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Reduction too much too fast?
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An_246720 posted:
Hi,

Accidently posted this in another post but my question is this. I was prescriped norco 10/325 q 150 for over six months after multiple and sever shoulder injries. Attempting to reduce dosage but the doc filled me once on 150, then I though I could go lower, so he bumped me down to 100 a month. I experienced extreme fatige, upset stomach, loss of weight, loss of appetite, etc, and my pain came back. Is that too much of a dosage reduction at a time?

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Anon_160307 responded:
I did not answer the poll because it depends on how you were taking the pills. 150 tabs of 10/325 prescribed every 30 days equates to 5 pills a day. 100 tabs of 10/325 prescribed every 30 days equates to ~3 pills a day.

If when prescribed 150 pills a day, you were taking as a baseline (meaning most days) 3 pills a day and only taking 4 or 5 on bad days (e.g., once or twice a week), then the reduction should not have been a major problem except for on bad days when you need more than 3 but are no longer allowed more. If you were taking 5 pills a day every day, then the reduction from 150 to 100 pills is significant as you were taking 50 mg of hydrocodone a day and now you are taking 30 mg of hydrocodone, which is a 20 mg reduction in hydrocodone. That is quite a steep drop when comparing to the reduction amounts typically used to taper off of a medication. So it is likely your symptoms are due to withdrawal from the hydrocodone.

When you reduce a medication that was controlling your pain, most times the pain increases as you aren't taking the amount required to control your pain anymore. Pain also increases as a symptom of withdrawal, so it will take more time at the lower dose to truly know what your real pain level is.

The better approach would have been (for example) to reduce the amount by 1/2 pill per day each week to see where the pain began to break through. This would have more better isolated the true pain from pain due to withdrawal and it would have allowed you to determine how much medicine you truly believed you needed. But, if you only took the hydrocodone when you had pain and not on a schedule and you needed to take 5 a day, then you probably truly needed 5 a day. If you were taking hydrocodone on a schedule regardless of if you had pain or not (e.g., every 4 hours), then a slight reduction; for example, 1/2 pill per day for a week and the another 1/2 pill reduction per day for a week, etc., would have been a better approach of determining how much hydrocodone was truly needed to manage your pain. In other words, the hydrocodone was dropped from 150 pills to 100 pills without any medical evidence showing that was the true amount you needed to manage your pain.

Be sure to always discuss a realistic tapering schedule (like the example I have written) with your doctor first to make sure that you both agree that the schedule should be used for determination of your true pain level.
 
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David Maine, MD responded:
Thank you for your post. The ability tolerate an opioid wean is extremely variable between individuals. Generally the symptoms of withdrawal can be controlled and last anywhere from 4-7 days. In regards to your lack of pain control you should discuss this with your prescribing physicians. A new plan may be warranted. Good luck.


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