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  • changing from methadone to......? high dosage??

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    Old 10-30-2003, 05:51 PM   #1
    brentskib
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    Post changing from methadone to......? high dosage??

    I've been taking methadone for chronic back pain,post 3 back surgeries and fusion that failed.
    I started off taking MScontin,60 mg 4x day and MS contin 30-60 mg. 4x day for BTP.(total 480 mg day)

    When my pain increased to the point where I asked my pain doc about increasing to a higher dose,he suggested switching me to methadone.
    At first I was hesitant due to the conotations that go along with methadone but he finally convinced me it was a good alternative for pain relief.(and much less expensive)
    He started me on 30 mg,4x day and 60 mg mscontin, 4x day for BTP.
    I moved to a different state and found a new pain doc who continued with the same dosage.The pain has incresded recently and my Dr. increased my methadone to 40mg. 4x day plus the same dose of mscontin for BTP.

    My pain continues to worsen and during my last visit, my Dr. asked if I would like to increase my methadone dosage. I told her I'd rather not overmedicate for now (as I have an appt. to see an orthopedist soon)

    Anyway, while looking through some 'Equianalgesic dosage tables', it seems that an 'equal' dose of morphine to the 160 mg's of methadone I take per day along with the 240 of morphine would be somewhere in the neighborhood of 1800 mg's of morphine per day. This seems way out of whack but all the 'narcotic analgesic calculators' came up with the same doses of morphine when compared to the amount of methadone I'm currently taking.

    Does this sound right to any one?

    Is there anyone else out there who is on a similar dose?

    Anyone change their meds from methadone to back to morphine(or another drug) with better success?

    (I'm somewhat hesitant, as I think she'd start me back to the dose of morphine I was previously taking which, according to all the 'converters', would be extremely low, compared to my current methadone and morphine dosage)

    Any and all responses would be greatly appreciated.

    Thank you,Brentski

    [This message has been edited by brentskib (edited 10-30-2003).]

    [This message has been edited by brentskib (edited 10-30-2003).]
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    Old 10-30-2003, 06:12 PM   #2
    Rosebud54
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    Hi Brentski , I am at no way near the dosages that you are but I have been switch from Vicodin/Hydrocodone which I was on only three a day and when I asked my doctor to please just give me two more Vicodin then it would last through out the day and night and it was working great for the pain, but instead of giving me two more a day she kept me on the three Vicodin a day along with Methadone, I have been on it for all most a month at 5 mg in the morning and 5 mg at night and she said if it doesn't help then she will raise the dosage. Well it hasn't helped the pain at all in fact I have other side affects that I have to deal with along with the pain and I can't take the Vicodin until 4 hours from the time I take the Methadone and boy I look forward to it because it helps the pain some but it doesn't work like it did before the Methadone, because the Methadone works against the Vicodin, so it's crazy and NO it doesn't make any sense why doctors do this other then it has helped some with long term pain and it's long lasting not like the other meds that are short lasting, but to tell you the truth The short term meds were helping me just wasn't lasting until I went to bed, so that is why I asked for two more, but now I have to go back and deal with this issue with my doctor again and hope that she will allow me to go off this Methadone and get the extra vicodin, which I get the generic name Hydrocodone. I'm sure don't want to go through the withdrawals but I don't want to raise the dosage and go through worse later. You are on a scary amount to me, I will pray that you can find a doctor that will help you with the pain at a safe level and a drug that will work for you. Sorry you have to go through all of this on top of your pain, Blessings, Rose

     
    Old 10-31-2003, 06:36 AM   #3
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    Sorry bout the test but with OAL you never know.

    Anyway I just took a look at the nimbers again.
    If you meant to say you were tyaking 240mgs of MsContin per day and have an additional 240 of Insatant release morphine that sounds correct. However replacing 240 mgs of MSC with 120 mgs then 160 mgs of methadone and keeping the MSIR the same for rescue, everything below satands true. If you truly need BT meds 4 times a day they really aren't BT meds then are they. They are just part of a daily regemin, which makes you tolerance equal to taking 480 mgs of MSC per day.

    Most every LA med mnufacturer suggest that if you need, big difference between needing and taking it because it's allowed.Your base dose is too low if you need BT meds more than twice a day.

