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Fentanyl and Methadone together?

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Old 07-15-2006, 10:42 AM   #1
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Fentanyl and Methadone together?

I'm currently using Fentanyl 50 mcg every 60 hrs as my LA med and Hydro 10/325 2 twice daily for BT and the recommendation from the PM consult the other day was to switch me to Methadone 5mg BID (what does BID mean?) for the BT pain.

I've not seen any posters here that are that type of med combination so was just wondering. I thought that most people use the Methadone for their base meds. So I'm a little confused.

Any help would be much appreciated



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Old 07-16-2006, 12:34 PM   #2
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Re: Fentanyl and Methadone together?

The combination of fentanyl (patch form) and methadone is unusual because both are considered long acting meds.

Usually, your pm Doc will rx you a long acting med and a short acting med for breakthrough pain.

For example, I am using the 100 mcg Fentanyl patch and 30 mg Roxicodone for bt.

While Methadone is not a sustained release med in the traditional sense, it does have a long half life and is certainly not used for those times when you need immediate relief.

Is your Doctor a pain management Doc or is it your family Doc? I can tell you that this combination is NOT usual.

Examples of immediate release meds would be Vicodin, Percocet, Oxycodone (like the Roxicodone I use) and Dilaudid.

I would, in a subtle roundabout way, try to find out the doc's strategy in rxing you two Long Acting meds with no breakthrough med.


Old 07-16-2006, 01:08 PM   #3
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Re: Fentanyl and Methadone together?

Thanks Alan

I have another post here that kind of explains what's going on with the whole PM issue for me (Had a rough appt today, I think). I think the main reason he suggested this, and he is a PM specialist, his designation behind his name is D.O. (not sure what that means) but anyway...that I'm a recovering alcoholic with close to 18 years sobriety but that apparently puts me in the category of one that "indicates a very high possibility of breaking her narcotic agreement".

I've been on Fentanyl for a relatively short period - 5 weeks or so now and prior to that I've been on Hydrocodone - 1st starting with 5/500 mg and then most recently, the past 3 0r 4 months on 10/325, up to 100 mgs a day. Since I started on the Fentanyl I've been alloted 2 10/325 twice daily for break through. I've not had to take them everyday but do notice that when the 48 hr mark or so that I start to have more pain, I change my patch at 60 hrs as of last week. And the Fentanyl could probably be a little stronger but I'll be having the medial branch blocks next week so I'm hoping that I get relief from that and will just stay put for now. In the 2 years since my pain all started with a herniated disc and subsequently led to an ACDF C-5-6 I have never abused by meds. So needless to say, I'm a little irritated by the whole thing.

In all my readings here and on another board I visit I've never heard of Methadone for BT, that's why I'm questioning it.



Old 07-16-2006, 07:29 PM   #4
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Re: Fentanyl and Methadone together?

JeanneO: Normally Methadone is not used for Breakthrough pain. I am on Meth and it is my base medication. In fact I'm on 180 mg per day and I don't have any BT meds.

Old 07-17-2006, 09:02 AM   #5
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Re: Fentanyl and Methadone together?

Hi Jeannie - Just wanted to add to the other posters - I'm on methadone 120 mg. a day 40mg. three times a day and 30mg. oxycodone for breakthrough pain every 6-8 hours if needed. Like the others, I've never heard of methadone being used as a breakthrough pain med. Also, the D.O. designation after his name stands for doctor of osteopathic medicine. You might want to look it up on the internet to get a better idea of what that means. I think I would want him to explain his reasoning on why he is choosing the methadone as a short acting/breakthrough pain med. Something just doesn't sound right. Let us know what happens, ok? All the best - KathyMac

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