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Old 06-22-2012, 10:14 PM   #1
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Switching from Methadone

Anyone have any guidance on switching from Methadone? I've been working with my new pain specialist on this for a few months now as my previous doctor wasn't willing to up my Methadone dose or change me to a different med. I had become tolerant to it as well as it wasn't lasting me through the night, so I woke up in a lot of pain and it took much of the day to get it under control.

I started on 70mg/day of Methadone. At first we added Fentanyl (25mcg/hr) to it, then Morphine (90mg/day). A different doctor had prescribed the Fentanyl and the one I usually see at the clinic said Fentnayl and Methadone was a bad combo, so that is why we switched it to Morphine. The Morphine seemed to help fill in the gaps some so we switched out 20mg Methadone for 90mg Morphine, so I was on 50mg Methadone + 180mg Morphine (60mg tid). Then the side effects caught up to me--twitching (especially in my sleep), flushing of my face, and sweating, in addition to the usual stuff like constipation.

I asked my doctor about getting off the Methadone since I was thinking it was the combo of the two meds and not so much the overall dose, as the side effects didn't start until we switched out some Methadone for Morphine, and I didn't see any way to make the Methadone dosing work. It was easiest to switch to Morphine since I was already on some and we knew I tolerated it fine. He warned me it was going to be uncomfortable since I was going to have to cut back on the Methadone before I could add back in some Morphine due to the long half life, but I wasn't exactly prepared for what happened next!

He decided to do a switch from 50mg Methadone + 180mg Morphine to 300mg Morphine. I had to stop the Methadone for 24 hours, then I got to increase the Morphine from 60mg tid to 100mg bid for two days, then 100mg tid. He said he didn't think I'd have withdrawal after I started the increased Morphine, but of course I did, since it was only 20mg/day more than I was on before (and I was minus the Methadone). I ended up having to take a lot of my bt med (Oxycodone) as well as some Methadone so I wasn't too miserable with the withdrawal. Thankfully he said I could take up to 20mg/day of Methadone if needed so that wasn't an issue (although I was supposed to wait a week).

So its a week later and I'm still in a lot of pain. I'm still even having some withdrawal symptoms unless I take Oxycodone (my bt med) or 20mg Methadone on top of the Morphine. I've been doing both. Unfortunately that means I'm using up my Oxycodone script too fast. Shouldn't be a problem contract wise but I know I likely won't get an early refill. I realized this conversion was pretty messed up. Previously it was a 1:4.5 ratio (which worked slightly in my favor) and this time it was 1:2.4. I know you have to be conservative in these conversions, but it made no since to try to do it all in one jump if you have to be that conservative. No idea why the doctor thought I wouldn't go into withdrawal.

Thankfully I have an appointment next week so I hope to get this sorted out. I didn't even bother putting in a call as I've been told previously they can't do med changes over the phone (they couldn't even give me a decreased dose of a non-narcotic med), and its not exactly an emergency. Anyone have thoughts on conversion off of Methadone? My doctor spent a lot of time trying to figure out how to do it and was wavering between keeping me on 20mg of the Methadone or saying I could take that much if I needed it after the switch. I was supposed to wait a week before adding the Methadone back in, but I didn't last that long due to the withdrawal and felt completely safe doing it.

Seems like I'm short more than 20mg Methadone, which the previous conversion showed me was 90mg Morphine. Hopefully they will allow me to go up enough on the Morphine to at least get back to where I was before in pain relief, which wasn't actually that good (but better than 6 months ago). In addition to the dose being quite short I have also now realized the Morphine doesn't last me 8 hours...more like 5-6. So, I still have the issue of waking up with a lot of pain.

I had asked before about switching to Kadian as that has a longer half life, but he wanted to wait until my Morphine ER dose was stable as he said that can be enough of a switch on its own. I also may need to switch to uneven dosing as I'm having more pain earlier in the day than later in the day (and can deal with the pain better at home than at work). I did this with the Methadone and was expecting that, but I wanted to try the equal dosing as I've actually never done that.

