Methadone
 

Ok, so I now that there are varying opinions on this medication, and I myself had a bias against it until very recently reading more on the topic.

However, my pain management doc just switched me to Methadone from Oxycontin ER. I had gotten unsatisfactory relief from OxyContin ER 80mg every 12 hours, and the doc presented two options. The first option was to increase the Oxycontin to 3x a day from the 2x a day which likely would have done the trick. HOWEVER, as we recently agreed to settle my work comp case leaving me responsible for paying for my own medications after this month, the Oxycontin is way out of my budget. (The cost of a monthly supply taking them twice a day exceeded $500, so I can only imagine how much it would be to take them three times a day!!!)

OR, the second option was to try the Methadone, which as the doc pointed out
(and as I've read here and elsewhere) can relieve nerve pain as well, since it acts with ALL pain receptors in the brain rather than one or two...AND it is significantly cheaper than the Oxycontin...(about$25/month!)

So...very slowly we are progressing...He began me on 5mg three times a day,
for one week, then said he will likely need to increase it at least once, to 10mg three times a day...

So it is now beginning the 3rd day of Methadone

My dosing so far has been:

Friday evening 6pm
Sat AM 2am
Sat 10am
Sat 6pm
Sun 2am

And this is doing absolutely nothing for the pain at all. I've also been experiencing some nervousness and restlessness, mild insomnia, some chills, and a feeling I can only describe as what I imagine Restless Leg Syndrome must feel like- like I need to keep stretching my legs and rolling my ankles....
Are these typical side effects of the methadone, OR are they more likely a withdrawal of sorts from the Oxycontin or both?

I also have Percocet 7.5/500 for 'breakthrough' pain, but since the Methadone isn't touching the pain yet, I've been taking the Percocet about every 4 hours, and it's not helping much either.

Any thoughts?

It is most likely withdrawal...it you are not having diarrhea or cramping, the withdrawal is mild compared to what it could be.

I sure hope your doctor gave you an EKG before starting you to screen for long QT syndrome.

Thanks for the reply, Mrs D. No, no EKG from this particular doc, but I've had them before, and never had any questions or issues of Long QT. I had a mild "childhood" murmur when I was a kid that I outgrew, and I had mitral valve prolapse in my 20s that I also outgrew...nothing since.

I thought this was likely withdrawal, but no, no cramping or diarrhea, yet anyway...

Is there anything I can do to ease this until the methadone builds up enough to work?

Don't get dehydrated, and eat foods high in potassium and magnesium daily.

Even normal cardiac people can get long QT event from being low in these two electrolytes.

Almonds are high in magnesium, for example 270mg/3oz.

http://www.healthaliciousness.com/ar...-potassium.php

V8 juice is very high in potassium too.
More information here:
http://www.azcert.org/

Another consideration with methadone is sleep apnea and other breathing disorders. If you have any of these, talk to your pharmacist/doctor.

careful
 

I don't want to be an alarmist and keep in mind I know very little about the med . There was an article in our local paper about it, it said the potential for overdose was high because the pain killing effect didn't last too long
(7-8 hours ?) but the actual half life of the stuff (how long it stays in your system) was longer, I think 2 0r 3 days but am not sure. I hope you are careful and talk to your doctor about dosing and do not get creative. It did say it was effective for nerve pain. I really am not familiar with it so ask your Dr.
Zygo

Zygo is correct.... methadone leaves the receptors for pain, before the drug is cleared from the body. This leads to taking more for relief and exposing you to further risks.

Low dose methadone is useful. The minute you move into high dose areas..you place yourself at further risk.

Thanks everyone for your input! I did know that about the Methadone and it's long half life, and that's exactly why the doc started with only 5mg every 8 hours beginning last Friday (the 9th). He asked me to phone him on Wednesday with an update, and that he will likely need to increase to 10mg every 8 hours beginning this coming Friday. I have an alarm set at 2:00am, 10:00am and 6:00pm to take the medication, which is when is best suited by my personal schedule, and my loved ones know the schedule and keep an eye on everything to make sure that I don't miss a dose or take any extra too soon. If I find that it is not working to provide adequate relief, I'll let my doctor know, and take Percocet until we can up the Methadone dosage.

Two words: Pill Organizer :D

You can tell at a glance if you've taken something or not. ;)

http://neurotalk.psychcentral.com/post827273-11.html

Doc

I do have a pill organizer, but although I can tell at a glance IF I've taken something already, it doesn't make me take it on time, or ensure that I don't take the Methadone too soon. ;-)

It should help with the latter. If the last one is gone, and it's not time to take the next one yet, it'll still be there, and should be until it IS time/alarm goes off. ;)

Doc

methadone...you have a ways to go before being concerned!
 

B"H

hello,

it sounds like you are opiate tolerant if you were on that dose of OxyContin, so the methadone should not be a problem. while it does have metabolytes after it leaves your liver which means it remains in the body awhile, you are on a very cutios starting dose. mine was at 10 mgs three times daily. I am now up to 30 mgs for times daily for nerve pain in addition to a high dosed fentanyl patch and fentanyl breakthrough buccal tabs. it sounds like you are having mild withdrawal symptoms that the methadone is keeping at bay due to its long half-life. I would not worry about overdosing too much as your doctor seems competent and is being cautious in titrating you from Oxy to Methadone. I hope it works for you. it is nice that it is so affordable. for once, there is an affordable and effective medicine. that is like an oxymoron! good luck with the switch. if you have any questions, feel free to pm me. take care nd be well.

:hug::hug::hug:
Sloane

That sounds classic opiate withdrawal. I came off of oxycodone and had all your symptoms .. Nausea, restless legs, inability to sleep, very sore eyes, twitching, hot and cold ...the doctor offered me methadone as the ly thing tha would help this withdrawal. I said now.

I went through a week in hell.

I'm now taking another mix . Again opiates, and I fear ye another horrible withdrawal should my forthcoming scs work and allow me to come off of some of my medication.

P.s. I was on 40mg oxycodone twelve hour release topped up with
I quid oxycodone,

:confused: Not only is methadone not the only thing that will help ease withdrawal, it also induces dependency itself, and withdrawal from methadone can be as just bad (or worse) than from other opiates. It may be that it's just their standard/firstline method - I don't know.

Doc