    That could expalijn why you need so much meth but why the same amount of BT pain and med when the strength of your base dose has been increased 3-6 fold
    the rest is below.

    I just realized I wasn't able to edit my own post thanks to my great ISP.

    You ask for info... Unfortuanetly I can't post artiicles that aren't .gov or *** that's all I can say. I would love to see you stabalize and learn to manage your pain a bit better. I'm assuming you understand shooting for O pain is not the goal of most CP patients.
    Take the next post with my only intent to see you be safe and stabalize, but your conversion is scarry. Was it done as a cold switch?
    Shore

    [This message has been edited by Shoreline (edited 10-31-2003).]

     
    Old 10-31-2003, 07:31 AM   #4
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    Hi Brent, I assume you mean your taking MSContin and MSIR. Otherwise you post doesn't make sense.

    As far as equianalgesic charts I haven't seen one that is accurate on methadone. At best they are single dose comparisons and don't acount for the build-up and long half life of methadone, 30+ hours

    Most conversion charts have it roughly 3 times more potent than morphine, However the more recent article suggest that that conversion is way off and that meth produces the widest range of anelgesic dosing of any opiate. More acurate conversion would be 4-10 times more potent than morphine.

    I switch back and forth betweeen 600mgs of morphine per day and 120 mgs of methadone per day. I Just resently broke another screw and they increased my daily doese to 150 mgs of meth per day. It took me a month to make the increase.

    IF you decide if your satisfied with your dose based on inacurate conversions you will never be satisfied. The charts you are using are just guides and terribly inacurate.

    Methadone needs to increased slowly or it will sneak up on you and you will OD. The straight switch from MSContin to methadone looks extremely high and I would imagine you had quite a honeymoon.

    This is a safe conversion found at the end of an article called "methadone rediscovered"
    Daily oral morphine dose Approximate conversion ratio

    < 100 mg 3:1

    101-300 mg 5:1 replacing base only, this should be more accurate.

    301-600 mg 10:1

    601-800 mg 12:1

    801-1000 mg 15:1

    >1001 mg 20:1
    .

    Please clarify what your doses of Long acting morphine were and what your dose of short acting morphine is. They can not be both MSContin. That doesn't make sense.
    MSIR perhaps?

    Anyway, I've taken meth for years and done tons of reading and research and although the conversion may look acurate for single dose comparison it doesn't acount for the half life and build up. If you take 160 today and 160 tomorrow then tomorow you would have 240 mgs of meth in your system, That number will continue to rise for about 4-5 days and then steady off.

    Needing more mgs of meth than morphine doesn't make sense unless you base relief on level of sedation and false sense of well being.

    Eqauting relief to the feeling morphine gave you can be extremely dangerous with methadone. If you were to switch back to morphine after becoming acomadated to this dose of meth your morphine need will increase expedentially and you will probably would need 1600mgs of morphine to give you the same level of relief your getting from meth.

    How did you go from 480 to 1600 mgs so quickly? because you relied on a chart to tell you if you were feeling anelgesia or you relied on obtaining the same feeling morphine gave you. Meth won't make you feel the same as morphine so be very careful and look for articles, not inacurate conversion tables.

    Switching from meth to another opiate aint no picnic and increasing the dose just to limit the withdrawal and you will end up at 1600mgs of morphine per day.

    Methadone will not give you the same feeling morphine does. A large component of morphines anelgesic effect is altered perception of pain. Meth works entirely different.

    You can get high on meth as long if you start with an outragous dose and continue to increase it. It's extremely unsafe and you will not get the same feeling from meth that you do morphine for long, and that feeling will disapate fast if it doesn'tkill you.

    Relating anelgesia with the feeling morph gave you will jack your tolerance through the roof. IT will also deminish the euphoira of MSIR but not deminish the anelgesia.

    So if your equating anelgesia to euphoria you are headed down the wrong path.
    Sorry bud, but I have never seen anyone need more methadone than morphine unless they are trying to obtain the same sensation that morphine gave you.And that will not last, the euphoric feeling of a high dose of meth will disapate faster than morphine. I hope you have someone to keep an eye on you so you don't turn blue while you are alone.

    The biggest misconception of methadone aside from it's potency is that it can't be abused because there is no high. If you start high enough and continue to increase it you can get high but you will likely kill yourself in the process.

