Pain Management Community

You can die from Tylenol if you take it the wrong way.

What does your MD say? Have you discussed your concerns with the MD who prescribed it for your pain?

I know my MD would be pretty pissed if a pharmacist was trying to do his job which is prescribing and managing your follow up.

There are many, many people who have been taking Methadone for years for pain management. It is, indeed, meant to be taken for long-term pain management.

If you take it as prescribed and follow up with the prescribing MD, there shouldn't be that sort of fear.

Please talk to the MD who prescribed it for you.

I take methadone, have for about 3 years now, I think. It is not any more dangerous than anything else you take. The only thing I could find on line when I researched it was that it could cause prolongation of the Q-T segment in your heart. I discussed this with a pain management doctor that I see every few years and he felt it was not an issue in my case, but told me it might be at higher doses, and getting a yearly EKG would probably put my mind at rest. So now I do that, so far, so good. I certainly do not worry about it. I also do not discuss my meds with anyone other than my MD. It is only her and my business. Some people are anti-opioids altogether, just the way they are.

As far as making the decision to get off of methadone, it you switch to another opioid, it should be no big deal at all. Even if you decided to get off of all opioids, as long as you do it slowly, you should be fine as an out patient. My husband got off of methadone twice without any withdrawal at all, I slowly decreased his dose. Now he takes only over the counter meds for his pain, his choice.

I took benzos for a short time, once a day at bedtime, and I had significant withdrawals when I stopped taking them. I required medical intervention, but at home not in the hospital. It was unpleasant, but not any worse than the flu. I won't take them again. My choice.

Don't panic, do your own research, and decide for yourself what to do with your doctor's input.

Take care, Annette

It sounds like this woman may be experiencing the life threatening QT prolongation interval side effect from methadone because she said in her post that she is experiencing an irregular heartbeat along with palpitations.

I think your pharmacist is doing the right thing by advising you to get off methadone as soon as you can as it could mean life or death for you. Also, given your symptoms, it is better to be safe than sorry. Methadone is a very old drug just like Morphine but the fact that it can screw up your heart rhythm which can be deadly steered me cleared from it. From what I have heard and read is that this side effect is rare but unfortunately your symptoms paint the perfect picture of this side effect.

I don't think going cold turkey is the answer as there are many other opioid medications that don't have rare side effects that are lifethreatening besides an allergic reaction. I would have your doctor do an EKG asap and request to be switched to the equivalent dosage on a different opioid.

I do think it was wrong for your doctor to not disclose the possible deadly effect that methadone can have on some people's hearts. When my doctor offered it to me, he gave me the choice between methadone and morphine. But he didn't tell me the deadly effect that methadone has had on some patients. I instead found out online just like you did. Doctors should give their patients enough information to make an informed decision. I chose morphine as I know that it is a very trusted medication that has been around for a long time and I had prior experience with it during labor without any complications.

I do wish you the best and please post how you are doing. Take care.

Q-T prolongation does not generally cause an irregular heart beat or palpitations in my experience. You have a regular heart beat with a longer Q-T segment than normal. If the heart beat starts up during this time, bad things can happen, due to the heart tissue repolarizing electrically.

A simple EKG test can show the doctor if you have this rarity or not. Discuss it with the prescribing doctor and ask for this simple test.

Don't go by what you read on the internet, here or elsewhere, always discuss your concerns with a trusted doctor. Do your research, but discuss it with a doctor before making any decisions.

Take care, Annette

If Doctors sat and told you every posable side effect you would not be on the medication now you would still be debating all the possible side effects of any particular drug.

You can Go on Amazon.com and for a couple of hundred dollars buy a high quality ECG/EKG machine that is a little bit larger than a deck of cards yet capable of giving a correct 5 lead ECG/EKG and identifying and capturing almost any heart dysrythmia or malfunction so when you get to the Dr. or hospital they can download it and watch the whole event live and in color as when your machine caught it, and i have personally checked mine against my Dr.'s office and they agreed with each other.

i wish you luck in your search for a Medication that somewhere in its list of possible side effects it does not list something that makes you say "I don't want to take that!"

Peace

I think the pharmacist should have advised her to call her MD or go to an ER if she felt as if she was having cardiac problems.

The type of irregularity that can be caused by methadone is VERY rare and does not have symptoms.

The sensations the original writer says she had been experiencing are NOT indicative of a prolonged Q-T seg.

Smoking 1/2 pack of cigarettes per day is more dangerous for the cardio-vascular system than a prolonged Q-T segment if, indeed, the methadone was causing the rare adverse effect of abnormal EKG (heart electrical conductivity).

The med was prescribed by her MD. I do not think the pharmacist was in line to tell her to stop taking it, and now she has to experience withdrawal on top of pain.

Calling the prescribing MD to discuss her concerns could have allayed so much fear (with an EKG, if indicated) and she would not have had to suffer through withdrawal.

More than fifty medications, many of them common, can lengthen the Q-T interval in otherwise healthy people and cause a form of acquired long QT syndrome known as, "drug-induced long QT syndrome".

Medications that can lengthen the Q-T interval and upset heart rhythm include certain antibiotics, antidepressants, antihistamines, diuretics, pain medications, heart medications, cholesterol-lowering drugs, diabetes medications, as well as some antifungal and antipsychotic drugs.



In people with long QT syndrome, fainting spells (syncope) are caused by the heart temporarily beating in an erratic way. These fainting spells may happen when you're excited, angry or scared, or during exercise.


