Hi, everybody:

I use Duragesic (fentanyl patches) 125 mcg (one 100 mcg patch and one 25 mcg patch every 72 hours) for intense chronic pain caused by generalized internal chronic RSD and I take MSIR (morphine sulfate immediate release capsules) 30 mg (one capsule once or twice daily as needed) for breakthrough pain.

I have very intense fatigue. No one knows why. My primary care doctor, my only doctor, does not believe me, but there are witnesses at my workplace who have seen me extremely tired, trying to keep my head from falling on my desk from such tiredness. I sleep about 8 hours a day, sometimes less, sometimes more.

I have some leftover dextroamphetamine tablets, which were prescribed for me in the U.S. a long time ago by my wonderful U.S. pain management doctor. I do not have access to new dextroamphetamine tablets anymore because I am not in the U.S. (French doctors look at me as if I am pointing a gun at them when I ask for a dextroamphetamine prescription renewal, even though this medication was already prescribed for me in the past by a U.S. doctor) I take a 5 mg tablet of dextroamphetamine when my fatigue gets sooo extreme I think I cannot take it anymore. I noticed the more tired I am when I take my dextroamphetamine tablet, the more effective it seems to be. I wonder why. If someone has any ideas, feel free to share them with me.

My other questions are:

-Can dextroamphetamine be taken with opiates circulating in the blood?

-Can dextroamphetamine be taken at the same time as MSIR without these two medications cancelling each other's effects? If no, how long do I have to wait, when I took one of these two medications, to take the other one? I am asking these questions because a person can be tired (thus needing dextroamphetamine) and in intense pain (thus needing MSIR) at the SAME time. Then what do I do?

Thanks for sharing your opinions and answers.

I wish I knew more about the med you are asking about so I could be of more help.
I just wanted to share that the Fentanyl can certainly make a person very drowsy. I was tired all the time also when I was on the higher dose of 100mcg.
Now I'm down to 50's and don't seem to get drowsy as much.

If you suspect there might be something else going on, it might be wise to get your thyroid checked. So many things went wrong with me when it was discovered that I was hypothyroid. The main thing it caused was chronic drowsiness, no energy, hair falling out and weight gain.

Now that I'm on the proper med for my thyroid function, I feel much better.....except for the pain issues - grrrrr

Just a thought
Caring,
Rae

hello kitty!

boy, how cute it sounds to say that and mean it literally. nonetheless, the dextroamphetamine should not be a problem if taken with your breakthrough MSIR. you are taking two totally different types of drugs that as far as I know are not contra-indicated. I am on phentermine and fentora ( fentanyl) breakthrough along with the fentanyl patch. phentermine is like dextroamphetamine in that they are both amphetamines or stimulants. I am also on another stimulant for ADD which helps wake me up and keep me focused. I would not worry about taking them together.

however, it seems to me, you are eventually going to run out of them. then what can you do? I understand they help for the fatigue that comes from chronic pain and rsd. I experience the same problems. it is not the fentanyl which causes my tiredness or fatigue. rather, it is the medical condition that causes it. I think the dextroamphetamine's stimulant effects are more pronounced the more tired you are simply because you are more tired and can feel the stimulant better...if you get what I mean. perhaps you should conserve using it until you are at your worst in order to have it as long as possible.

I think I answered your questions in full as best as I can. I hope I helped clear something up for you. take care and be well. then, stay well! good luck!


Sloane

Drugs, and interactions, can effect people differently. I checked ONE drug interaction site that said something like "No interactions found for [those two drugs]", but I think it would be prudent to check a few other sites, ask your pharmacist/doctor... stuff like that.

I don't know if they would cancel each other out or if the amphetamine would act as a potentiator for the morphine (which could potentially be dangerous, depending on variables) which is why I'd run it by a professional.

