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Old 04-05-2013, 08:01 AM   #1
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Methadone

It seems that methadone is not prescribed that often. My pm started me on a very low dose, 2.5 mg 4 times/day. I am not sure where i will be when i get out of my brace post op shoulder surgery. It was #6, so don't have high expectations. For those who take it, are you ok with it? My pm doc said i could take 5 mg, as i still need the oxy between doses for now. My surgery was a salvage reverse replacement.

 
Old 04-06-2013, 11:07 AM   #2
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Re: Methadone

Hi there. It depends on the doctor/area. Doctors seem to either be for or against it. There is of course the reputation of it being used for addiction. Also, sometimes it can cause a problem with qt prolongation; an ECG should be done to check everything looks ok.

It is a very good pain med for me. Literally nothing else gives me even close to the bang for the buck (ie. I'd be on more than double of an equivalent dose of something else). It has a bit more side effects for me (sedation especially at first), but definitely keeps your mind clear.

What do you mean by "are you ok with it"? Are you asking if it is helpful for our pain, or ok with the idea of taking methadone? For me, I'd say yes to both. I hope it is helpful for you. Keep in mind that since it has such a long half life, it can take awhile for the pain relief to catch up to you.

This also means that it can be easy for some folks to overdose on it, as they increase the dose too fast. I'd give it some time. The four times a day schedule is very good. Often doctors start it at only two times a day. I definitely need that four times a day schedule. Best wishes.
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Old 04-06-2013, 02:36 PM   #3
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Re: Methadone

Yes, I did mean the questions both ways. I have heard that some docs are not wild about the idea of methadone, while my PM is very much in favor of it for the long term. There definitely is a bit of a stigma attached with the connection to heroin from what I have read.
Your info is helpful. I am not sure if I will still need it long term because my surgery is supposed to relieve pain but we know how that goes. My PM was very insistent on not having any more surgery, but there really is nothing more to be done - this was the last resort (until it fails, which it will sooner or later.)
He said I could take 5 mg if I needed it (then not take a dose the next day) so I did try that one. Big difference in the pain levels. I guess I will see how it goes. I started on it in December.

 
Old 04-06-2013, 06:38 PM   #4
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Re: Methadone

Its works very well for some folks. Some doctors are quite for it as its more likely for the patient not to build tolerance as fast, patients won't have cost issues with it (unlike most of the other long acting meds), and it hits different receptors (why it works for some folks where nothing else seems to work, like me probably).

Others aren't as informed on it or think the cardiac/lung or overdose risk is too great. I don't think its as ideal of a first line med though (although oddly enough it was mine), due to slightly higher risks than other pain meds. You have quite a lot of room for dose increase. In case you are curious, I required quite a bit of dose titration at first, but my dose has been steady now for awhile. Definitely discuss your pain goals with your doctor. Best wishes.
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Old 04-19-2013, 03:45 PM   #5
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Re: Methadone

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Originally Posted by tortoisegirl View Post
Its works very well for some folks. Some doctors are quite for it as its more likely for the patient not to build tolerance as fast, patients won't have cost issues with it (unlike most of the other long acting meds), and it hits different receptors (why it works for some folks where nothing else seems to work, like me probably).

Others aren't as informed on it or think the cardiac/lung or overdose risk is too great. I don't think its as ideal of a first line med though (although oddly enough it was mine), due to slightly higher risks than other pain meds. You have quite a lot of room for dose increase. In case you are curious, I required quite a bit of dose titration at first, but my dose has been steady now for awhile. Definitely discuss your pain goals with your doctor. Best wishes.

 
Old 04-21-2013, 12:33 AM   #6
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Re: Methadone

Tortoise,

A few questions for you regarding Methadone. I'm debating a switch to Methadone from IR Oxycodone (30mg QID). Cost has become a real issue. IR Oxymorphone worked best for me when I had insurance. Out of the question now.

I've seen quite a few conflicting conversions to and from Methadone. I assume the different applications (Opiate dependency or Pain Management) require different doses? I've been reading about Methadone and it seems like a very complex drug to prescribe. In your opinion what would be an appropriate starting dose -and what dose will I be titrating to? What differences will I encounter switching from Oxycodone? How many hours of good relief are you getting per dose?

