Methadone adjustment/Horizant

[wantokporo]

Just started methadone 1.5 mL. I have a lot of trouble with drug side effects. After years on pregabalin more or less successfully treating my PLMD, it started making me nervous/anxious so I tried Tylenol #2 which made me very nervous and now I am trying the methadone. Years ago I tried 5mg of methadone and it totally wasted me (I slept day and night), although it did work. Anyway, this time the 1.5 mL is not completely covering the PLMD, although I would live with it, but two nights now it has caused extreme nervousness and insomnia. I am only in the second week, and just increased the dose to 1.5 from 1 mL. I know this sounds ridiculously small but this is how I am. Anyway, I am hoping maybe it is just that I am adjusting to the methadone, and the increase and should hang in there a bit, but not sleeping at all (it is 3am now and I am wide awake and feeling frazzled) is not a plan either. So that is the first question: could this be adjustment and dosage change? (I used to have severe side effects on pregabalin when changing from one dose to another but after 4 days or so my body would settle down.) Second question is, and maybe this is part of the problem here: I am still weaning off gabapentin (which I tried to see if it wouldn't have the same side effect, which didn't work) and I'm at 500 mg. I think the gabapentin I am taking in the day has actually helped to counteract the methadone sedation with the paradoxical response I have with gabapentin waking me up. I am thinking, should methadone fail, I should try horizant and I am wondering if I can switch over from gabapentin directly or if I have to get off of it completely and then start the horizant?

[SueJohnson]

You should be able to switch directly from gabapentin to horizant.

[joebeddall in reply to SueJohnson]

Ihave all the same problems as you.I have Phyiso Neurophy and tried alsorts.there is no cure yet.Used pregabalin for 2yrs.got all your probs.Came off it for couple of months.Back on it now on a reduced dose.Had probs.with gobapentin.Feeling a little easer,appears nothing on way to a cure.hope you find something.Good luck.

[SueJohnson in reply to joebeddall]

I think you meant this reply to wantokporo.

[SueJohnson in reply to joebeddall]

You might want to consider an opioid like buprenorphine.

[wantokporo in reply to SueJohnson]

I tried it. Went through the roof. It was so bad I couldn't consider a second night. I have heard people have had such luck with it. Thanks for thinking of me.

[Joolsg]

You are suffering opioid alertness/wakefulness and anxiety. Very common. However, the normal recommendation from the top RLS doctors would be to add a small dose of pregabalin or gabapentin.You sadly have anxiety on these drugs as well.

I would suggest contacting Dr Buchfuhrer. He has a lot more experience of drug interactions and opioid induced anxiety. He may suggest adding clonazepam or trazodone.

His email is

somno5586 @ outlook.com

[wantokporo in reply to Joolsg]

I went to see Dr. B twice. My experience has not been so good with him. Last time I saw him (and he insisted I fly there to do it) he dismissed me telling me I was a hopeless case. But it is worth a try. What have I got to lose.

[Joolsg in reply to wantokporo]

I'm so sorry to hear this. He always says 97% of RLS patients can be symptom free with correct treatment. It would seem you may fall within the 3%. However, I'm sure with some tweaking, you can settle the wakefulness/anxiety. There are other meds that can have a sedating effect but I really hope they don't also trigger anxiety.

Trazodone and wellbutrin are possibilities. Or certain cannabis strains.

I really hope you can find something that helps.

[FlintHills in reply to Joolsg]

I wouldn't go back to any doctor wo said I was a helpless case, unless you misinterpreted what he said.