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  • Fentanyl to Methadone Symptoms PLEASE HELP

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    Old 06-29-2008, 11:29 AM   #1
    Ford98
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    Question Fentanyl to Methadone Symptoms PLEASE HELP

    Hello, I am new here but I feel fortunate to have found this board, I am searching for info for my wife. She has several illnesses and chronic pain pain is terrible issue for her. She was prescribed Oxy for pain originally by her PCP which helped get her to about a 7 in pain management then it began to be insufficient. The PCP then prescribed Fentanyl 50 mcg patch which worked very well for a while then she had to nove up to 75 then 100 then again up to 125mcg. Eventually the 125 wasnt working well. She has been on the fentanyl for 3 years. Recently 2 weeks ago the PCP sent her to a pain clinic and now the plan is to switch to Methadone for pain control. Over a 2 week period she was given 10 mg of Methadone once a day then 20 mg per day then 30 mg per day, all the while reducing the fentanyl dosage which she is now off of completely. The Methadone is helping with her pain tho not completely but the problem is she has been in bed for most of the 2 weeks since switching, she has felt so weak and fatigued she can not stay awake for any length of time, she has also had muscle cramps, agitation, headache and sometimes a low grade fever, and of course this has led to depression. Are these symptoms normal for converting to Methadone, if so how long will it last, or could it be her body withdrawing from the fentanyl. This has become a debilitating problem for her. Thank You for reading and any helpful info would be greatly appreciated. Thank You

     
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    Old 06-29-2008, 01:02 PM   #2
    forginon
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    Re: Fentanyl to Methadone Symptoms PLEASE HELP

    I have switched a number of times from one opioid to another. I've even switched from fentanyl patches to methadone. However, I went completely off of fentanyl before starting methadone. Cold turkey! Now that was something I NEVER want to experience again.

    Anyway, what is your wife's daily dose of methadone now? If it's still at 30mg daily, IMHO that's too low. I think she is fighting off withdrawal (WD) symptoms, although the methadone is warding off the worst of it. The only symptom that bothers me is the fever. However, when suffering WDs, the immune system takes a huge hit, and it could allow a minor infection to creep in. Is the doc open to continuing the dosage adjustment? If so, I would consider trying 40-50mg daily. I started at 10mgs methadone per day as well, and ultimately settled at 80mgs daily. And I held at this dose for a few years until I switched to MS Contin, which I'm on now. While on the methadone, the pain cointrol was so good I didn't even need BT meds.

    Everyone's different, so she may not need to go to 80mg/day as I did, but I do think that going from 125mcg/hour of the fentanyl patch to 30mg of methadone daily is insufficient, and is probably causing her discomfort...

    Please keep posting and telling us her progress. You have come to the right place. Here you will find incredible support, compassionate, caring and most of all, understanding.

    Oh, and Welcome!

    steve

     
    Old 06-29-2008, 11:36 PM   #3
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    Re: Fentanyl to Methadone Symptoms PLEASE HELP

    That really isn't a signifficamt dose of methadone given her previous dose of Fentanyl. She's not even at what's considered a dose high enough to curb withdrawal from meds weaker than fent. Only her doc can do something about it and if she's to sick to call the help line or whatever do it for her. She needs to be evaluated and have her meds adjusted. Personally I think it's a waste of time to ask for a doc to call or ask questions over the phone if the ultimate answer is to be seen as soon as possible ot have her meds adjusted.

    2 weeks in without a comlaint is certainly giving it a try and not whining about any discomfort she's already had, 2 weeks is also a safe interaval to make an adjustment with methadone. There really is no reason not to call, explain how sick she is and tell them she needs to be seen asap. Just be clear and direct. Most docs won't OK increases over the phone so you may waste days waiting for a call back when he may be able to squeeze her in before the 4th of july. MY docs have never refused to see me if I called with a problem transitioning from one med or dose to another. They actually leave room in their schedule knowing patients will have problems after procedures or pump adjustments or new meds. It's part of PM.

    Docs know people get sick during med changes, a safe doc is going to start on the low side but they dont know your wife is this sick if you don't bring her in to have something done, whether it's adding fentanyl back in or increasing the meth. They can fix the problem, you just need to let them know there is a problem. .
    Good luck, Dave

     
    Old 06-30-2008, 08:08 AM   #4
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    Re: Fentanyl to Methadone Symptoms PLEASE HELP

    I am also surprised at the dosage, I started on 10 mgs per day of methadone, but I was only coming off tramadol and 3 lortab 7.5's per day, a much lower dose of a much weaker med than your wife is on.

