the precautions of morphine. It is a long acting drug, each dose lasts 6-8 hours by injection or by tablet.
Levo-Dromoran comes in 2 mg tablets with the usual dose being one tablet every 6 to 8 hours. The dose can be increased to 1 1/2 tablets.
Opana (Oxymorphone)
This potent (about twice as potent as oxycodone) narcotic has previously only been available as an injectable or suppository type of drug. It is now available in an immediate release and extended-release formula. There is really no experience with this drug for treating RLS as of yet.
It is available in 5 and 10 mg tablets for immediate release (given every 4-6 hours) and 5, 10, 20 and 40 mg tablets for extended release use (given every 12 hours).
Ultram (Tramadol)
Ultram is a new synthetic medication for pain relief and is not chemically related to the opiates unlike all the above medication in this class. It works on the central nervous system by two different mechanisms. First of all, it is a weak opioid inhibitor which only binds weakly to the opioid mu receptors (which is the opioid pain receptor). It also works by blocking the reuptake of two different neurotransmitters in the brain, norepinephrine and serotonin. Ultram is metabolized to another compound which actually is more potent than the original tramadol in helping to block pain. The drug does not appear to be as addictive as others in this class of RLS medications, but cases of addiction have occurred. Special care should be taken in patients with a history of addiction to opiates, as they may be more susceptible to addiction with Ultram.
This drug can be very effective for treating RLS and many RLS sufferers have gotten excellent relief from the intermittent use of this drug. Some patients have used Ultram for drug holidays from the other pain killers above (in the narcotic family). This seems to have been very helpful for many, and no cross tolerance has developed. This information however, is only anecdotal, and is not proven yet in a clinical study or trial.
There have been reports of aggravation of seizures in patients with a prior seizure history, although the incidence appears to be small occurring in 1 out of 100,000 patients. It also may be riskier in patients who are on antidepressants (especially serotonin reuptake inhibitors such as Prozac, Zoloft or Paxil for example) or tricyclic antidepressants such as Elavil. Tramadol may need to be reduced in dosage or eliminated in patients who are on other tranquilizers or sedating medication.
Ultram comes in 50 mg tablets. It has a half life of 5.6 hours after a single dose and 7 hours after multiple doses. It can be given at 50 - 100 mg every 4-6 hours with a maximum daily dose of 400 mg. Some RLS patients have reported longer duration of action of 6-8 hours, but 4-6 hours is quite common.
There is a newer form of Ultram, called Ultram ER. This is a longer acting form of Ultram and is available only in 100 mg tablets. It is taken once per day. Doses start at 100 mg per day and can be increased to 300 mg (3 tablets) per day.
I copied/pasted this info from www.rlshelp.org/rlsrx.htm (which is the So. CA RLS support group web site.
Listed below are all the pain meds used to treat RLS.
Dilaudid hydromorphone is discussed in this listing, Hope this will be of some help to you.
___________________________________________________________
3) Analgesic (pain-killing) Medications - Opiates/Narcotics
These medications are very helpful for treating RLS. Many patients will get relief from this class of drugs. Many physicians have significant fears about patients getting addicted to these mainly narcotic derived drugs (derived from opium, hence the term opiates). This generally does not happen if the medications are used to just blunt the majority of the RLS symptoms, rather than increasing the dose to completely eradicate all symptoms and possibly "overshoot" using more drug than really needed. Intermittent use and drug holidays (using other medication in place of the narcotic for a few days) can often insure that no tolerance/dependence will occur. In patients who use the opiates daily and cannot stop them, keeping them at the lowest dose to relieve most of the symptoms should greatly reduce the chance of addiction. There are many patients who have been using these medications daily for years without problems. A recent study (Walters, A.S. et al, Long-term follow-up on restless legs syndrome patients treated with opioids. Mov Disord 2001;16:1105-1109) which found the narcotics to be very safe even when used for long -term use in RLS patients.
Constipation can also occur with this class of drugs. This may limit the use of this class of medication, but adding fiber (Metamucil, for example) may help this problem. Nausea can also be a significant problem and can be overcome by adding an anti-nausea pill before taking the opioid.