    Back off and think in terms of pain relief, not how it makes you feel. You don't need to be high to obtain pain relief. When I switch back to morphine the dose will be roughly 600mgs a day, I know this because I have switched back and forth before. Always requiring about 1/4 the meth that I do morph. It looks like your MSIR has increased too because the meth takes the buzz from the morph so that's been increased too?

    JMHO. Take it for what it's worth. Only you know if your chasing the buzz morphine gave you or your just not getting anelgesia from methadone. I've never met someone that stopped taking meth because it didn't work on pain, people stop because of the side effects and the sedation meth can cause that looks like narcelepsy when you nod off.

    Many people fall into the trap of relating euphoria to anelgesia, You don't need a buzz to obtain relief. It can cost you your life when you do this with methadone.
    Good luck Shore

    You are right, when you switch back to morphine your old dose won't do squat now that you have jacked your tolerance with meth.
    Sorry bud, I'm not looking for an argumant, Just hoping your not alone taking this much meth and MSIR combined while you are alone. The increase in meth overdoses has skyrocketed because few docs really know what they are doing and actually use some stupid chart rather than first hand knowledge.

    It's not that I think 160 mgs of meth is a huge amount, I take 150mgs of meth and use 30-60-90mgs of MSIR at a time NOt 120mgs daily because I'm alloweed but as a BT med appropriate for the level of pain usually once a day. It's definitely not the amount.

    The huge jump and the 240mgs of BT med used like clockwork and still thinking your dose was converted low based on some chart that every recent artcle says is tptally inacurate as far as underestimating the strength and your conversion back that is scary.

    Needing an increase on top of this should confirm to your doc that no amount will satisfy you, whether your expectations aren't realistic given your conditiopn, which is a huge hurdle to come to terms with what you can't do anylonger.

    ZPerhaps you have a crazy metabolism and you need to have your serum levels checked to make sure your in a theraputic range. Somehow I doubt ypur doc knows how to do this test and how to interpret the results though.

    A 3-4 times increase in base strength is no joke and is dangerous when done to fast. Especially with a med like meth. It was nice your doc allowed yopu a BT med during titration but BT meds should be treated as such. What will you do if you have a flair and your used to taking the max dose allowed every single day. TRy cuttting that back and adjust yopur dosing schedule on the meth. Talk with him about a serum level check because the numbers just don't make sense given your level of discomfort. I'm not a doc but Something is not right, just because a doc gives it to you doesn't mean you have to telk every mg like clockwork. I would even bet the MSIR is worderded to take 1-2 30mg tabs as needed for BT pain every 6 hours. That's if you have BT pain. What willlhappen the day you slip on the icxe or you have a huge change in Barametric pressure or the slighest flair happens. You don't don't have the means to manage the slighest flair if you take BT meds as part of you daily regemin regardless of level of BT pain.

    Most CP patients pray for a doc as aggressive but this guy is more than agressive and doesn't appear to have knowl;edge about prescribing methadone. The only thing I hope for is that you have the mellencropt "Methadose" It's consistanly weaker than the other generic made by roxanne and the name brand product Dolophine that only comes in 40mg Discettes.Every I know that had it tested came back 20-25 weaker than methadone by Roxanne. So all generics are not the same. The FDA allows a 15% ovage of active ingredient and a 20 shortage and still callls it the highest rating generic "AB"

    [This message has been edited by Shoreline (edited 10-31-2003).]

     
    Old 10-31-2003, 01:13 PM   #5
    brentskib
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    Shoreline,

    The value of 1800 mgs of morphine I gave is only what the 'calculator' gave me when I put in the combinations of my current meds,(160 mg of methadone and 240 mg of MSIR daily)not what I have ever taken.

    I had originally started on 60 mg of MSContin,4x day w30-60mg of MSIR for BTP.

    As I mentioned, my doctor suggested I switch from the MScontin and MSIR(doses above) to Methadone,30 mg 4x day along with the MSIR staying the same for BTP which I did.
    (and no, I didn't feel any difference between the switch from 240 mgs of mscontin to 120 mgs of methadone. In fact,my Dr. told me to make sure I let him know if I felt any feelings of withdrawal initially during the switch )

    I've since had my methadone increased to 40mg 4x day, with the MSIR dosage staying the same for BTP.

