Hydrocodone not working anymore

[Retiredandrestless]

I will be seeing my GP this month,hydrocodone has stopped working after 14 years. I'm debating on gabapentin or methadone? I was on gabba years ago,it ruined my gallbladder and had to get it removed. How have any of you using either of these meds helped with your rls? I don't know which one would be a better option? Thanks for any advice 😉

[LotteM]

Sorry to hear this. We tend to think that low dose opioids will work ‘forever’. Obviously not in your case.

Has anything changed? That is the first question.

If not, I hope you have a good and knowledgeable doctor and can discuss alternative with her/him. Given you earlier experience with gabapentin, do discuss whether you should try Horizant (gabapentin enarcabil) or pregabalin, the first gabapentin with a different delivery mechanism and the second a different medicine in the same class. It sounds like you should be reluctant, but do not shy away from the discussion. The alternative is to either up your current dose (assuming it is still a low dose) or -maybe better- switch to a different opioid. Methadone and buprenorphine are currently preferred for refractory RLS as they are long-lasting. Methadone effective doses start at (2.5 or) 5 mg and buprenorphine at (0.2 or) 0.4mg. But quite a few people need higher doses. I always like to find the lowest effective dose as it reduces the chance of side effects and leaves room to up the dose later, if needed.

Do check out rls.org for good information. And make sure you have a knowledgeable doctor. If you let us k ow where you are based, other people in the US can hopefully recommend a good doctor nearby.

Hope this ‘thinking aloud’ helps.

[Retiredandrestless in reply to LotteM]

LotteM, I'm based in west palm Beach, Florida. I've been with my Dr for over 20 years and he is,understanding to my problem. So,do you think pregabilin would be a better option ?this sounds silly,but the methadone is not the same as the stuff on the streets? I know weird question. I need something that if it wakes me,up in the middle of the night,like I have to do now. I'm already have gone from 1 ten mg of hydro to 3 mg during the night. I don't want to be taking that .much and my legs still wake,me up. Just looking fore the badge option for me. Thanks

[LotteM in reply to Retiredandrestless]

Methadone as well as buprenorphine are longlasting opioids. Usually no need to take extra in the night. Although some people divide their buprenorphine into an early evening and late evening dose. I don’t know whether people on methadone do that.

I don’t know about the pregabalin for you, as I don’t know your situation. But I do think it is always good to discuss different options with your doctor and make informed choices on your medicines.

[SueJohnson]

I would go with methadone considering your past experience with gabapentin.

[Retiredandrestless in reply to SueJohnson]

Is method one a safe drug? That's why I want off hydro. And if I wake up with my legs going crazy can I take another one or cut in half? I don't know if they are pills or capsules? Thanks for your help

[SueJohnson in reply to Retiredandrestless]

Methadone should last 24 hours so if you are taking the correct dose you shouldn't wake up. Yes they come in pills so you could cut one. The usual starting dose is 2.5 to 5 mg and the usual effective dose is 5 mg to 20 mg according to the Mayo Clinic Updated Algorithm on RLS.

13 mg hydrocodone is right between the starting dose of 10 to 15 mg but it only lasts 4 hours which is why you are waking up at night.

[Busunsc713 in reply to SueJohnson]

Question: when switching to methadone or buprenorphine from hydrocodone….. is hydrocodone stopped immediately and methadone or buprenorphine started? Is there a need to wean off hydrocodone before starting methadone or buprenorphine? How is the transition done for RLS?

[Merny5 in reply to Busunsc713]

I made the move from oxycodone to methadone and it worked very well. There was no transition for me, I just started the methadone and dropped the Oxy.

[Retiredandrestless in reply to Merny5]

That's good to know

[SueJohnson in reply to Busunsc713]

Since you are only on 13 mg which is a starting dose you could switch directly.

[SueJohnson in reply to Retiredandrestless]

Actually since your gallbladder has been removed gabapentin and.or pregabalin could be used. Beginning dose is usually 300 mg gabapentin (75 mg pregabalin). It will take 3 weeks before it is fully effective. After that increase it by 100 mg (25 mg pregabalin) every couple of days until you find the dose that works for you.

Take it 1 to 2 hours before bedtime as the peak plasma level is 2 hours. If you need more than 600 mg take the extra 4 hours before bedtime as it is not as well absorbed above 600 mg. If you need more than 1200 mg, take the extra 6 hours before bedtime. (You don't need to split the doses with pregabalin)

Most of the side effects will disappear after a few weeks and the few that don't will usually lessen. Those that remain are usually worth it for the elimination of the RLS symptoms. According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin (200 to 300 mg pregabalin)."

[SueJohnson]

In doing my research I can't find anything that says gabapentin can cause gallbladder problems, but everybody is different and react differently to medicine. I am so sorry that happened to you.

[Retiredandrestless in reply to SueJohnson]

I was actually in the middle of weaning off gabby. I went very slow,e even water titrating,then my gut started acting up and ended up getting surgery

[Birdland]

I haven’t heard of any particular problems with methadone over any other opioid. I know it can sound scary because it’s associated with heroine users. Many RLS sufferers take it. I have tried every opioid available but am very sensitive to drugs, especially opioids, so I am unable to take any of them on a regular basis. I have a script for methadone and take it when I am desperate. I settled on methadone because it’s the only opioid that doesn’t cause me insomnia.

[Retiredandrestless in reply to Birdland]

I didn't know that opiods,cause insomnia. Maybe the hydro was the ,culprit in keeping me awake,besides the legs too

[Birdland in reply to Retiredandrestless]

Opioids can definitely cause insomnia. Not everyone experiences it but it’s quite common. After taking them I can be very relaxed with no RLS yet very alert like I’ve had coffee.