Below is a chart comparing equianalegesic doses (doses that have the same pain relieving effect) of the different narcotic pain medications. These doses are calculated for the relief of severe post-surgical pain and may not be accurate for their effect when used to treat RLS. The combination drugs (Propoxyphene, Codiene, Hydrocodone, and Oxycodone) have considerably more effect for post surgical pain due to the added aspirin or acetaminophen. Since aspirin and acetaminophen have no effect on RLS, these drugs are less potent than listed when used for RLS treatment. This chart is just a rough reference guide to the potency of the narcotics.
DRUG APPROXIMATE EQUIANALGESIC ORAL DOSE
Morphine 30-60 mg every 3-5 hours
Morphine, controlled-release (MS Contin) 60-120 mg every 12 hours
Hydromorphone (Dilaudid) 7.5 mg every 3-4 hours
Levorphanol (Levo-Dromoran) 4 mg every 6-8 hours
Meperidine (Demerol) 300 mg every 2-3 hours
Methadone (Dolophine) 20 mg every 6-8 hours
Propoxyphene (Darvon, Darvocet N-100, etc.) 270-300 mg every 3-4 hours
Codeine (with aspirin or acetaminophen) 180-200 every 3-4 hours
Pentazocine (Talwin) 150-170 mg every 3-4 hours
Hydrocodone (Hycodan, Lorcet, Lortab, Maxidone, Norco, Vicodin, Vicoprofen, Zydone) 30 mg every 3-4 hours
Oxycodone (OxyContin, OxyFast, OxyIR, Percolone, Percodan, Percocet, Roxicodone, Tylox,) 30 mg every 3-4 hours
Oxymorphone (Opana IR or ER) 15-20 mg every 4-6 hours
Fentanyl (Duragesic patches) 50 mcg/hour patch
Darvon (Propoxyphene)/Darvocet-N, 50,100
Darvon is the weakest drug in this class of medication. It comes in several forms. Darvon comes in a plain form with 65 mg of Propoxyphene hydrochloride (this is equal to 100 mg of propoxyphene napsylate) and as a compound (Darvon Compound-65) combined with 389 mg of ASA and 32 mg of caffeine. Darvon-N has 100 mg of propoxyphene napsylate, Darvon-N 50 has 50 mg of propoxyphene napsylate with 325 mg of acetaminophen, Darvocet-N 100 has mg of propoxyphene napsylate with 650 mg of acetaminophen. The drug has a rapid onset of action (less than 30 minutes) and will last hours.
The dose Darvon, Darvon Compound, Darvocet-N 100, or Darvocet-N (all of these have about the same effective amount of propoxyphene) is from 1 to 8 tablets per day taken on an as needed basis of 1-2 tablets every 4-6 hours. The average daily dose for patients with significant RLS is about 3-4 tablets per day. The choice of the various forms of Darvon will depend on trial and error and intolerance of the additives (for example patients with ASA/aspirin intolerance should not take the Darvon Compound). For regular daily usage, the compound with Tylenol or ASA are best avoided to lessen the chance of side effects from a second drug.
This drug may also decrease the arousals from PLMS, but does not seem to decrease the amount of PLMS.
Codeine/Tylenol with Codeine No. 2, 3, or 4
This is the next in potency at its lower dose formulation (15 mg). At the higher doses, it may be just as potent as the other narcotic agents. Codeine comes in 15 mg, 30 mg, and 60 mg tablets. Tylenol with Codeine has 3 strengths each in combination with 300 mg of acetaminophen; No. 2 has 15 mg of codeine, No. 3 has 30 mg of codeine, and No. 4 has 60 mg of codeine. It has rapid onset of action (less than 30 minutes) and will last 3-6 hours.
Codeine doses range from 15 mg to 240 mg per day. The medication can be given at 15 mg to 60 mg every 3-6 hours. For regular daily usage, the compound with Tylenol is best avoided to lessen the chance of side effects from a second drug.
Warning: Some of the SSRI antidepressants (Paxil, Prozac, and Luvox) can cause a decrease in the effectiveness of codeine. These drugs inhibit the O-demethylation of codeine to its active form of morphine. The pain killing effect of codeine can be significantly decreased if you are taking one of the above antidepressants. This problem does not occur with other pain killers on this list.
