My husband has been on Methadone (10MG) currently and Gabapentin (1200MG) daily, for approximately 2 years now.. Prior to this ( and I may have mentioned in a previous post ) at the time we didn't know about anything about augmentation. He had been on Pramipaxole for a very long time, at a high dosage. He figured out on his own that it just wasn't working and essentially started to wean himself off of it (with no assistance). By the time he was at his wits end, we finally got in to see a neurologist after nearly a year wait and after trying a few different things, he was placed on Methadone and Gabapentin. We live in Canada , and there appear to be very few people at least coming forward or acknowledged with this situation. The neurologist had never prescribed this for RLS before, he was one of the first. At first it did help, certainly the augmentation stage left great damage, and the dosages have gradually ticked up on both as they seem to work for awhile and then they plateau or become less effective. He has also tried different dosage schedules for the Methadone (and Gaba) as he seems to suffer from Alerting on the methadone so we we switched to some of the dose taken earlier in the day, but again over time that seems to be ineffective. Our neurologist has agreed to now try Buprenorphine - I printed off and showed him articles that you have posted in the past indicating the positive results. Unfortunately, we are not as educated on what the process is to get off the Methadone and Gaba prior or during the transition to Buprenorphine. We went to pick up the prescription and it was a patch - which from your past comments appears to be the least effective method of utilizing as well? We didn't pick it up but plan to contact the neurologist again to switch to either tablets or sublingual.
So what we are seeking is recommendations for the delivery system, and also guidance in how to switch over. The pharmacist was unwilling to comment on this, and the neurologist had suggested cutting the methadone in half each day , no comments on the Gaba reduction. We also received a Naloxone kit for overdose risk (I assume this is common).
Any help you can provide is appreciated, you have literally got us to this point, without this site and information we cant imagine where we would be right now..
Thank you!
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Gosask
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Hi Gosak, can you share what other non-RLS medications your husband is on? Especially things like anti-depressants, calcium channel blockers and PPIs. Also, please think about having your husband try 56mg of ferrous bisglycinate on an empty stomach about two hours before bed, rather than the extended release iron. One of the best things your husband can do is eat nothing after the dinner hour. The ferrous bisglycinate should provide him with a good amount of relief, about 1.5 hours after taking it, if he’s an immediate responder, as many of us on here are. See below:
Last but not least, magnesium glycinate, taken during the day - day in day out - month after month, may help to up-regulate your husband’s down-regulated dopamine receptors. MANY people on here swear by magnesium.
He does not need to wean off the methadone. He can switch directly. Someone else will be able to give you the equivalent dose, but he might want to try the patch since it spreads out the dose over 24 hours rather than all at one time. If he does he will probably find out as others have that a 7 day patch lasts only around 5 days. People usually put the new patch on but leave the old patch on at the same time for the 7 days.It also takes awhile when you start it to be effective.
For itching try one of the non sedating antihistamines claritin, allegra or zyrtec.
Looking at your previous reply, he was taking gabapentin wrong. Also the average effective dose according to the Mayo Updated Algorithm is 1200 to 1800 mg so he may not have been taking enough.
Take it 1-2 hours before bedtime as the peak plasma level is 2 hours. Since he needs more than 600 mg take the extra 4 hours before bedtime as it is not as well absorbed above 600 mg. If he needs more than 1200 mg, take the extra 6 hours before bedtime. He was taking 600 mg at 5, 300 mg at 8 and 300 mg at 10. It should be 600 at 10 and 600 at 8, assuming 10 is 1 to 2 hours before his bedtime.
If he takes magnesium he shouldn't take it within 3 hours of taking gabapentin as it will interfere with the absorption of gabapentin and he shouldn't take calcium nor calcium-rich foods within 2 hours for the same reason. Have him check out the Mayo Clinic Updated Algorithm on RLS which will tell him everything he wants to know including about its treatment and refer his doctor to it if needed as many doctors do not know much about RLS or are not uptodate on it at mayoclinicproceedings.org/a...
I would try to increase the gabapentin before giving up on it. If he does decide to come off it he needs to do so very slowly to avoid withdrawal effects. Reduce by 100 - 200 mg every 2 weeks. If he does so he will have very few or no withdrawal effects. If he does have any, slow down even further, In very very rare cases he still might have withdrawal effects
You say Gaviscon did not work for his acid reflux, but was it Gaviscon Advance as this is the one he should take.