    I titrated up to 40 mgs a day and thats where I am now, but I wouldnt be surprised if someone coming off of 125 fent patches started at that and still was sick. Its just way too low, imho.

    Maybe you can ask for a consult on med doses, just tell the doctor that according to your own research, you are wondering if her symtoms arent being aggravated by her comparatively low dose of methadone.

    Good luck and let us know what happens, you and your wife are both welcome here!

    Your Friend, Fabby

     
    Old 07-11-2008, 08:27 PM   #5
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    Re: Fentanyl to Methadone Symptoms PLEASE HELP

    Hello, well after two weeks on 30 mg of methadone my wife is still in pain although most of the withdrawal symptoms from the fentanyl have gone. Today she went to the pain clinic again and the Dr. raised her methadone dosage to 40mg daily. 10 mg taken 4 x a day. Now I have another question, she takes several other meds one being 1 mg xanax daily. She hasnt had any problem with it thus far but today I read online that methadone and xanax are a deadly combination and should never be combined. All of her Doctors are aware of all the meds she takes and everything is filled at the same pharmacy. Does anyone have info about taking these two drugs together.


    Thank You

    Last edited by Ford98; 07-11-2008 at 08:29 PM.

     
    Old 07-17-2008, 01:10 PM   #6
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    Re: Fentanyl to Methadone Symptoms PLEASE HELP

    No wonder your wife is in pain! That is quite a small dose of Methadone, I take 145mgs of Methadone each morning and evening (so 290mgs a 24 hr period) AND Ketamine nasal spray 4 times a day on top of the Methadone for breakthrough pain. I'm not suggesting your wife should be on my dosage but I think you need to go back to the pain specialist or find a new one because she shouldn't be on such a small dose after changing from a very potent medication. Her symptoms do sound like classic withdrawl, which can be hell-ish. I do wonder if the doctor knows what he's doing, putting someone through such a dramatic drop in dosage of opioid medication. No wonder she's so uncomfortable. You need to be her advocate now because when your in a lot of pain it is hard to be your own advocate when dealing with a these issues. My heart goes out to her...
    Cheers,
    Lily

    Last edited by Lily2008; 07-17-2008 at 01:18 PM. Reason: additional info

     
    Old 07-17-2008, 03:34 PM   #7
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    Re: Fentanyl to Methadone Symptoms PLEASE HELP

    I was taking Fentanyl, 100 mcg, with 30 mg of Roxicodone for BT prior to switching to Methadone. I think (sorry it's been over five years now) my doctor started me at 10 mg TID, with Roxi, 30 mg, q4h prn for BT. He increased my Methadone about every five to seven days, until I was at 180 mg a day, with no BT meds.

    I stayed at 180 mg for five years, until my doctor retired and I then was referred to a PM doctor. She said the 180 was too high for someone my age (62 years old), so she decreased the dose by 20 mg per month for three months. I've been at 120 a month for the past two months and I think think this is were I'll be for the time being. Most days I'm pretty good at this dose, but I do have days where it's a little rough. I see her at the end of the month, so we'll see if she wants to change it or not.

    I think 40 mg of Methadone a day is definitely too low for someone like you, when you came from 125 mcg of Fentanyl and I think you need an increase to at least 80 over a period of time. As far as the Xanax and Methadone together, I take Klonopin with Methadone and have for several years. They are both CNS depressants, so you need to be careful with your doses. I am scripted for TID, but most days I only take one or two. They are the one mg tabs.

     
    Old 07-17-2008, 05:04 PM   #8
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    Re: Fentanyl to Methadone Symptoms PLEASE HELP

    I fully agree with Lily,

    You must be a strong advocate for her, because she is going through too much to be her own advocate.

    Her pain is not yet controlled.

    I'm not talking about removing her pain altogether, just controlling it. Her pain is still too high.

    I am glad the WDs are gone, but that never should have happened in the first place. As Lily pointed out, it could very well be possible that this doc does not know what he's doing. Many docs, even pain specialists, do not understand the complexities of methadone. There are so many factors to take into account when switching someone from another opioid to methadone. And the higher the previous dose of opioid, the more complex it gets.

    I firmly believe that for folks on very high doses of opioids, the switch to methadone and the titration to the appropriate dose would be done in the hospital. If it were we'd be seeing many less deaths. Your wife doesn't need to worry about something as extreme as death because her methadone dose is too low rather than too high - which is where the fatalities are coming from.

    Regarding Xanax and methadone - as Director wrote - they are both CNS depressants. So, obviously, care s/b taken.

    steve

     
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