I got some great advice from folks the last time I posted and wanted to get advice on transitioning from Mirapex to an opiate. Right now I'm taking .25 mg Mirapex at 6 p.m. then 1 mg about an hour before bedtime. Doc gave me T3 which didn't do a darn thing and now I'm transitioning onto oxycodone. I usually get symptoms no earlier than 4 or 5 p.m. unless I try to take a nap. Any suggestions how to best transition off the Mirapex and onto the opiate?
Thanks!
Kristi
Transition: Mirapex to oxycodone
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emmettdigger
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SquirmingSusan
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I understand that you can just stop the Mirapex and start the oxycodone. Just make sure you have enough of the oxy to cover the worsened RLS - When stopping DAs, you can have a few weeks of dramatically worsened RLS before things settle back down, especially if you were having augmentation issues. And be prepared for serious constipation which comes with opiates. You'll likely be quite groggy from the oxy for a couple days until you get used to it, as well. So maybe start it when you don't have to do much or drive anywhere.
T3? What's that? As far as I know it's a thyroid hormone, so I don't know why it would be helpful for RLS...
Best wishes with it.
T3? What's that? As far as I know it's a thyroid hormone, so I don't know why it would be helpful for RLS...
Best wishes with it.
Susan
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emmettdigger
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SquirmingSusan
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Just be real careful with the Oxycodone.. I know I sound like a broken record, but that stuff can be a lot more addictive than other opiates..
My advice would be to try tapering off while introducing the oxycodone.. Without your prescribed dose and quantity I really couldn't reccomend what to try though.
I would just say take a little bit less Mirapex, and add 5mg of Oxycodone or something like that, etc.. Also don't go overboard with it. I got really freaked out the day after I took my first Oxycodone dose. I was pretty tolerant to hydrocodone at the time as well, so I kept imagining I had breathing problems and was pretty groggy / doped up feeling all day. But that could have just been me. Either way it was enough to scare me back into the doctors office and ask for something else, heh... I eventually took it regularly for a period though.
It's still a good medicine, pretty strong stuff really. If you find that it works well for you, but you start having problems with it wearing off, try and speak with your doctor about that immediately and ask about the possibility of switching to the controlled release version. It's called Oxycontin and unless you have good insurance its going to be real expensive depending on your pharmacy... But It'll last you a lot longer and when it does wear off it should be a bit more gradual to deal with. Oxycodone is one medicine where you don't want to start that "hmm... bad day, have a little extra" mentality if you have problems with it wearing off too early.
My advice would be to try tapering off while introducing the oxycodone.. Without your prescribed dose and quantity I really couldn't reccomend what to try though.
I would just say take a little bit less Mirapex, and add 5mg of Oxycodone or something like that, etc.. Also don't go overboard with it. I got really freaked out the day after I took my first Oxycodone dose. I was pretty tolerant to hydrocodone at the time as well, so I kept imagining I had breathing problems and was pretty groggy / doped up feeling all day. But that could have just been me. Either way it was enough to scare me back into the doctors office and ask for something else, heh... I eventually took it regularly for a period though.
It's still a good medicine, pretty strong stuff really. If you find that it works well for you, but you start having problems with it wearing off, try and speak with your doctor about that immediately and ask about the possibility of switching to the controlled release version. It's called Oxycontin and unless you have good insurance its going to be real expensive depending on your pharmacy... But It'll last you a lot longer and when it does wear off it should be a bit more gradual to deal with. Oxycodone is one medicine where you don't want to start that "hmm... bad day, have a little extra" mentality if you have problems with it wearing off too early.
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emmettdigger
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The Mirapex worked like a charm for a couple of years but my dose has just been escalating. I didn't have augmentation until last year - started around 6 p.m. Now I have it earlier in the day but not every day. I make sure to check my ferritin regularly and don't drink too much caffeine.
I like the idea of tapering the Mirapex and adding the oxycodone. My doc recommended taking 2.5 mg of the oxycodone and stepping it up as needed. He's totally open to methadone but wanted to start me on the lowest possible dose of opiod so we'd make sure to get what fits best with me.
Zach - is there less potential for addiction with methadone than oxycodone?
Thanks everyone!
I like the idea of tapering the Mirapex and adding the oxycodone. My doc recommended taking 2.5 mg of the oxycodone and stepping it up as needed. He's totally open to methadone but wanted to start me on the lowest possible dose of opiod so we'd make sure to get what fits best with me.
Zach - is there less potential for addiction with methadone than oxycodone?
Thanks everyone!
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ViewsAskew
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emmett, methadone had less risks in some ways. It's Dr Buchfurer's "go-to" opioid. But, Josh, our resident pharmacist, doesn't put it first on his list.
It does have less risk of addiction - that is the physical AND emotional attachment to the high. There is little or no high with it. There is a pronounced high for many with other opioids (depends on the opioid - oxy is regularly abused because of its high).