At the risk of once again .... Have you had your adrenal hormones checked? Intractable pain and long-term opioid use can deplete/suppress them, and that can cause fatigue (among other things). I know my energy levels are higher since supplementing my adrenals (which tested at or below minimums).
http://www.practicalpainmanagement.c...tractable-pain

Doc

Kitty, I have PN and have been taking Methyl B-12. As well as Benfotiamine. A couple of weeks after starting these 2, I started taking R-Lipoic Acid (Best stabilized). (these are recommended as a possible nerve regeneration.)

But; and the main reason for this post is - within a week or so, after starting the Stabilized R-Lipoic Acid, I started having much more energy. (also as a side benefit, did lose a few pounds too.) I am on Oxycotin, Percocet, Vallium, Abien Cr and still this really gives me an energy boost.

Hi, Rrae:

I assumed that, if my American pain management physician in San Francisco accepted to prescribe some dextroamphetamine tablets for me while he knew I had been using fentanyl patches and taking morphine sulphate immediate release tablets, it must mean there would be no negative interactions between them. I also assumed that this doctor would, maybe, take my narcotic painkillers away if he thought they made me that sleepy, instead of prescribing some dextroamphatamine pills for me.

Quote: "I just wanted to share that the Fentanyl can certainly make a person very drowsy. I was tired all the time also when I was on the higher dose of 100 mcg. Now I'm down to 50's and don't seem to get drowsy as much."

I always change my fentanyl patches at 10 PM every 72 hours, when I do not forget. The following day, the first 24 hours of my patches, I am sometimes tired, but not this often.

Like I said in my first message in this thread, my primary care physician is the only one willing to treat me, whether it is for my pain problems or for my thyroid problems. When it comes to my thyroid problems, this doctor looks at my normal thyroid blood test results to say I am fine. Before I started taking one 25 mcg tablet of levothyroxine daily, my thyroid blood test results were abnormal and I had many hypothyroidism symptoms. After I started taking one 25 mcg tablet of levothyroxine daily, my thyroid blood test (without the tests for the thyroid antibodies) results were normal, but I still have many hypothyroidism symptoms.

Quote: "The main thing it caused was chronic drowsiness, no energy, hair falling out and weight gain."

I am almost 100% sure and certain that my strong tiredness comes from my thyroid problems (Hashimoto's hypothyroidism). Sometimes, I am so tired that when I type or read, I cannot keep my eyes open. It is just too hard.

It is great your thyroid problems are solved. Hopefully, it will soon be the case also with your pain problems. Good luck and thanks for your information.

Hi, Sloane:

Quote: "Nonetheless, the dextroamphetamine should not be a problem if taken with your breakthrough MSIR. You are taking two totally different types of drugs that as far as I know are not contra-indicated."

Thanks. This is reassuring.

I fear the day when my American prescribed dextroamphetamine tablet bottle goes empty. There is just absolutely no medication other than dextroamphetamine (and probably medications from the same family) that will help me with my extreme tiredness.

Frankly, I do not believe my extreme tiredness is caused by my strong narcotic painkillers. What I really think is that my hypothyroidism or some undiagnosed fatigue syndrome cause my extreme fatigue.

Unfortunately for me, French Doctors, especially those in French Polynesia, have their ears stuck to such a point that they will refuse to listen to their suffering patient, no matter how polite he/she is. I even think such doctors literally "itch" telling their patient he/she is a liar when he/she dares complain of anything. So, let's just suffer in a corner! This is the message I (and certainly many other French patients) get.

Ahhh! If wonderful America sees me someday on its soil, I will never, ever leave it again! I miss the country that I adopted and that adopted me so lovingly! Even if I have no drop of American blood in my body, I know without the shadow of a doubt that my heart is 100% American!

I do not know how you were able to convince your doctor to prescribe the amphetamines for you. I can only imagine it is because you have the health conditions that warrant the use of amphetamines. I also have the health conditions that warrant the use of amphetamines, but unfortunately, I do not have and cannot find a doctor like yours.

