Been on methadone for about two years and tolerance is becoming a problem. I take 30mg bid. I have taken Kadian in the past with success. I despised the Fentanyl patch so thats not an option. If I switch to Kadian does it follow the 4 to 1 conversion that most opioid converters show when going from methadone to a morphine med? How do you switch from methadone to Kadian since methadone has such a long half life?
Conversion is something for your doctor to do. Often they start low (such as 50% of the expected dose), just to be safe. So, its possible you will have extra pain or even withdrawal in that process. Is your doctor opposed to increasing the dose? Its expected to have tolerance, but it depends on the doctor as whether they want to increase the dose or try to switch to take advantage of the potential lower cross tolerance.
I have been switched straight over from methadone to morphine. They had be wait some time between starting the new med, and started me at such a low dose I was in withdrawal. Often they have you come in every 1-2 weeks during that sort of time, and may give you some extra breakthrough meds. Some doctors prefer to decrease the old med while increasing the new one though.
I'd just go into your next appointment and discuss your decreasing pain relief, and ask what can be done. They will either say they don't want to do anything, try to add in another med or treatment, increase the dose, or switch you. Your best way to be informed is to know what has and has not worked for you in the past, and maybe to double check that your doctor doesn't start you at too high of a dose (unusual).
With trial and error, oddly enough, I've found that methadone is the only realistic long acting med for me. Every other one doesn't give me nearly as much bang for the buck, so I'd require a much higher equivalent dose. Everyone is different though. Surprised you only take the methadone twice a day...I require four times a day, and would do even better with five. Meds burn through my system very fast. Best wishes.
constant head pain, fibro, and other fun!
chronic pain established in 2006
The Following User Says Thank You to tortoisegirl For This Useful Post: Bilbo (12-29-2012)
Thanks Tortoisegirl. I know the conversion is done by the Dr. I wasn't suggesting I was going to go in and tell them what I want. I just know from past experience, and you alluded to it, where the morphine sulfate drugs were OK but the PM center I was going to had me taking upwards of 400mg of Avinza with norco for BT. We had a oxycontin and methadone scandal in my area about 8 years ago. It was really an oxy problem but the news media incorrectly reported it and there remain a black cloud over the whole PM system. Methadone has always been the best for me but when I told my Dr that I was getting less relief from what I was taking their 1st idea was to go to a 24 HR morphine med. I would rather just up the dose. Methadone is effective and cheap. I don't understand why I am not taking methadone 3 or 4 times a day. In 2007, after a three level lumbar fusion, I was taking 40mg 4 times a day. I got better over time but I just had a hip scope where they took out 50% of the labrum (that was in October) and its just another layer of pain added to my spine problems. I am going to talk with my Dr about just going 3 times a day with the methadone. It would be cheaper and easier.