Many Thanks

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Old 04-21-2013, 04:16 AM   #7
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Re: Methadone

First of all there is no "buzz" what so ever, just pain relief.
I used to take both but had a problem with oxy and now only take 30mg 3x/day.

Best of luck and God bless.

 
Old 04-21-2013, 11:56 AM   #8
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Re: Methadone

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Originally Posted by Isotope View Post
I've seen quite a few conflicting conversions to and from Methadone. I assume the different applications (Opiate dependency or Pain Management) require different doses? I've been reading about Methadone and it seems like a very complex drug to prescribe. In your opinion what would be an appropriate starting dose -and what dose will I be titrating to? What differences will I encounter switching from Oxycodone? How many hours of good relief are you getting per dose?
Hi there. The conversion rate does not differ for dependency vs. PM, but just on what reference you look at. It really can vary that much patient to patient. The main difference between taking it for dependency and PM is that for PM it is dosed 2-4 times a day, instead of once a day.

A good doctor will not look at a conversion chart so much but start you at a very low dose...even 5 or 10mg a day, giving you breakthrough meds. Then, increase it slowly. Having you come in for visits every 2 weeks to adjust the dose would be ideal.

Another thing that should probably be done either prior to or after you have been on it awhile (depend on who you ask) is an ECG, as some folks get prolonged QT interval. Its more of a precaution, and not all doctors do that. My primary doc started me on methadone and not until I saw a PM doc a couple years later was the ECG suggested. They are quite cheap and easy to get done though (my primary doc's office did it, and it was less than $100 and took only 10 minutes).

Its also good to be aware that some folks get breathing problems. As I have a lot of morning grogginess and daytime fatigue, my doctor wanted me to have a sleep study to ensure the methadone wasn't causing central sleep apnea. Sometimes someone can breathe ok when awake, but not in their sleep.

It is very dangerous to try to start at the expected therapeutic level or even half of the expected therapeutic level, as is often done with other conversions. This is a med where a theraputic dose would be just a guess until you get there.

Especially when switching to methadone, breakthrough pain would be expected. Getting to the correct dose is a process which can take a period of weeks or months to do it safely, but the payoff is great for some folks. You can't increase the dose after only a period of days as it actually builds up in the system during that time.

There have been cases of overdose in patients taking it as prescribed (their doctor started them at too high of a dose or it was combined with benzos). This is one of the meds you want an experienced doctor, and you want to have done some research on your own too. I read a study that said methadone only accounts for 5% of opiate prescriptions but 1/3 of accidental deaths by opiates.

I would fathom a guess though that methadone would be more than 5% of long acting opiate prescriptions, and that 1/3 of accidental deaths statistic doesn't consider only PM patients, but those taking it for dependency, which are more likely to be mixing other meds with it. Therefore, my take is it can be a good med, but its something to be even a little more cautious of than other meds....you especially want to trust your doctor's prescribed dosing.

Some folks like me just don't respond to other meds, or at least not until very high doses. Methadone hits different receptors than other meds, plus it is very long acting. For me, methadone gives better more stable pain relief. It is much less likely to have cognitive impairment such as some folks get on other meds (especially at first).

It is more likely to be sedating though, especially at first. There is a phenomenon nicknamed "the nods". Someone may feel completely fine/awake one moment, then start nodding off. This has happened to me while driving, so the possibility is something to be very careful and aware of.

Its not so much long acting in the actual pain relief as it is in your system (very long half life). They will likely start you at twice a day and move up to three times a day if needed. I take it four times a day which is more unusual. I find it lasts me about 5 hours, which is on the short time. Many folks who aren't fast metabolizers get 8+ hours out of it.

Switching from a short acting med to a long acting med, once dosed correctly, should be helpful. Even though oxycodone is one of the longer acting short acting meds, especially at night, your levels will drop a lot, causing you to play catch up. I hope your doctor is receptive to the switch and you find it helpful. Best wishes.
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Old 04-22-2013, 12:35 AM   #9
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Re: Methadone

Tortoise,

Good points, I appreciate your time. Yes, long half-life doesn't necessarily mean long relief. Are Benzo's more of an issue with Methadone? I'm a PRN Klonopin user, 0.5mg-1.0mg every other day or so. I assume not much of a problem. I've gotten the 'nods' on almost Opiate I've tried so that won't be a surprise.