Quote: "However, it seems to me, you are eventually going to run out of them. Then what can you do?"

I am stuck. I know there are web sites that sell them without a prescription. My U.S. pain management doctor would not write a prescription for me (he probably could not legally write a prescription for me since I am not in a consultation with him in the U.S.). This is why I would have to use a web site that accepts dextroamphetamine orders without a prescription.

Problem: the f***ing French Polynesian customs would seize the medication, prescription or not. It does not matter to them that, out there, there is a patient suffering intensely with her extreme tiredness, patient who French doctors refuse to help. French Polynesian customs just put everybody in the same basket: to them, we are all druggies. I have never been, I am not, and I will never be a druggie. I am just a patient who suffers from intense chronic pain caused by generalized internal chronic RSD (pain controlled with various types of painkillers) and I am a patient who suffers from extreme fatigue caused by a host of health conditions (tiredness NOT controlled without dextroamphetamine). I am really ANGRY because French Polynesian customs are heartless. When I think there are French Polynesian customs agents stealing in tourists' suitcases without their knowledge!!!! The tourists find out only when it is too late. One of these French Polynesian customs agents got caught, but what about the others!?!?

You experience some of the same problems I do, so you understand how I feel. Doctors do not.

Quote: "It is not the fentanyl which causes my tiredness or fatigue. Rather, it is the medical condition that causes it."

This is totally true for you and for me.

Quote: "I think the dextroamphetamine's stimulant effects are more pronounced the more tired you are simply because you are more tired and can feel the stimulant better... if you get what I mean."

I understand what you mean. You gave me a very good explanation. Now, I understand why dextroamphetamine works so well for me.

Quote: "Perhaps you should conserve using it until you are at your worst in order to have it as long as possible."

This is what I will do. Thank you really much for sharing this idea with me.

Quote: "I think I answered your questions in full as best as I can. I hope I helped clear something up for you."

Yes, you did. Thank you so much for your information and kindness. I am in the process of adopting a new baby boy to give my two-year-old baby boy the brother he has been asking for for so long. I will call him Joshua Sloane.

Hi, Dr. Smith:

I will, as you advised, check several web sites for medications interactions.

However, I will never talk about my taking dextroamphetamine to any French doctors or pharmacists because, like I mentioned in my first message in this thread, "French doctors look at me as if I am pointing a gun at them when I ask for a dextroamphetamine prescription renewal, even though this medication was already prescribed for me in the past by a U.S. doctor." Just pronouncing the word "dextroamphetamine" is enough to get me a murderous look from most, if not all, French doctors and pharmacists. Like I told Sloane, I am not a druggie; I am just a patient asking for her extreme fatigue to be relieved.

Quote: "Have you had your adrenal hormones checked?"

I do not know what adrenal gland and hormones are. I had my thyroid gland checked once and my thyroid hormones tested three times.

Quote: "Intractable pain and long-term opioid use can deplete/suppress them [adrenal hormones], and that can cause fatigue (among other things)."

Unfortunately for me, my intractable pain (caused by generalized internal chronic RSD) cannot be cured, so I have to take strong opioids for the rest of my life because no other medications work as well.

I will have my adrenal hormones checked if I can find a doctor willing to write a prescription for me. Like I said, the French Polynesian public health insurance company does not stop harassing doctors who prescribe tests, medications, braces, etc... for me. This insurance company always complains my health care is too expensive for them compared to the premiums I pay.

I will check the link you posted and print the interesting information. Thanks for your information and link.

Hi, ger715:

Where to find or order online Methyl B-12, Benfotiamine, and R-Lipoic Acid? Do I need a prescription to obtain these? I could try them and see what they do for me. Thanks for sharing your ideas.

These are all over-the-counter vitamins and supplements - no prescriptions are needed. Google each one, as there are many manufaturers/sources, and prices/sales can vary month to month. Some vendors will also provide free shipping, but that will depend on how far away they are.

Doc