Has anyone else had to dose Morphine ER more than three times a day? Anyone have experience with conversion rates off of Methadone? I know it really varies, but I sure hope what I end up needing is within a reasonable range. Anxious about what they will be able to do for me. Thanks for reading! Best wishes.
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Old 07-22-2012, 05:12 PM   #2
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Re: Switching from Methadone

I really can't give any advise on your question but I am kind of in the same situation as far as wanting to get off methadone,but I am even scared to ask my Dr...I was taking tramadol then moved up to Hydrocodone,then vicoprofen for 2 years then,I lost health insurance and my job,so the only thing I could afford was methadone. which costs pennies per pill....My dr was hesitant about giving it to me,but he did..I am up to 100 mg's/day and sleep all day and I am scared to switch to anything else for fear of withdrawel and not anything else coming close to giving me pain relief...I looked at my pharmacy and morphine sulfate 30 mg's is the cheapeast narcotic @(40$ for 60)I could take besides the methadone...I don't know what to do..I don't see him again until sept 28th so I have a while tot think about it!! I hope you find what can work for you too!

Last edited by GaNeal; 07-22-2012 at 05:17 PM.

 
Old 07-22-2012, 08:30 PM   #3
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Re: Switching from Methadone

This is an old thread of mine (no longer applicable), but thanks for the response. I believe the morphine quote you got was for short acting...you'd want a quote for Controlled/Sustained release...my pharmacy stubs were over $600, but I wasn't shopping around. Its definitely in the hundreds of dollars though. More if you want generic Kadian capsules and even more for brand name Avinza. Plus you'd need a higher dose than 30mg, but often the price for higher mg pills isn't too much different. You are correct that next to methadone, morphine should be the cheapest long acting med, as many are brand only.

I wouldn't be hesitant to tell your doctor that your current regime isn't working. However, do be prepared for a bit of a rough time in switching...doctors often start you so low to be safe that you can be put into withdrawal, in addition to low pain relief. A good doctor will be seeing you every 1 or 2 weeks during this process, plus be available by phone, and may even give extra breakthrough meds. Once you mention this isn't working for you and your doctor recommends something new, be clear that you can only afford generic, and that you are scared of being dosed too low and going into withdrawal or having out of control pain.

Another idea is to give you something to help combat the sedation (which can be common to have and to treat if the med is working well)...there are a few generics such as Ritalin. I take this for my fatigue (not med related though), and have to pay cash...maybe $40/month. Have you mentioned the sedation to your doctor? I'd mention the problems you are having and your cost concerns if you were to switch meds, but nothing by name. Good luck! Best wishes.
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Old 07-22-2012, 10:24 PM   #4
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Re: Switching from Methadone

Yes you are correct,the 30mg morphine is the short acting now I m even more depressed. and discouraged...i looked online for the longer acting morphine and it's in the 100 of $$$ I just need to accept this is why I went on methadone to begin with...it's longer acting and CHEAP....maybe I just need a breakthrough like 10 mg percocet...My partner tells me there is no way he will give me 2 narcotics at once,while my other friends say to go ahead and ask...
Every trip to the Dr I do have to fill out a sleepiness study quizz and he even sent me to the hosptital last december for a sleep study which was a night wasted for me because I just tossed and turned because of the pain I was in,but I never fell asleep so there was nothing for them to Diagnose...He did give me samples of Provigil which wored okay but they are in the 100 of dollors too. To be honest though I have taken adderal and ritilin and they make me nervous,so I honestly would rather nod off all day than be nervous and never blink thanks for the advice...I just hope this new alleged healthcare 2014 will help because I am not qualified for anything else for at least 2 years...I am in the process of trying to get SSDI and it hads been 3 years and I am still waiting!

 
Old 07-23-2012, 04:32 AM   #5
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Re: Switching from Methadone

Just FYI but I take two forms of long acting Morphine...The generic MSContin 30mg (60 pills) are around $67.00 at Sam's Club...And by law, you do NOT have to be a club member to use their pharmacy...but I think they may be around $10 more without the card.

So, I pay the $40 for the year to get the deeper discounts at the pharmacy, as well as gas because they are .30 cheaper per gallon in our area.