Talwin/Talacen (Pentazocine)
This medication comes in a 50 mg tablets. This is equivalent to a codeine dose of 60 mg. The dose range is 50 - 200 mg per day, taken at 1 tablet every 3-6 hours as needed. The onset of action is 15-30 minutes and lasts 3-6 hours.
NOTE: There is a new formulation of Talwin called Talwin Nx which contains pentazocine and naloxone which is an opioid antagonist which can worsen RLS. This drug may help RLS at first but chronic users may need larger doses and develop tolerance to the drug and experience renewed symptoms.
Vicodin/Lorcet/Lortab/Tylox/Zydone/Norco (Hydrocodone)
Vicodin and Lorcet are trade names for the same drugs. Vicodin and Lorcet HD each contain hydrocodone 5 mg and acetaminophen 500 mg. Vicodin ES and Lorcet Plus each contain hydrocodone 7.5 mg and acetaminophen 750 or 650 mg respectively. Lorcet 10/650 contains the highest dose with hydrocodone 10 mg and acetaminophen 650 mg. Lortab comes in 3 strengths, each combined with acetaminophen 500 mg; and hydrocodone 2.5 mg, 5 mg, or 7.5 mg.
A new medication is Zydone which has a lower amount of acetaminophen at only 400 mg combined with 5, 7.5 or 10 mg of hydrocodone. Another newer preparation of the medication is Norco, which also has lower doses of acetaminophen at 325 mg combined with either 5 or 7.5 mg of hydrocodone.
The daily dose ranges between 5 mg to 40 mg of hydrocodone per day. The drug will last and should be given every 3-6 hours as needed. The onset is rapid with effect noted in less than 30 minutes.
Percodan/Percocet/Percolone/OxyContin (Oxycodone)
This drug is amongst the strongest of this class of medications. It comes in 5 mg tablets combined with ASA 325 mg (Percodan) or with acetaminophen 325 mg (Percocet). It also comes in a smaller dose of 2.5 mg called Percodan-Demy. It also comes in a 7.5 mg tablet with 500 mg of acetominophen and a 10 mg tablet with 650 mg of acetaminophen. You can also get pure oxycodone in the form of Percolone at 5 mg tablets without any additives.
The dose range is 2.5 mg to 20 mg per day divided into doses every 4-6 hours. The average dose was 16 mg per day in one study. This medication works very well for RLS but also may have some benefits for PLMD. Some studies have shown decreased PLMD, and even decreased arousals from the existing PLMS.
OxyContin is a potent 12 hour duration medication that is used mainly in patients with severe pain (like cancer patients). It come in 10, 20, 40 mg, and 80 mg tablets which can be taken on a twice daily basis. It is a slower acting drug and will not be active for at least one hour. It has potential benefits for RLS patients who are taking other narcotic agents at high doses every 3 to 6 hours (by being in a more convenient 12 hour preparation and it does not contain acetaminophen (Tylenol)), but experience in RLS with this medication is minimal, and for now this drug should be reserved for severe pain patients.
There is also a quick release formula called OxyIR which contains 5 mg of oxycodone and can give immediate relief for pain or RLS discomfort.
Dilaudid (Hydromorphone)
This drug is a very potent narcotic pain killer. It is on a par with the strongest narcotic medications and has similar side effects. It comes in 2 mg, 4 mg, and 8 mg tablets. Its use in RLS has been limited, but it is an option for difficult RLS cases. Some RLS specialists have found this drug to be very effective for severe RLS patients.
Demerol (Meperidine)
This drug is very frequently used by intramuscular injection but can be used orally with a significant decrease in effectiveness. The amount of this decrease is not well established. 60-80 mg of Demerol (given by intramuscular injection) is roughly equal to 10 mg of Morphine.
Demerol causes less constipation and depression than equal pain killing doses of Morphine. Demerol comes in 50 mg and 100 mg tablets and can be given every 4 to 6 hours for pain/RLS relief. Its use in RLS is quite rare and really no data is available.
Duragesic Transdermal Patches (Fentanyl)
This is another potent narcotic, but with a unique delivery system. Instead of a pill, a patch is placed on the skin which contains the active drug and slowly, but steadily releases it over 3 days. There are four different patches named by the amount of the drug released per hour; 25 ug, 50 ug, 75 ug, and 100 ug.
