Originally Posted by Isotope
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.