The generic MSContin 15mg (60) are $31.00

I also use OxyIR 5mg. For 120 pills they are $18

Definitely check around with Costco, Target, Walmart and Sam's club in your area for different prices. But for me, I drive across town as the Sam's club has been the least expensive...even more so than Walmart even though they are the same company...the Sams gets larger discounts.

I get 5 prescriptions for $170.

Last edited by Ilovemycutedog; 07-23-2012 at 03:18 PM. Reason: I'm a dork~

 
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Old 07-23-2012, 07:06 AM   #6
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Re: Switching from Methadone

Thanks very much I will check around then!!

 
Old 07-23-2012, 03:19 PM   #7
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Re: Switching from Methadone

Quote:
Originally Posted by GaNeal View Post
Thanks very much I will check around then!!
I'm a dork and edited my post as I looked at the prescriptions wrong. As it makes sense the 30mg is more expensive than the 15mg (both long acting)..So I reversed the numbers accidentally before.

But it's still VERY cheap for both of those!

 
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Old 07-23-2012, 08:50 PM   #8
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Re: Switching from Methadone

I could see why you are having problems without a breakthrough med...it is quite common to get one. What does your doctor say when you say you have times when you have increased pain? Most pain doctors believe its better to keep the long acting meds at a lower dose and take a short acting pain med for pain spikes (which most types of chronic pain conditions come with), then to dose the long acting meds for the worst pain. Are you seeing a pain specialist? If not, they are more versed in these meds and alternative treatments as well.

If you wanted to make a long acting med switch but don't want to be stuck with a script you can't afford, you can ask in advance what dose/amount it would be written for (keep in mind they often start at half to be safe) and price compare with Sam's, Costco, Walmart, etc. It will go up substantially with more pills and doses (it often needs to be taken three times a day), but it could be workable. Best wishes.
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Old 07-23-2012, 09:42 PM   #9
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Re: Switching from Methadone

Honestly my dr intimidates the Heck out of me.....I am a shy person and not very assertive at all...I have always had trouble "connecting" with this Dr....he tellls me when I tell him that I am still having bad days he says "welcome to the life of a chronic pain" He is not actually aa Pain DR...but A neurologist...but my neurosurgeon that did my 2 failed back surgeries recommneded me go to him he is in the same office...anyway it took foerever for me to ask about even switching from hydrocodone to methadone...but one day I was waiting for 3 hours and I was hurting so bad and so mad I asked him for it and he gave it too me...i was to the point I was going to have to go without meds because 120 10 mg lortabs cost 70 bucks a month and I could not afford even that...120 methadone is 15 bucks...that I can do!!! I am in a somewhat better position now..I could pay about 50 bucks a monthe more for a break through med like 10mg percoset...I just wonder if my body would even respond to that now that I am use to 100mg's of methadone a day??

 
Old 07-24-2012, 08:08 PM   #10
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Re: Switching from Methadone

I can tell you from my experience, I was taking 70mg of methadone a day and it took 60mg of oxycodone to be beneficial for breakthrough. However, that is much higher than average...I think 15% of the daily dose is average? I highly recommend you find a pain management specialist which you can form a greater connection with. They would recommend a good starting med/dose to try and you work from there. All you would have to do is stress what concerns you have, such as your pain levels in response to the treatment, and cost.

Yes it is expected the pain will be a daily struggle (you don't want to aim for 100% pain relief as that will turn you into a zombie and drive up your tolerance), but the goal of pain management with medications is to ease the pain a bit...50% is a good goal. Its ridiculous for a doctor to do nothing when you are having increased and under treated pain. It can be quite tough to find a good doctor though. In my opinion its a better idea to add in a breakthrough med to be able to take a few days a week then to increase the baseline med to an amount which may be too much for times when you aren't having breakthrough pain.

I was in a similar situation to you in that I saw my primary doctor for pain meds (on suggestion of my neuro). He was comfortable with prescribing up to a certain level, then nothing...he was not willing to up the dose or even change the meds. He had no referral suggestions so I spent a year interviewing pain specialists to find a good fit. Sounds like your needs have outgrown this doctor relationship and your pain management goals could be better met elsewhere. Best wishes.
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