After having gone through sinemet, clonazepam, neurontin, mirapex, requip, and amantadine over the last 15 years, I've finally arrived at the opiates.
I've been taking 7.5mg oxycodone once at night for the past week, and it takes care of the symptoms completely. However, I'm starting to wake up a couple of times a night now with RLS. Plus, I'm starting to feel tired and anxious during the day.
My sleep doc wanted to try the oxycodone because its shorter half life might mean fewer side effects during the day. However, my experience is that a shorter half life is not always a good thing. The doc is perfectly happy prescribing methadone if I want to switch.
Does anyone have any advice regarding oxycodone vs. methadone?
Oxycodone vs. methadone
Well, I use hydrocodone, which is generally pretty similar in my experience, albeit weaker. As you say, the lesser half-life isn't necessarily a good thing. The quick onset is the good thing, but it's gone by halfway through the night and then the symptoms come back. For me, they're not as strong as earlier in the night, but they're enough to keep me awake.
Thus I also take a small dose of methadone a few hours after the hydrocodone, and that comes on slowly and carries me satisfactorily through the night and much of the next day.
If I use just methadone, the amount I need to handle the evening creepies is enough to leave me groggy all day because the half-life is so long, so this is a nice balance of peak performance in the evening and gentle performance the rest of the day.
The problem is that methadone, even the amount left 21 hours after taking it, seems to retard the effect of other opioids. It's tricky, and a little inconsistent, to get the right amount of hydrocodone. It seems to depend a lot on chance and random digestion and such.
I wish I had something that was about half the half-life of methadone, and about double the half-life of hydrocodone, but this is working okay.
If I were you and I wanted to try methadone, I'd first try just methadone and see how I feel during the day. It made me drowsy, but a lot of people around here take several times as much as I do and function pretty well, so it must vary by metabolism and other factors.
There may be other things you could try first, though, like an extra (smaller?) dose of oxycodone later in the evening, or something like that. Maybe tack a little DA onto your oxycodone if you can. Methadone's a pretty hefty drug in several ways, so you might want to see if you can get away with something less.
Thus I also take a small dose of methadone a few hours after the hydrocodone, and that comes on slowly and carries me satisfactorily through the night and much of the next day.
If I use just methadone, the amount I need to handle the evening creepies is enough to leave me groggy all day because the half-life is so long, so this is a nice balance of peak performance in the evening and gentle performance the rest of the day.
The problem is that methadone, even the amount left 21 hours after taking it, seems to retard the effect of other opioids. It's tricky, and a little inconsistent, to get the right amount of hydrocodone. It seems to depend a lot on chance and random digestion and such.
I wish I had something that was about half the half-life of methadone, and about double the half-life of hydrocodone, but this is working okay.
If I were you and I wanted to try methadone, I'd first try just methadone and see how I feel during the day. It made me drowsy, but a lot of people around here take several times as much as I do and function pretty well, so it must vary by metabolism and other factors.
There may be other things you could try first, though, like an extra (smaller?) dose of oxycodone later in the evening, or something like that. Maybe tack a little DA onto your oxycodone if you can. Methadone's a pretty hefty drug in several ways, so you might want to see if you can get away with something less.
Disclaimer: I often talk about what I do and what works for me, but these are specific to me and you should always consult a healthcare professional before trying these things yourself, lest you endanger your health or life.
I agree. You will want to try methadone just by itself. If you do end up the route of taking only a little methadone and a little oxycodone, you may not have to worry as much about how much of the Oxy the Methadone will block, as it is considerably stronger than hydrocodone, etc..
I would caution you to pick one drug and one drug only, unless you absolutely need them both.. Oxycodone in particular can be viciously addictive, and is often called "Hillbilly Heroin" because its cheaper compared to hard drugs like H, and you can get it just about anywhere these days.
It's a big problem across the country really, but I would simply say use the one that makes you feel the most comfortable and gives you the most relief.
Good luck and I hope you find what works for you.
I would caution you to pick one drug and one drug only, unless you absolutely need them both.. Oxycodone in particular can be viciously addictive, and is often called "Hillbilly Heroin" because its cheaper compared to hard drugs like H, and you can get it just about anywhere these days.
It's a big problem across the country really, but I would simply say use the one that makes you feel the most comfortable and gives you the most relief.
Good luck and I hope you find what works for you.
There actually is something 1/2 the half-life of methadone and double the half-life of hydrocodone--> oxycontin.
Brig--Opioids are a lot like cars-- you really have to test drive them before you know whether they will work for you. Since you're having breakthrough symptoms in the middle of the night-- which is nearly identical to what I exerienced years ago- you may want to try oxycontin before switching to methadone. (only because you said oxycodone took care of your symptoms so well). Oxycontin lasts 8-12 hours as opposed to the 4-6 that regular-release oxycodone lasts. This may get you through the night.
ps....Universally- there seems to be this awful feeling when opioids wear off... not so much withdrawal as there appears to be a "worsening" of RLS symptoms. It's almost like a mini- augmentation period-- that gets better as the drug completely exits your system. This isn't dangerous but it can cause some folks to have a short period of agony and "anxiety" as the body adjusts. Longer-acting opioids like oxycontin, MS contin and methadone can help with this "anxiety" by slowing down the exit of the opioid from your body and preventing the "peaks" and "troughs" associated with shorter-acting opioids.
Brig--Opioids are a lot like cars-- you really have to test drive them before you know whether they will work for you. Since you're having breakthrough symptoms in the middle of the night-- which is nearly identical to what I exerienced years ago- you may want to try oxycontin before switching to methadone. (only because you said oxycodone took care of your symptoms so well). Oxycontin lasts 8-12 hours as opposed to the 4-6 that regular-release oxycodone lasts. This may get you through the night.
ps....Universally- there seems to be this awful feeling when opioids wear off... not so much withdrawal as there appears to be a "worsening" of RLS symptoms. It's almost like a mini- augmentation period-- that gets better as the drug completely exits your system. This isn't dangerous but it can cause some folks to have a short period of agony and "anxiety" as the body adjusts. Longer-acting opioids like oxycontin, MS contin and methadone can help with this "anxiety" by slowing down the exit of the opioid from your body and preventing the "peaks" and "troughs" associated with shorter-acting opioids.
Josh