It does however still have the risk of dependence (physically "needing" the drug, so when you stop, you get sick). There are differing views on this. Going back to Dr Buchfurer, he indicated that he hasn't seen problems in his patients with this if they dose methadone just once a day. But, I've read of people who did just dose once a day and they did have dependence issues.
Methadone is also safe during pregnancy and since it's been around so long (since the 30's or 40's), it's been studied more than any of them, I'd guess. While there are risks with it, to me it seems to be one of the safer choices.
It does have less risk of addiction - that is the physical AND emotional attachment to the high. There is little or no high with it. There is a pronounced high for many with other opioids (depends on the opioid - oxy is regularly abused because of its high).
It does however still have the risk of dependence (physically "needing" the drug, so when you stop, you get sick). There are differing views on this. Going back to Dr Buchfurer, he indicated that he hasn't seen problems in his patients with this if they dose methadone just once a day. But, I've read of people who did just dose once a day and they did have dependence issues.
Methadone is also safe during pregnancy and since it's been around so long (since the 30's or 40's), it's been studied more than any of them, I'd guess. While there are risks with it, to me it seems to be one of the safer choices.
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 would say Methadone is probably a lot less addicting than other opiates from a psychological stand point, but I have also seen a lot of statements that it is incredibly hard to get off if you ever stop taking it, or in the case of addicts using it to taper off street drugs, some think its great, while others think its easier to just go cold turkey off heroin, etc..
I am however, a big proponent of Methadone. I am a recovering addict, and I started down that road ironically because of my RLS treatment. Methadone as a whole will not give you this intense physical or mental peak like a lot of other medications will, but it does still have somewhat of a relaxing anti-anxiety effect to it. Codeine and Hydrocodone in particular can induce large amounts of Euphoria in small doses when you first start them, but they scale up poorly on a diminishing returns system so that is what traps a lot of people. For me, Oxycodone didn't do too much, it felt more like a transition point between what Hydrocodone feels like and what Methadone feels like. It definitely is easy to take a lot of the stuff though, and it has replaced heroin and other street drugs as the drug of choice in many rural and suburban street markets.
This however is not a reason to dismiss it as unusable. There are many people here who take Oxycodone with little or no problem at all. And again, I would reckon Oxycontin would be a lot easier to deal with as it is a controlled release medication over a period of about 12 hours if I recall correctly. Of course you don't have the luxury of breaking it up and are stuck with a finite minimum dose, as well as finite increase stepping stones, as it would lose its slow release function and be a danger to your health. They actually pulled one or two of the higher end doses off the market because they were such an E.R problem with abusers crushing them, overdosing, etc.
It all comes down to you personally, with RLS treatment though. You might find it works for you, and you only need one or two 5mg doses a day or something like that.
Methadone is not a controlled release medication, however it acts like one for whatever reason. It has a half-life of 72 hours, but in real terms that translates to between 12 - 24 hours of relief per dose, best case scenario. Right now I take 15mg/day in the morning, and I stagger the doses 5mg every hour or so, and I also have 20 extra pills a month that I can use if I need an extra pill one day. So far it's turned out to be the best medication for ME, but everyone is different. All I can say is I'm sleeping properly for the first time in my life, and rarely stay up all night although I do have ocassional insomnia. I'm usually good for the whole day after I've taken my medication over the span of the morning as opposed to short acting meds like Hydrocodone, Codeine, Tramadol, Oxycodone, etc.
I used to be able to take one large dose of Hydrocodone, etc and be good for 24 hours, but that kind of diminished as the years went on.. During my early months on Methadone when I was still having abuse problems I would occasionally get a script for Hydrocodone to fill in the gap for a week or something and taking 8 (prescribed as such) 5mg's over the course of the day was extremely hard to do, and barely kept me out of withdrawal and my symptoms would come back after only an hour or two sometimes.
Be that as it is. If you find your RLS increasingly difficult to deal with, getting either a time released medication like Oxycontin, or MS Contin (morphine... even I would never touch that stuff), or a long acting medication like Methadone or Subutex (buprinorphine, also used for addiction treatment like Methadone) is going to be the best route to deal with it.
These are all pretty powerful medications too, so I would caution you if you ever do move up to any of them, not to rush it. Not to scare you, but you could easilly kill yourself by taking too much Methadone at first.. I make it a point to tell this to everyone, even though it applies less to those of us with previous moderate/heavy opiate exposure from our RLS treatments, simply because Methadone takes a lot of flack on this issue. If some people had their way it would be illegal and banned. Stepping up from Oxycodone to Methadone shouldn't be a problem for you though.