These patches are used for patients with chronic pain syndrome such as cancer, arthritis, etc. We have seen a few patients who have been on Duragesic patches for RLS with some success, but its use in RLS has been quite limited so far. As with all narcotics, the smallest dose should be tried first, and increased only if necessary.
Dolophine (Methadone)
This drug is actually very effective in RLS. Most physicians will not prescribe Methadone due to its association with drug dependency treatment. Many patients may get relief from this drug when other ones in this class have failed. It should be reserved for when patients fail the other narcotic drugs.
Methadone comes in 5 mg and 10 mg tablets. The dosage range is from 5 mg to 30 mg per day. When given for pain relief, the drug lasts 3-4 hours. In RLS, many patients report much more prolonged duration of effect, often up to 6-12 hours.
Morphine
This is the one of the most potent medication in this class. Because of this, and its reputation as a potent narcotic, Morphine is seldom used in the treatment of RLS.
Morphine comes in 15 mg and 30 mg tablets. These should be used in the smallest dose necessary to achieve relief of about 90% of RLS symptoms on a 3-6 hour basis. There are two 12 hour sustained release forms of Morphine, called Oramorph SR and MS Contin. They comes in 15 mg, 30 mg, 60 mg and 100 mg tablets dosed every 12 hours. This might be a useful medication for severe RLS if used carefully, but we do not yet know of much experience with this sustained release form of Morphine.
Levo-Dromoran (levorphanol tartrate)
Levo-Dromoran is a synthetic analgesic that is as potent as morphine. It can be used by injection or by tablet and is as potent by either route. This drug is a narcotic and has an addiction potential equal to morphine. The drug should thus be given all the precautions of morphine. It is a long acting drug, each dose lasts 6-8 hours by injection or by tablet.
Levo-Dromoran comes in 2 mg tablets with the usual dose being one tablet every 6 to 8 hours. The dose can be increased to 1 1/2 tablets.
Opana (Oxymorphone)
This potent (about twice as potent as oxycodone) narcotic has previously only been available as an injectable or suppository type of drug. It is now available in an immediate release and extended-release formula. There is really no experience with this drug for treating RLS as of yet.
It is available in 5 and 10 mg tablets for immediate release (given every 4-6 hours) and 5, 10, 20 and 40 mg tablets for extended release use (given every 12 hours).
Ultram (Tramadol)
Ultram is a new synthetic medication for pain relief and is not chemically related to the opiates unlike all the above medication in this class. It works on the central nervous system by two different mechanisms. First of all, it is a weak opioid inhibitor which only binds weakly to the opioid mu receptors (which is the opioid pain receptor). It also works by blocking the reuptake of two different neurotransmitters in the brain, norepinephrine and serotonin. Ultram is metabolized to another compound which actually is more potent than the original tramadol in helping to block pain. The drug does not appear to be as addictive as others in this class of RLS medications, but cases of addiction have occurred. Special care should be taken in patients with a history of addiction to opiates, as they may be more susceptible to addiction with Ultram.
This drug can be very effective for treating RLS and many RLS sufferers have gotten excellent relief from the intermittent use of this drug. Some patients have used Ultram for drug holidays from the other pain killers above (in the narcotic family). This seems to have been very helpful for many, and no cross tolerance has developed. This information however, is only anecdotal, and is not proven yet in a clinical study or trial.
There have been reports of aggravation of seizures in patients with a prior seizure history, although the incidence appears to be small occurring in 1 out of 100,000 patients. It also may be riskier in patients who are on antidepressants (especially serotonin reuptake inhibitors such as Prozac, Zoloft or Paxil for example) or tricyclic antidepressants such as Elavil. Tramadol may need to be reduced in dosage or eliminated in patients who are on other tranquilizers or sedating medication.
Ultram comes in 50 mg tablets. It has a half life of 5.6 hours after a single dose and 7 hours after multiple doses. It can be given at 50 - 100 mg every 4-6 hours with a maximum daily dose of 400 mg. Some RLS patients have reported longer duration of action of 6-8 hours, but 4-6 hours is quite common.
There is a newer form of Ultram, called Ultram ER. This is a longer acting form of Ultram and is available only in 100 mg tablets. It is taken once per day. Doses start at 100 mg per day and can be increased to 300 mg (3 tablets) per day.
