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absmom 10-06-2005 01:57 PM

??? about switching from Oxicontin to Methadone
I hope someone here has some knowledge they can share to make this transition successfull.

My husband has several things wrong with his back. He's 41 and has the back of a 90 year old man. Last year he was accepted into a trial for an artificial disk which we thought was going to fix everything but it didn't.

At present he is/was on 80mg of Oxicontin twice per day. This was increased a couple of weeks ago and he felt like the medicine was doing absolutely nothing. He definitely went downhill after switching to the generic but I don't think he ever really got the pain control that he could be getting even from the namebrand. After a week on the 80/80 dose he was desperate. I did some online research on different boards and one med kept jumping out to me as being successful for people that tried it. My husband does not have a pain management doctor as there is not one available in our network. His primary doctor had been very good about working with my husband and trying to relieve his pain.

We went to him last Friday and asked him what he thought about trying Methadone. He was all for it surprisingly. I feel this could really be a great med for my husband. I know you have to work until you find what is right for you though.

Well, this is going very bad. My husband keeps switching back to the Oxi because he can't stand it another second. We've put calls into the doctor but are getting nowhere. The nurse said the doctor called the pharmacy to find out what the conversion rate was before he wrote the script and that my husband would probably be a little uncomfortble for 72 hours.

This is way beyond being a little uncomfortable. The doctor put him on 10mg of methadone 4 x daily. My husband is not getting pain control, he is pouring sweat, shivering, and other common withdrawal symptoms. He was a lump on the couch all weekend. Plus he has no choice but to go to work. I feel so very bad for him. I want this medicine to give him his life back but I thought with addicts, (which he is not) but my understanding was they increase methadone until those symptoms go away. Wouldn't this be done the same way? He can't be at the right dose to be feeling this bad and not be getting pain control either. In my own reading it seems Methadone has to build up in your system a bit so he's really tried to hang in there and get 3 or 4 doses in. But it just gets to be too much.

Does someone on here know what amount of methadone he should be taking based on the med he was on before which was not providing good pain relief. It was oxicontin 80 mg twice per day. Any help would be greatly appreciated. It would be easier if his doctor were a real pain management doctor but I really appreciate his willingness to try to get my husbands quality of life back for him. Thanks! I'm hoping against hope someone on here has some suggestions that we will be able to talk to the doctor about.

Rrector 10-06-2005 03:01 PM

Re: ??? about switching from Oxicontin to Methadone
I'm certainly no doctor or an expert of any kind, but I am a chronic pain patient who has been on both drugs you are talking about in your post. I hope I can give you some help.

I was on Oxycontin for about 18 months and I was up to 160 mg TID. Briefly, my doctor even went to 160 mg QID. I then tried the patches and currently I am taking Methadone, 180 mg a day. Although this is a fairly high dose, everyone is different and our systems are different too.

Your husband was on 160 mg of Oxy per day and now he is on Meth, 10 mg QID. You are correct about Methadone taking time to build up in the system. It takes about a week. Methadone has a very long half life and as each day goes by, the more relief there should be from the build up. After a week or so, the doctor can start titrating the dose upwards about every five days. The conversion he got from the pharmacist is nothing more than a starting point and should be viewed as such. If there isn't sufficent pain control at 40 mg. the doctor should bump the dose up by approximately 50%. After five days on 60 mg he can increase it again, until a satisfactory dose is found.

A word of warning though, Primary Care Physcians who aren't use to prescribing Meth can get a little nervous when the dose gets higher. I also have my PCP prescribing my Meth and fortunately he is okay with it. It's just an "educated" guess on my part, but I would think your husband should be somewhere in the neighborhood of 80-90 mg per day. About 30 mg TID. Be aware though, Methadone is usually quite sedating, especially when you start getting to the higher doses. This usually occurs when you do non-stimulating activities. For me (and most people), driving long distances, tends to be very difficult. What I have to do in this type of situation is take only a minimal dose until we reach our destination. My work was also very sedentary in nature. That is one of the reasons I am not working now.

I hope your hubby finds some relief soon. I can't believe he has to work through this. I would be unable to do it. In fact, I am on Social Security LTD due to chronic pain and several medical problems. I will make an attempt at answering any further questions you may have.

absmom 10-06-2005 03:24 PM

Re: ??? about switching from Oxicontin to Methadone
Thank you so much. That makes me feel better and more educated as to how this medicine works. I'll have my husband read this and I also plan to print it out for the doctor. I feel terrible for my husband. I don't know how he puts one foot in front of the other some days. We have 4 young children that we have to take care of. I am often scared that there will be no choice but for my husband to end up on disability but then none of us would have insurance. It's just so hard.

Oh! I also don't really know what Qid or Tid mean??