The bigger picture here is, every drug has its strenghts and weaknesses. Augmentation has caused your symptoms to progress and show up early, translating into a longer period of RLS, or RLS that potentially will never go away and may progress to 24/7. In that case a controlled release medication, or long acting Methadone / Subutex would be better options for you to consider. Give the Oxycodone a chance though, try not to take more than two doses a day unless you really need it, and if you find you are taking 5 - 10mg 3 times a day in the long run, consider switching to something else.
The benefits of Methadone for me have been.. Normal sleep cycle for the most part. I've been an insomniac since my first memory in life, and the RLS and heavy opiate abuse made that a lot worse.. Being a zombie for two or three days is very annoying. Also when my meds come off the peak effectiveness, it is a much gentler let down, which helps spurn annoying feelings about taking more pills, etc to get back to where you were. I think those are good qualities to look for in an RLS medication when treating a disease that is long-term, chronic, and will progress throughout your life.
I am however, a big proponent of Methadone. I am a recovering addict, and I started down that road ironically because of my RLS treatment. Methadone as a whole will not give you this intense physical or mental peak like a lot of other medications will, but it does still have somewhat of a relaxing anti-anxiety effect to it. Codeine and Hydrocodone in particular can induce large amounts of Euphoria in small doses when you first start them, but they scale up poorly on a diminishing returns system so that is what traps a lot of people. For me, Oxycodone didn't do too much, it felt more like a transition point between what Hydrocodone feels like and what Methadone feels like. It definitely is easy to take a lot of the stuff though, and it has replaced heroin and other street drugs as the drug of choice in many rural and suburban street markets.
This however is not a reason to dismiss it as unusable. There are many people here who take Oxycodone with little or no problem at all. And again, I would reckon Oxycontin would be a lot easier to deal with as it is a controlled release medication over a period of about 12 hours if I recall correctly. Of course you don't have the luxury of breaking it up and are stuck with a finite minimum dose, as well as finite increase stepping stones, as it would lose its slow release function and be a danger to your health. They actually pulled one or two of the higher end doses off the market because they were such an E.R problem with abusers crushing them, overdosing, etc.
It all comes down to you personally, with RLS treatment though. You might find it works for you, and you only need one or two 5mg doses a day or something like that.
Methadone is not a controlled release medication, however it acts like one for whatever reason. It has a half-life of 72 hours, but in real terms that translates to between 12 - 24 hours of relief per dose, best case scenario. Right now I take 15mg/day in the morning, and I stagger the doses 5mg every hour or so, and I also have 20 extra pills a month that I can use if I need an extra pill one day. So far it's turned out to be the best medication for ME, but everyone is different. All I can say is I'm sleeping properly for the first time in my life, and rarely stay up all night although I do have ocassional insomnia. I'm usually good for the whole day after I've taken my medication over the span of the morning as opposed to short acting meds like Hydrocodone, Codeine, Tramadol, Oxycodone, etc.
I used to be able to take one large dose of Hydrocodone, etc and be good for 24 hours, but that kind of diminished as the years went on.. During my early months on Methadone when I was still having abuse problems I would occasionally get a script for Hydrocodone to fill in the gap for a week or something and taking 8 (prescribed as such) 5mg's over the course of the day was extremely hard to do, and barely kept me out of withdrawal and my symptoms would come back after only an hour or two sometimes.
Be that as it is. If you find your RLS increasingly difficult to deal with, getting either a time released medication like Oxycontin, or MS Contin (morphine... even I would never touch that stuff), or a long acting medication like Methadone or Subutex (buprinorphine, also used for addiction treatment like Methadone) is going to be the best route to deal with it.
These are all pretty powerful medications too, so I would caution you if you ever do move up to any of them, not to rush it. Not to scare you, but you could easilly kill yourself by taking too much Methadone at first.. I make it a point to tell this to everyone, even though it applies less to those of us with previous moderate/heavy opiate exposure from our RLS treatments, simply because Methadone takes a lot of flack on this issue. If some people had their way it would be illegal and banned. Stepping up from Oxycodone to Methadone shouldn't be a problem for you though.
The bigger picture here is, every drug has its strenghts and weaknesses. Augmentation has caused your symptoms to progress and show up early, translating into a longer period of RLS, or RLS that potentially will never go away and may progress to 24/7. In that case a controlled release medication, or long acting Methadone / Subutex would be better options for you to consider. Give the Oxycodone a chance though, try not to take more than two doses a day unless you really need it, and if you find you are taking 5 - 10mg 3 times a day in the long run, consider switching to something else.
The benefits of Methadone for me have been.. Normal sleep cycle for the most part. I've been an insomniac since my first memory in life, and the RLS and heavy opiate abuse made that a lot worse.. Being a zombie for two or three days is very annoying. Also when my meds come off the peak effectiveness, it is a much gentler let down, which helps spurn annoying feelings about taking more pills, etc to get back to where you were. I think those are good qualities to look for in an RLS medication when treating a disease that is long-term, chronic, and will progress throughout your life.