However, while methadone alone may prolong the QT interval, most reported cases of methadone-associated cardiac event have involved other risk factors as well.


There are many scholarly articles (peer reviewed studies) as well as medical journal studies easily readable via a google search.

You are absolutely correct!! I used Google to find studies about this before I started taking methadone. It is sometimes difficult for lay folk to read a study correctly though.

Be sure and print out any studies and take them to your doctor so he can go over them with you. It is pretty amazing how some folks can write an article based on 25 people reacting a certain way. This may be grounds for doing more research, but it is rarely grounds for stopping a medicine prescribed by your doctor.

No one is always right or always wrong, we are all human after all.

Take care, Annette

I'm sorry to hear about your physical issues. I've been living with chronic back and leg pain for the past 40 years. I know what it's like.

You can die from any medication. Methadone is actually one of the safer opioids and it's certainly one of the least expensive. I've not heard of A-fib or arrythmia from methadone. Have you considered that you might have developed those issues regardless of your pain medication?

As far as I'm aware, you can take methadone for a lifetime without physical problems. Opioids are a natural substance in the body, just as are endorphines. They all bind with receptors i nthe brain to reduce pain. I think that you may have jumped to an incorrect conception here. The relationship between methadone and A-fib is not a correlation that I have seen.

Good luck with your pain and other physical issues.

After 3 years I have decided to get off fentanyl patches. I am currently on a 75mcg patch every 72 hrs & plan to get down to 12.5mcg over a period of about 3 months, then stop.

I have already started gabapentin 100mgs to 'settle' my system down before starting this in a couple of weeks. I will have oxycontin 20mgs & maybe 40mgs plus xanax 2mgs (if needed) to help me along the way. I need to do this- the side effects of the patches are becoming intolerable.

I have one question which I hope someone can help me with. I plan to 'step down' to the lower strength patch every month. Do I just replace it every 3 days as normal or wait until the w/d starts & then put the lower strength patch on? Either way there will be w/d symptoms but hopefully only for a day or so...

perhaps this should be a question for the MD who is prescribing this withdrawal protocol. please ask.

Guyser, it can be dangerous to ask questions like that of us. Ask your physician. Withdrawal can be very uncomfortable. You might also want to ask your doctor about using an opioid antagonist, such as naltrexone or suboxone.

I'm wondering one thing here. First, what kind of nasty side effects are you having from Fentanyl? The most common is constipation, which can be releived by regular use of a stimulant laxative. Other potential common side effects include itching and dry mouth. What else is it doing to you? How long have you been using it?

Second, are you having less pain? I only ask because Fentanyl is by far the mot powerful pain medication available. Many of those who try to switch from Fentanyl to other time-delayed opiates (Oxycontin, Kadian, etc.) find that their pain without Fentanyl is crushing, that the substitute is not as effective and that the increase in chronic pain is worse than the side effects from the Fentanyl.

We're all different. That which works well for one of us may not work at all for another. One person might experience few or no side effects and others may experience many side effects. It is important to understand which medications work best for your unique body chemistry.

Finally, I've discovered that the best solution for me (and many others) is in using a combination of long and short-acting opiates (short-acting is for breakthrough pain), plus an anti-depressant (to inhibit the reuptake of Seratonin) and an anti-convulsant to reduce neuropathic pain. Adding an anti-inflammatory (Celebrex, etc.) can also help. Remove any of these medications and the result may be noticeably more pain. It can take literlaly years of trial and error to determine your best combination. Contemporary research backs this up. Chronic pain patients who employ several different medications, including off-label drugs, concurrently seem to have more efficacious pain management.

Good luck in stopping Fentanyl. But if you still have the same amount of pain or higher, you may struggle to find any another medication with the same potency. Sometimes we learn that it is better to live with side effects and have improved pain control, rather than reduce or eliminate the powerful drugs and deal with higher levels of chronic pain. I wish you the best of luck!

thanks for your replies. Of course I shall be asking my GP more about the withdrawal process next time I see him, I was just curious if anyone here could have helped with my enquiry but realise that is unrealistic & unfair.

The main side effects are the hot/cold flashes which number up to 10 per day. Especially during the evening when I sometimes have to change bed clothes twice. I also get opiate-related insomnia & cannot sleep the night of 'patch day'. The constipation has sorted itself out. No dry mouth or itching.

I am not having less pain but am finding that I have to 'up the dose' of the patch every year or so because the pain relieving properties don't seem to be as effective. I am already on Oxycontin 20mg once or twice a day for break through pain, so I'm hoping that the 80mg tablet would be sufficient to help with the pain going forward.

My main motivations for getting off fentanyl are that I now have time to do this (I have recently left work) whereby I would hate to have to come off the patches (cold turkey) involuntarily if a situation happened whereby the patches weren't available. Drug supplies are running low at the moment.

At the end of the day I am just trying to get more comfortable with as little opiate dependency as possible. If it becomes too much to bear (the withdrawal) then I shall just stay on them & cope with the side effects. Thanks for your input- much appreciated...

You should do just what your doctor tells you to do when he writes the RXs. You may not have any w/d symptoms at all, everyone is different. Go slowly, and be prepared for the worst, but hope for the best.

I worked with heroin addicts at a treatment center in the 1970s and the older heroin addicts, who had been using for 20 years, told me that opioid withdrawal was like a bad case of the flu, bone aches, shivers, etc., but it only lasted a week or less. From what I saw, I tend to believe them. I also know we were able to taper clients off of methadone without any w/d symptoms at all if we did it very slowly.

Best of luck to you.

Take care, Annette