He is taking iron but has he had his ferritin checked? If so what is it? This is the first thing his doctor should have done. Improving ones ferritin to 100 or more helps 60% of people with RLS and in some cases completely eliminates their symptoms. If not when he sees his doctor ask for a full iron panel. Stop taking any iron supplements including in a multivitamin 48 hours before the test, avoid a heavy meat meal the night before, fast after midnight and have his test in the morning before 9 am if possible. When he gets the results, ask for his ferritin and transferrin saturation (TSAT) numbers. He wants his transferrin saturation to be over 20% but less than 45% and his ferritin to be at least 100. If they are not, post them here.
The slow release iron bypasses the area where the iron is absorbed.
If he takes blood thinners, iron binds with blood thinners, potentially reducing the effectiveness of the blood thinners and of the iron so check with his doctor.
Since he has gut problems he should take 50 mg to 75 mg (which is elemental iron) of iron bisglycinate with 100 mg of vitamin C or some orange juice since that helps its absorption. Also take Lactobacillus plantarum 299v as it also helps its absorption. If even the iron bisglycinate bothers his gut, then try liquid iron making sure it has at least 65 mg of elemental iron. He could also take it or take the iron bisglycinate with food although less will be absorbed that way. If even that doesn't work he could try heme iron although less is absorbed.
Take it every other day as more is absorbed that way, preferably at night at least 1 hour before a meal or coffee or tea and at least 2 hours after a meal or coffee or tea since iron is absorbed better on an empty stomach and the tannins in coffee and tea limit absorption.
If he takes magnesium (or magnesium rich foods), calcium (or calcium rich foods) or zinc, even in a multivitamin take them at least 2 hours apart since they interfere with the absorption of iron. Also antacids interfere with its absorption so should be taken at least 4 hours before the iron or at least 2 hours after.
Don't take his iron tablets before or after exercise since inflammation peaks after a workout. Don't take turmeric as it can interfere with the absorption of iron. If he takes thyroid medicine don't take it within 4 hours. It takes several months for the iron tablets to slowly raise your ferritin. Ask for a new blood test after 3 months.
Some things that can make RLS symptoms worse for some people are alcohol, nicotine, caffeine, sugar, artificial sweeteners, carbs, foods high in sodium, foods that cause inflammation, foods high in glutamate, ice cream, eating late at night, dehydration, electrolyte imbalance, melatonin, Monosodium Glutamate (MSG), collagen supplements, low potassium. eating late at night, stress and vigorous exercise.
Some things that help some people include caffeine, moderate exercise, weighted blankets, compression socks, elastic bandages, masturbation, magnesium glycinate, fennell, low oxalate diet, a low-inflammatory diet, selenium, 5 minute shower alternating 20 seconds cold water with 10 seconds hot water finishing with hot water for another couple of minutes, hot baths, distractions, applying a topical magnesium lotion or spray, doing a magnesium salts soak (epsom salts), vitamins B1, B3, B6, B12, D3, K2, if deficient, and potassium and copper if deficient, massage including using a massage gun, vibration devices like therapulse, using a standing desk, playing and listening to music, creative hobbies, meditation and yoga.
Many medicines and OTC supplements can make RLS worse. If he is taking any I may be able to provide a safe alternative.
As methadone and Buprenorphine are both opioids, you usually make a straight switch overnight at the equivalent dose - however as your husband has been on 10mg methadone for some time, the doctor and pharmacist should first confirm the correct equivalent dose of Buprenorphine sub lingual.Looking at UK opioid equivalent charts, it would appear that 0.4 to 0.6mg of sub lingual Buprenorphine is equivalent to 10mg methadone, but your doctor and pharmacist really needto confirm this.
When he does, you can then make the straight switch overnight.I switched from 25mg Oxycontin to 0.4mg Buprenorphine overnight.
Gabapentin was probably prescribed to counter opioid 'alerting'.But you don't normally need such a high dose to act as a sedating drug.
So he should first switch to Buprenorphine and only after 2 weeks - while his body adjusts to Buprenorphine, should he start gabapentin reduction.
The usual advice is to reduce gabapentin slowly, by no more than 10% a week. So ask for 100mg pills. You can even cut the pills and split the powder.
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