    To be honest, I never have any feelings of euphoria or sedation of any type with taking my meds,maybe in the very beginning,years ago. All I know is that I'm getting relief from the pain.

    Recently, when I told my pain Dr. about my increased pain,she asked if I wanted to increase my methadone dosage.
    I told her I'd rather not 'overmedicate' as I have an appt. set up with an othopeadic surgeon to look at the rods and screws from my failed fusion to see if that might be the cause for the increase in my pain

    I'd very much like to switch between drugs as I've heard you get a better analgesic effect though I've never heard of switching between them on a daily basis(if I understand correctly,that's what you're doing).

    This seems as though it would negate the effects of changing as methadone has such a long half life compared to most other long acting drugs.

    I really do appreciate all your input,especially from someone who seems to have the same problems that I may possibly have.(with the rods and screws)

    Again,thanks so much for your help and assistance.

    Please let me know if I'm on the right track here.
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    Old 10-31-2003, 01:48 PM   #6
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    Hey Brent, How long did you take the 120 mgs of meth before making a 40mg increase. 40mgs is a healthy increase. I went from 120 to 150, tried just adding the 30 and found it would be easier to get used to the side effects I'm experiencing at a higher dose by just adding 10mgs a week.

    I'm glad you took my post in the spirit it was intended. The daily use of BT meds concerned me but if you truly take it as a BT med, when your pain spikes and you need something strong to get it down it is proper use of these meds.
    The initial conversion scares me but apparently you have a healthy tolerance.

    Methadone blocks the NMDA receptor. This is believed to increase ones tolerance to pain and slow ones tolerance to the opiates.Hopefully you will reach a stable dose and stabalize for some time. Don't over do it if you find new found relief.

    It's kind of unusual to see such a large amount of BT medication available but every doc is different. Your the only one that knows if your use is appropriately or if it has just become part of the daily regimen. You loose the ability to manage BT pain when you do this, plus it spikes your tolerance.

    Your conversion factor will be higher if you switch back to morphine. But if meth works why switch.

    I don't think your doc made a truly safe transition though. 60-80 mgs would have prevented any withdrawal from the morphine. Morphine doesn't hit a single receptor that meth doesn't, making the switch to methadone easy.

    Now switching away from methadone will be a little harder since no other drug aside from Levo-dromoran, which hardly anyone prescribes or stocks. Acts the sameway meth does.

    It's really not the actual dosage. We pretty much take the same dose and use the same BT med. I'm given 160 30mg tabs but have yet to use that much. It's nice to have when you act like your old self and help someone move furniture.LOL

    I've seen people take 4 times your dose and the impairment just isn't there. So it's not the number of mgs but how it was done that concerned me. Following instructions is what patients do so if you doc said it was safe to just stop the MSC and take 30mgs of meth QID a day I can't fault you. Use your BT meds with discretion and with meth, an increase can sneak up on even the most accommodated patient. I saw where a doc made a huge mistake on another forum and killed a long standing memeber.

    She didn't have a chance to read the posts that warned here that tripling 120mgs of meth wasn't safe and his error cost her life. She reported feeling no pain the first day, well of course, but by the second day of that increase, she never woke up because of the way it accumulates. You still have half the next, then half and quater and so on. It does take 4-5 days to reach a steady plasma level

    I do feel more comfortable having talked to you about my concerns. I'm sure watching the loss of one forum member to meth had me a little scared.

    I did add some stuff about the proper use of BT meds and how switching back to morphine will require a higher dose or ratio than switching from morphine to meth

    Be aware of the rapid drowsiness it can cause and when you make an increase go slow. Take care, Shore


     
    Old 10-16-2011, 03:48 PM   #7
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    Re: changing from methadone to......? high dosage??

    I was taking 10mg 3x per day of methadone and my pain worsen so the PM put me on 15mg 3x per day of morphine and 90mg cymbalta once per day ,now my pain is worse than ever. Also I used to sleep good, now since I've been on the different meds I can't sleep at all. I have been on the new meds program for 3 weeks now, is there anyone out there that might advise me what to expect, or is there a need to add to the medication. Need help here in Kansas. Thank you, Babe144

     
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