Iso~

 
Old 04-22-2013, 01:47 AM   #10
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Re: Methadone

My doc will not let me touch benzos. And my pcp cut me off ambien because of the methadone. Not a problem as tylenol pm will work fine now. I am still on a low dose and can get very tired.

 
Old 04-22-2013, 08:14 PM   #11
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Re: Methadone

Isotope: I do think benzos are more of an issue with methadone than the others. My doctor will also not let me try one, even though it could help my type of pain, and I have had a stable methadone dose for quite awhile (which is quite under treating my pain). Just an FYI methadone is way way more likely to cause sedation than the other meds as well.

I've had no sedation on any other opiates, and have a lot on methadone, especially at first. Its one of the contributing causes to my need to be on Ritalin. Its something to discuss with your doctor. I would be wary of a doctor who started you on methadone or any opiate for that manner without discussing the potential interaction.

galalena-Might you want to talk to your doctor about something else as a sleep aid, at least something without added tylenol (such as Unisom)? Maybe even something natural like melatonin? Be sure they know you are taking something otc, as even otc meds can have interactions. Sleep aids mixed with opiates are a valid concern. My doctor will also not let me be on a sleep aid, but is ok with sedating meds (such as Zanaflex, a muscle relaxer). Best wishes.
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Old 04-22-2013, 10:18 PM   #12
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Re: Methadone

Good idea on the sleep aid. He had me try trazadone for sleep before my most recent surgery when i was not taking methadone. That stuff gave me the worst stomach cramps! I do not take any other tylenol, but will cut it out.
The methadone was ok until i stopped wearing the immobilizer, oh my goodness, we are talking some pain now! The shoulder has a long way to go to heal. I see him again in 2.5 weeks so will take it easy until then.

 
Old 05-01-2013, 12:41 AM   #13
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Re: Methadone

Tort-

My PCP started me on Methadone at 10mg, t.i.d. It all took place via their messaging portal, no visit, no special instructions or warnings, he said to just jump right in with the 10's. He also said that 0.5mg (or less a day of my PRN Klonopin would be fine. I broke the 10mg Methadone tabs in half and made my schedule 6x/d just so I could avoid any peaks and valleys, so far so good. He also wrote me for some BT Oxycodone (#60, 15mg). I feel much more clear headed, not tired at all, pain seems under control though I've had a good week so it hasn't been challenged yet. Overall I'm glad I switched and I think I can stay at 30mg/d for quite some time before needing to increase.

Iso~

 
Old 05-01-2013, 07:46 AM   #14
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Re: Methadone

Dear galalena, Im so sorry to hear that the big pain is back, you have been through so much but it is progress taking off the immobilizer right? When do you see the dr again, shoulder surgeon?pain dr? which is in 2 weeks?

Last edited by gmak; 05-01-2013 at 08:00 AM. Reason: wording

 
Old 05-01-2013, 11:19 AM   #15
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Re: Methadone

i have been on methadone . i took it for 9 yrs i thought it was the best thing ever but in fact it was killing me inside i had no idea at first i only took 5 mg but after a while it wasnt helpin they kept raisning the dose till one day yrs later i was takin 130 mg. a day to even function . i have watched my brother an two of my bestfriends overdose on it becouse of docters giving them zanix with it i am here to tell u that methadone is a blocker an if ur takin it with lortab or oxys ur not going to get the affects of it the methadone will block it an u will just be damagen ur liver .When u mix it with other drugs u might want to look into what it can do. The docters dont tell u everything i come off methadone becouse i almost overdosed my self . i said then i was not going to be on this anymore i winged my self down an my body shut down my bloodpresser was so high an i started havin seziers it took 7 mths of pain no eatin an depression i was told i have become bipoler , due to it . But now its been A yr an a half since i hav had a single methadone an my mind is back i feel normal agian the seziers hav stoped an i feel alot better . Methadone is the worst thing u could ever start please look into it an stop it before it is to late....

 
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