I have been seeing a neurologist for a couple of months now as I have really severe RLS day and night I have posted before so some of you may remember the 91 year old lady still fighting to get some quality of life. As the Tramadol has stopped working ,although I am still taking four tabs a day because of withdrawal symptoms, DrBagary prescribed clonazapam half a tab for two weeks and then two halves for another two weeks. They haven’t suited me at all made me dizzy and unsteady to the point of falling down. He rang me this morning to see how I was and of course I explained I wasn’t getting on with the clonazepamand asked for Temgesic . He has agreed at last and is sending me a Prescription.I hope he sends instructions as to their use because of the fact that I am still taking Tramadol so please can you knowledgeable people help me please. Do I come straight off the Tramadol and simply exchange one opioid for the
other or must I come off the Tramadol more slowly.As they are capsules they cannot be cut in half like tablets. I have waited and waited for months and months for this prescription so I am praying that it helps. Please anyone with any knowledge at all get in touch with your help and advice as I am so anxious for this to work
Thank goodness for the forum and all the lovely people on it
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bedith6
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According to cep.health/media/uploaded/C... Decrease the total daily dose of the current opioid by 10–25% per week while titrating up the total daily dose of the new opioid weekly by 10–20% with a goal of switching over 3–4 weeks.
SueJohnson's advice is probably wise, but maybe difficult to follow. I just want to share my experience. I was on 10mg oxycontin in the evening (and another 5 or 10mg in the morning to combat mini-withdrawal) when I was prescribed Temgesic. I did a clean switch to at first half a 0.2mg tablet in the evening (8-9PM). After a few days I increased to 1 tablet of 0.2mg Temgesic. I did not need daytime dosing to combat the RLS. After a while I also got something akin to miniwithdrawal with the Temgesic. In the end, after a year, upon advice of the pharmacist and approved of by my neurologist I switched to a buprenorphine 7 day patch of 5mcg/h. I suspect your tramadol dose is still low enough to do the clean switch. Like me, you may want to start with half a pill Temgesic as it works pretty quickly (1-1.5hrs). If it isn't enough and you don't have nasty side effects, you can take the other half after that time. For example Joolsg had initially strong nausea when she started Temgesic. Several others as well, but by far not everybody. Most people need two tablets of 0.2mg Temgesic, but other people need far higher doses. Given your age, but also in general, go slow and see how you react.
Bedith, I remember your earlier postings and struggle well and I am so happy you finally got the Temgesic. I hope very very much that it works well for you and that a low dose of 0.2-0.4mg suffices and doesn't give you side effects. If constipation, ask your pharmacist for something to help with that. And please let us know how you react. I wish you blissfull nights with restorative sleep! 😴 💤
I had a look at Sue's link after I wrote the reply. As I suspected, the described conversion on that table/website is for far larger doses of opioids.
I did find this website with equivalent doses of various opioids to 10mg morphine. It says tramadol's pharmacology is complex, thus hard to convert exactly.
As I said before, Temgesic works fairly quickly allowing you to see how things go and adjust accordingly. In anyway, go slow. I hope it goes smoothly. And soon! No problems with filling your prescription, I hope.
Thank you for your reply LottieM . Because Tramadol is a capsule and can’t be halved in the same way as a tablet I think it is going to be difficult. I take 4 capsules between 4.00 and 10.00 (200) I am thinking of cutting the capsule in half and just using the powder perhaps a quarter less each week and at the same time see how the Temgesic affects me.. I have asked Dr To also prescribe some anti nausea tabs ( ones that don’t affect rls badly) to which he agreed. Has anyone else on this forum managed to come off Tramadol successfully.? I’ll let you know how I get. on best wishes
Although you haven’t had instructions yet from the neurologist about how to swap I am sure if you ask him he would be able to supply this info. It is complex as others have said but I would honestly ask for professional help with this. You are 91 and it is very important to get this right & not be taking too much opioid at one time which could be dangerous. Metabolism alters as you get older. It may also depend a bit on your size. I’m not sure which country you are in but in the UK they are very knowledgeable. They do a 3 or 4 year degree studying the complexities of medicines & are trained to give advice. I would ask your pharmacist. If they don’t know they will ‘know a man who does’ to paraphrase a saying.
See below which I should have read before posting. So I mean I’d advise to ask the neurologist. If he isn’t certain ask your pharmacist who will either know or direct you to someone who does
I can’t advise on your tramadol reduction but i can on the anti nausea med if you don’t already know the anti nausea med you need is Zofran it’s RLS friendly.
I am still waiting for prescription (they obviously don’t realise how long and agonising my nights are). I did ring the pharmacy up just to let them know I would be bringing a prescription for Temgesic shortly and all they said was that they would have to order it in but couldn’t until they have the prescription .
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My not so famous last words/ final manifesto:
Went to the ER last night
2 months of RLS and Alpha Lipoic Acid worked last night
RLS has positive results on housework!