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ViewsAskew
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I hope I didn't come across as argumentative...if so, my humble apologies. From my persepctive, neither did you or Moss or anyone in this thread. Just people offering the info they've read or heard and adding their own experiences.tunesmith wrote:I'm certainly not going to argue with you on this, Ann. You have an exceptional amount of experience and the doc said what he said.
So, I don't know who's right on this, but I do know if I were to decide that I no longer want to take opioids for my RLS, that I'm in for a very long taper, along with the suffering that comes when my primary RLS isn't being treated.
I know that "just stopping" isn't an option.
tunes
How strange what Dr B said...about RLS and what I thought was RLS not being RLS (how confusing even to write about). It sure sounds like the same things to me (but that's why my signature says I'm not a do - beacuse there sure are many things I don't know). On occasion, by following links, etc. I've ended up reading posts by addicts who are suffering from horrid-what-I-thought-was-real-RLS...and they call RLS on those board. Huhn. What the heck is it if it isn't RLS???? I mean, I understand that other parts of withdrawal are different, but the RLS part seems like RLS, as Mack said.
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.
You didn't come across as argumentative, Ann, so no apologies necessary. I was seeking clarity and I could see that the subject had the potential of becoming very confusing to discuss. But, no harm done and no offense taken. Perhaps my wording could have been better.
Yes, it is strange what Dr. B said. I was (and still am) somewhat perplexed by it. For the record, here is an edited version of our exchange. It was set in motion by a writer who had commented on the similarity of his RLS symptoms and his earlier withdrawal symptoms from Lortab. It caused me to write the following questions and I received the following answers:
Q: I'm interested that the feeling of opioid withdrawal symptoms and the feeling of RLS are virtually the same (which I've suspected all along). Can you comment on why this is, please?
A: Opioid withdrawal is actually quite different from RLS. In that case, the return of RLS symptoms were mistaken for opioid withdrawal.
Q: If they feel similar and one is mistaken for the other, how can it be that opioid withdrawal and RLS are quite different from each other?
A: That is actually the point. They are NOT similar. Patients (who do not know the difference) may confuse them, but those who fully understand the difference, do not.
So, what do you think of that? Confusing? You bet. I still don't get it.
Anyway, please understand that I'm just trying to figure it out like everybody else. RLS is a very complex disorder, but the one thing that all addicts in withdrawal comment on is the horror of RLS. But for them, after detoxing, the RLS goes away in a month or two. Those of us with RLS must suffer forever. And the only connecting point between the two patients is that their RLS is alleviated by opioids.
And Ann, I think you are a terrific mod. Your constant care and attention (along with the other mods) keeps this board alive. Thank you for your commitment, knowledge, good humor and compassion.
tunesmith
Yes, it is strange what Dr. B said. I was (and still am) somewhat perplexed by it. For the record, here is an edited version of our exchange. It was set in motion by a writer who had commented on the similarity of his RLS symptoms and his earlier withdrawal symptoms from Lortab. It caused me to write the following questions and I received the following answers:
Q: I'm interested that the feeling of opioid withdrawal symptoms and the feeling of RLS are virtually the same (which I've suspected all along). Can you comment on why this is, please?
A: Opioid withdrawal is actually quite different from RLS. In that case, the return of RLS symptoms were mistaken for opioid withdrawal.
Q: If they feel similar and one is mistaken for the other, how can it be that opioid withdrawal and RLS are quite different from each other?
A: That is actually the point. They are NOT similar. Patients (who do not know the difference) may confuse them, but those who fully understand the difference, do not.
So, what do you think of that? Confusing? You bet. I still don't get it.
Anyway, please understand that I'm just trying to figure it out like everybody else. RLS is a very complex disorder, but the one thing that all addicts in withdrawal comment on is the horror of RLS. But for them, after detoxing, the RLS goes away in a month or two. Those of us with RLS must suffer forever. And the only connecting point between the two patients is that their RLS is alleviated by opioids.