Rrector 10-06-2005 03:39 PM

Re: ??? about switching from Oxicontin to Methadone
TID means "three times a day" and QID is "four times a day". Sorry about that. I sometimes forget there are people who don't know all the abbreviations. Also, I forgot to mention one thing both you and your husband should be aware of before he is titrated to a higher dose. Methadone is a very difficult drug to come off of, if that day should come. At 41, a lot of doctors are reluctant to increase the doseage too high or even put a patient on the med in the first place. I am almost 20 years older than your husband, so the age thing doesn't really become the issue it does for others.

Shoreline 10-06-2005 04:33 PM

Re: ??? about switching from Oxicontin to Methadone
Hi AM, Director covered it very well, You also have to understand that everyone responds differently to each opiate. Even though there are conversion charts an inexperienced doc can use, they are designed to get you in the ball park safely, that's it, Meth produces the widest response of all the opiates. Meaning It's very hard to predict whether he will need 1/4 the amount of oxy or 1/2 the amount of oxy.

Half life is the time it takes for 1/2 of the dose to be eliminated from his system, Meth has a half life of 20-30 hours, But that doesn't mean in 48 hours it's completely gone, It means every 24 hours he has half of what he had in his system the previous day. His dose will build up something look like this.

The first day you take 40 mgs
The second day you have 20 mgs left from day 1 and the 40 mgs you take on day 2.
On day 3 you have 10 mgs left from day 1, 20 mgs left from day 2 and the 40 mgs he takes on day 3
On the 4th day he has 5 mgs left from day 1, 10 mgs left from day 2, 20mgs left from day 3 and the 40 mgs he took on day 4
On day 5 he has 2.5mgs left from day 1, 5 mgs left from day 2, 10 mgs left from day 3 20 mgs left from day 4 and the 40 mgs he takes on day 5,. At this point you stabalize and he would have the equivelent of taking 77.5 mgs in a single day. That's why docs can't make an imedeate increase, sometimes they will satrt with a loading dose of say 60 mgs on day 1 and then day 2 you start with the 40 mgs a day, This will bost is serum level initially so the first days aren't rough. But he can safely increase 50 % every week untill he reachs a level of comfort and the last dose increases may only be fine tuning where 10%- 25% increases are used.

No doc can guess how he will repond or how much meth it will require, but after 5 days or the next increase, taking the oxy can start to be dangerous and if he accidently OD's he will be SOL and possibly burn the only bridge or doc willing to work with him because he chose to self medicate. Self medicating is never an ption unlesss you have docs lined upp waiting to gibe you a second then a 3rd and then a 4th chance. Most docs won't gibe you a second chance if you prove you won't comply with his directions, not to mention the horriable withdrawal when you run out and the doc won't reflill early or discharges you for non compliance.

The initial weeks of med changes suck, but cocompared to living in pain for years most will stick to the prescribed dose rather than risk doing anything to loose their only doc willing to manage his pain. Give it time.

I had a pump implanted last june, It took 6 months and 16 increases to reach a level that equaled the relief I was getting from oral meds. They started at 2 mgs a day and ended up at 12, 1/6th of the dose that actually worked, so it was a miserable few months but still better than not being treated at all.

Hang in there and the doc should expect to be seeing him more often but not more frequently than every week unless he's having side effects that are dangerous. If he's vomiting and dehydrated that's serious, an increas in pain in a chronic pain patient isn't quite as serrious.

He will get there, but you can't safely rush meth titration, the process of finding the proper dose. Drowsiness and sweating are also common side effects,I had to change clothes several times a day even after being stable on a dose for years while taking meth.However I was able to remain on the same dose for sevral years before I had the pump implanted. Tolerance seems to develop much slower with meth but it takes time to find the right dose.

Goodluck, we have all been there when changing meds. It sucks but it's better than nothing. Take care, Dave

absmom 10-06-2005 08:59 PM

Re: ??? about switching from Oxicontin to Methadone
Thank you both so much. That was very helpful and a lot of info we didn't know. I think both of us thought he was going to feel much better at once. It is really tough to go on with every day life and drag yourself to work every day when you feel that bad. I consider my husband to be pretty darn tough and when he is curled up on the couch practically in the fetal position I figured something had to be very wrong with this dose level. I also assumed that since they use meth for addictions that it would eliminate most of any withdrawal symptoms. I'm so glad to have this new information. I'm going to have my husband come in and read it right now!!

Thanks again!!

wolfmarket 10-07-2005 11:40 PM

Re: ??? about switching from Oxicontin to Methadone
I can relate to your post because I went through withdrawal for the first time this week when my 100 mcg Fentanyl patch failed to work. I was constantly cold and then hot, in oodles of pain, lazy, etc. Finally, I was told to replace with a new patch and it worked. I switched back to my old meds (100mg Ms Contin Bid and 30mg Roxi Tid) the very next day.

Hope he feels better soon! I know how he is feeling and w/d makes you like a stereotypical out of work bum...just want to lay on the couch and watch tv!


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