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Old 08-04-2009, 11:15 AM   #1
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switching from fentanyl to methadone

I a currently on 150mcg's ev 48hr of fentanyl. Also have 400mcg fentanyl actiq pops for breakthrough pain. I want very badly to change from the patch
to methadone. My PM says he can do it without going through withdrawls. I just don't see how I can make the change with the high dosage of fentanyl. I have been on the patch for about a year and a half. Is it possible to make this change without the horrible withdrawls. I have been through it several times and I am 43 and my body cannot take that kind of misery again not will I go throught it again. I have told me reg doc that I will not go through wd's again no questions asked. My reg doc does the prescribing while consulting my pain doc. I am at the end of my rope I can't take much more. I have been through several major surgeries and am developing a big mass of scar tissue in my neck where they did the last surgery. Any help would be appreciated.

 
Old 08-04-2009, 12:48 PM   #2
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Re: switching from fentanyl to methadone

I think that it can be done but you MUST slowly decrease the fentanyl patch while slowly increasing the Methadone. Please keep in mind that it takes much less of Methadone (per mg) as opposed to your fentanyl dose. You might end up (at say 60mg/day) of Methadone, just as an example. You won't be nearly as high per mg as you are on the fentanyl. These 2 medications do hit different narcotic pain receptors in the brain so you will "feel" some difference but not necessarily withdrawal if it is done properly. Tell your doctor that you want to slowly increase the Methadone while decreasing the fentanyl. Ask him what he will do if you start to experience withdrawals. He will probably have you either take something like clonidine (which helps WD) or increase you more quickly on the Methadone.

brian
P.S. the good news is that Methadone is ultra cheap and is the cheapest of the pain medications (ex. 60mg of Methadone is $15 without insurance)

 
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Old 08-04-2009, 05:35 PM   #3
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Re: switching from fentanyl to methadone

Yes, it can be done and if you're PM Doc is a good one and really knows what he's doing, then he's probably telling you accurately. I would be a little skeptical of a GP or family Doc only because they don't have as much experience.

When transitions occur, they usually do so slowly as Brian says. Frequent visits are imperative, as well as liberal access to BT meds in order to address the change. Opioid rotation has gotten a lot of press lately, and many experts think that periodic changes can really help the CP patient. Additionally, since all your meds are fent, your receptors may be saturated....A second med may do a lot of good. For example, my PM Doc really believes in one med for the LA, and a different one for BT. I take morphine for LA and like you, use Actiq for BT. Each med hits our receptors differently and depending on your specific injury / pain site, some meds work better than others. Pain is not necessarily pain. For example, the delta receptor is primarily responsible for spinal analgesia.

Best of luck to you.

Regards,

Ex

Last edited by Executor; 08-04-2009 at 05:52 PM.

 
Old 09-01-2009, 03:03 PM   #4
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Re: switching from fentanyl to methadone

I agree with Ex and Brian regarding transition.
My transition, due to severe reaction to high dose of Fentanyl patch, had to be abrupt, still I did not have much problems at all. As Ex said, the most importantly in this how knowledgeable your PM DR is.
I know everyone is different, but I believe you will be OK. My PM also believes in LA + BT meds. I am on Oxy as LA and Percocet as BT. I was switched couple of times; the minute my body becomes tolerant to medication and I feel more pain, my PM changes my medication and always works great.

I also do not believe in using GP or family Dr for pain management. Like my wonderful GP told me once that this is not a problem to Rx me Pain killers, but Pain mgmt is much more than just prescriptions; GP are not trained as PM Drs do.

Best of luck to you, sweet heart. Do not loose your hope, please. Tomorrow will be another day and hopefully better than today...

 
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