Increase Methadone or switch to buprenorphine patch or suboxone?

[Mongolia2020]

Drs appointment today. I am getting stronger and stronger breakthrough rls on 10 mg methadone, to the point where I want to do something.

My choices are:

Increase methadone to 12.5 mg. I’m not keen due to the constipation, daytime sleepiness and the slowing of my whole body and mind which I don’t like.

Switch to a buprenorphine patch called norspan - I have no idea what dose to try . Comes in 5 mg, 10 mg, 20 mg and upwards. Will I go through methadone withdrawal?

Switch to Suboxone, which also contains naloxone. I don’t really want to take something I don’t need, and unsure of dose.

I read about adding amitripyline in addition to methadone to counter tolerance, but I think I must have recorded the drug incorrectly.

Has anyone here tried hellminth therapy?

I am grateful for any suggestions. Any suggestions

[SueJohnson]

You don't want amitripyline - it can make RLS worse. All the other choices are fine. You won't go through methadone withdrawal. I'll leave it to others to advise on the dose.

[SueJohnson]

P.S. all opioids are associated with the side effects you are having with the methadone.

[Joolsg]

Naloxone is added to Oxycontin to prevent opioid induced constipation - so suboxone that is a good option.You make a straight switch overnight. 10mg methadone is low; so start with 0.2 or 0.4mg suboxone.

I don't know what doses of suboxone are available in NZ.

[JenniferBut in reply to Joolsg]

I have great success with 2 sachets of movicol each morning. Works a treat and non habit forming.

[Nanpat]

Hi, I’m on norspan 15mg patch

And zero rls for a year now, wish I’d tried it years ago

Good luck

[Mongolia2020 in reply to Nanpat]

Can you travel internationally with norspan ok? Do you have to declare it at borders? Any problems? Side effects?

[Rameau in reply to Mongolia2020]

The rule of thumb is that if you are taking a "controlled drug" in your own country it is likely to be controlled abroad. The embassy of the country you are visiting should be able to tell you about import restrictions. Also a personal letter from your doctor should help avoid any difficulties at a border - should you meet any.

[Nanpat in reply to Mongolia2020]

Not sure regarding travelling, would presume a letter from dr.

I had no side effects only constipation.

[vikkitennis]

I am using the buprenoorhine with suboxone and it has made a big difference with me, with breakthroughs. I work with a GI doctor for constipation relief.

[LotteM]

Note: Norspan patches come in 5, 10, 20 and upwards MICROgram /h, written as mcg/h.

1 microgram (mcg) is 1/1000 of 1 MILLIgram (mg). Quite a difference in dosage…

I have been using a. 5 mcg/h buprenorphine patch for almost 3 years now. And - provided it is the right brand for me (Teva, currently unavailable here in The Netherlands) - it works almost 100%. I only need(ed) to top up with half or one sublingual pill (0.2mg) in special situations, like very intensive activity all day.

[JenniferBut]

Hi, 👋 yes it is Amitriptyline. It's used in low dose, 5 mg along with opioids to assist in prevention of tolerance. All the best with your appointment 💖

[JenniferBut]

Hi there 🤗 I am on norspan 5 mg. It doesn't stop all my symptoms but when dr added 5 mg methadone it did. I tried stopping the patch but I got daytime breakthrough. I getting ready for a review as the honeymoon period is nearly over on my current dosage. I will ask more questions at my next visit about docs methodology re adding in methadone and not increasing norspan. I've had over 3 months relief on the dosage ( approx )

Good luck 🤞 💓

[Mongolia2020]

thank you everyone for your responses. I decided at the moment to increase methadone dose from 10 mg to 11.25 mg ( extra quarter of a tablet), so I will see how that goes. Am keen to travel to Europe during 2025, so will do some research about taking methadone with me.

Hope you are all doing ok.

🥰