And Ann, I think you are a terrific mod. Your constant care and attention (along with the other mods) keeps this board alive. Thank you for your commitment, knowledge, good humor and compassion.
tunesmith
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SquirmingSusan
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Re: anyone taking hydromorphone/dilaudid for their rls
Moss, those side effects that you are getting from the methadone really concern me. Are you sure those are side effects and not some other condition that needs to be looked into? I guess I've never had anything like that, and haven't heard of anything like that, but I'm not a doctor or a pharmacist.moss wrote:
However there are several side effects that I would like to not have. Besides the low, low testosterone, there are some pretty severe breathing/heart problems from sudden exertion that I occasionally have that make me feel like I have been waterboarded and might not get my breath again.
Do all opioids suppress testosterone? Or is that specific to methadone?
It seems like all the opioids work in similar enough ways that they all would suppress breathing to some extent or affect hormone levels or whatever. I know that people do react to them all differently, though.
With all this talk about the dependence thing - I have to mention that Friday I had no pain whatsoever and no RLS anywhere. And my pill alarm batteries are dead, and I got busy with stuff, and forgot to take my methadone. I never did take it. I took my teeny little mirapex chunk and took an Ativan to help me sleep, but never took the methadone. People were talking about this storm that was coming and my legs always ache when there's a storm coming. But they never hurt. Then this morning, as the barometer fell below 30, I could have crawled out of my skin. Weird though. I thought I was cured for a day.
Honestly, I don't worry about dependence on a medication that keeps me from being miserable. If they discover a cure for RLS that makes it so I don't ever have to take anything for it again, I'll worry about quitting the methadone.
Susan
Hello SquirmingSusan,
You asked 'Do all opioids suppress testosterone? Or is that specific to methadone?'
My understanding (from the hormone specialist at Johns Hopkins) is its only methadone that shuts down testosterone production and not other opioids. She says as little as 5 mg a day will do it. (anyone wants to be in a test on that they are constantly looking for volunteers). Yes, I can put on a testosterone patch to overcome that side effect but...
The suppression of breathing is something that might be just peculiar to me and the way my body reacts to these medications. Actually, I run a farm and am constantly pushing my body in ways that most people today don't. My recent attack happened when I was chasing a stray dog that had one of my chickens in its mouth.
Since I have excellent insurance through my wife's work I've seen a number of specialist and no one seems to know what's up (even if they should)
Different suggestions and tests have eliminated
1. lung cancer.
2. blocked arteries.
3. because of the sweating induced by the methadone I was becoming chronically dehydrated which caused the acute shortness of breath.
So far no real answer though drinking a sports drink helps the dehydration. That's why the search for another medication even if its only for a trial period.
I personally find the talk about dependence somewhat naive and generally reflecting that individuals relationship with drugs. When I came back from Vietnam I worked for a while on a ward for vets withdrawing from heroin. I don't see anything recreational about opioids. To be sedated is not my idea of fun. Also, the idea that withdrawal from opioids and rls are similar is an ill informed idea. They aren't. To say it does not make it true.
A side note. I was recently in Paris during the transportation strike and did a heck of a lot of walking. (averaging 15-20 miles a day). My rls and my usual need for methadone disappeared each day while I was up and out walking. It only came back at night when I sat down in my room. In other words, I'm taking methadone for rls, I'm not taking methadone for methadone. As Dr. Earley at Hopkins told me. 'With rls if you could walk 24/7 you wouldn't have any problem with rls. Right?'
(and I hate to say it because I don't want to be grouchy but I feel somewhat irritated with people who look at drugs as recreation as several people who have picked up this thread seem to.
I agree with you whole heartedly about not being worried about dependence on a medication that keeps me from being miserable. If they discover a cure for RLS that makes it so I don't ever have to take anything for it again, I too will worry about quitting methadone then (and will do so easily because there is nothing in any of the opioid that I want besides relief from rls. The thought that one of these might be, as someone said, one of the things you must experience before you die strikes me as rather childish.
You asked 'Do all opioids suppress testosterone? Or is that specific to methadone?'
My understanding (from the hormone specialist at Johns Hopkins) is its only methadone that shuts down testosterone production and not other opioids. She says as little as 5 mg a day will do it. (anyone wants to be in a test on that they are constantly looking for volunteers). Yes, I can put on a testosterone patch to overcome that side effect but...
The suppression of breathing is something that might be just peculiar to me and the way my body reacts to these medications. Actually, I run a farm and am constantly pushing my body in ways that most people today don't. My recent attack happened when I was chasing a stray dog that had one of my chickens in its mouth.
Since I have excellent insurance through my wife's work I've seen a number of specialist and no one seems to know what's up (even if they should)
Different suggestions and tests have eliminated
1. lung cancer.
2. blocked arteries.
3. because of the sweating induced by the methadone I was becoming chronically dehydrated which caused the acute shortness of breath.
So far no real answer though drinking a sports drink helps the dehydration. That's why the search for another medication even if its only for a trial period.
I personally find the talk about dependence somewhat naive and generally reflecting that individuals relationship with drugs. When I came back from Vietnam I worked for a while on a ward for vets withdrawing from heroin. I don't see anything recreational about opioids. To be sedated is not my idea of fun. Also, the idea that withdrawal from opioids and rls are similar is an ill informed idea. They aren't. To say it does not make it true.
A side note. I was recently in Paris during the transportation strike and did a heck of a lot of walking. (averaging 15-20 miles a day). My rls and my usual need for methadone disappeared each day while I was up and out walking. It only came back at night when I sat down in my room. In other words, I'm taking methadone for rls, I'm not taking methadone for methadone. As Dr. Earley at Hopkins told me. 'With rls if you could walk 24/7 you wouldn't have any problem with rls. Right?'
(and I hate to say it because I don't want to be grouchy but I feel somewhat irritated with people who look at drugs as recreation as several people who have picked up this thread seem to.
I agree with you whole heartedly about not being worried about dependence on a medication that keeps me from being miserable. If they discover a cure for RLS that makes it so I don't ever have to take anything for it again, I too will worry about quitting methadone then (and will do so easily because there is nothing in any of the opioid that I want besides relief from rls. The thought that one of these might be, as someone said, one of the things you must experience before you die strikes me as rather childish.
Yes, I'd say you're being "grouchy" (your words), Moss. In reading this thread, only one person talked about recreational use, whereas all of the other comments were serious discussion of opioid withdrawal and RLS.
Calling ideas "naive" and "ill-informed" with no further comment, clarification or explanation strikes me as somewhat arrogant. Negative judgment of others does you no service.
We're all doing our serious best, and name-calling to a number of people - when in fact it was only one - doesn't help. Send a PM if it bothers you that much, but please don't tarnish us all with the same brush.
We wish you continued good luck with discovering what's causing this breathing problem.
tunes
Calling ideas "naive" and "ill-informed" with no further comment, clarification or explanation strikes me as somewhat arrogant. Negative judgment of others does you no service.
We're all doing our serious best, and name-calling to a number of people - when in fact it was only one - doesn't help. Send a PM if it bothers you that much, but please don't tarnish us all with the same brush.
We wish you continued good luck with discovering what's causing this breathing problem.
tunes
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SquirmingSusan
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I don't want to be argumentative here, but Moss posed a question to the group and the group was immediately sidetracked into a discussion about dependence on opioids, and started giving Moss advice about how to make the switch and the dangers of withdrawal from methadone.
It is clear from the question that Moss is working with his doctor on this. We are not doctors, for the most part. I know of one doctor who has been on the board lately asking for advice and he's not a part of this discussion. So, for myself, I would assume that Moss and his doctor can work out the medication switch, and that it is my part in this discussion to answer his original question. Which was, I believe, "has anyone here used dilaudid for RLS and how did it work.?" (paraphrased)
I think when we all stick to the topic, and discuss what the person posting is looking for, then we avoid these little squabbles and "pinches."
It is clear from the question that Moss is working with his doctor on this. We are not doctors, for the most part. I know of one doctor who has been on the board lately asking for advice and he's not a part of this discussion. So, for myself, I would assume that Moss and his doctor can work out the medication switch, and that it is my part in this discussion to answer his original question. Which was, I believe, "has anyone here used dilaudid for RLS and how did it work.?" (paraphrased)
I think when we all stick to the topic, and discuss what the person posting is looking for, then we avoid these little squabbles and "pinches."
Susan
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ViewsAskew
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I've taken the liberty of splitting the posts as best I could to keep the topic on track as identified by Susan and requested by Moss.
My apologies in advance if anyone's topic ended up in the wrong place
My apologies in advance if anyone's topic ended up in the wrong place
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.