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Butrans and Methadone?

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TXBullet View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote TXBullet Quote  Post ReplyReply Direct Link To This Post Topic: Butrans and Methadone?
    Posted: Jun/10/2011 at 12:46pm
I am new here, but I wanted to post my latest issues.
I am a Veteran and also have some training in Pharmacology from the USMC.
 
I have been taking 50mg of Methadone (tabs) for Pain Relief for the last 2 years with great results--after trying the gammet (Oxy, Diladud, etc) I found Methadone to be the ticket to opiate pain relief. Lately, I wanted to try a pain patch to combine with Methadone to try and get more extended relief, my doc suggested Butrans..after doing some research, I found Butans to be a partial agonist, which blocks some opiates as some of you may know, including Methadone.. I told him Duragesic would be a better option, but he suggested the Butrans first..it is pitiful the ignorance out there, I know more about Opiates than the Doctors!!
 
Anybody have some input on this?
Degenerative Disc Disease, Mild Scoliois, 2 Back Surgeries, Leg Neuropathy.
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Stevie View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Stevie Quote  Post ReplyReply Direct Link To This Post Posted: Jun/10/2011 at 2:02pm
Hey Tx---

We have been discussing Butrans here recently as we are seeing more and more members being put on it for pain relief.  Here is one thread that I am not sure you have seen about it:http://chronicpainsite.com/mb/forum_posts.asp?TID=4543&title=butran-vs-fentenyl  

Also, I just found this in one of my PA journals and it also talks about Butrans and other opioids:

Finally, just because buprenorphine can be used doesn't mean it should be used. There are many proven alternatives available for the treatment of pain. Providers should be familiar with the pharmacodynamic effects of buprenorphine. The drug has a high affinity for opiate receptors and displaces other opioid agonists. When used in patients who are opioid dependent, it can precipitate acute withdrawal symptoms. Additionally, buprenorphine has a ceiling effect for pain management. This means that above a certain dose, providing higher doses will not result in an increased analgesic effect. Providers should be knowledgeable about pain management and use caution if prescribing buprenorphine off-label for the treatment of pain

Here is the link to the entire article: http://www.jaapa.com/pa-prescribing-of-buprenorphine-swapping-out-aminoglycosides/article/197451/

In my opinion, there are reasons to prescribe this medication for chronic pain---sometimes so that people are able to continue working in certain fields, but from what we have been seeing, it may not be a good choice for pain management when other options are available.

Yes, the effectiveness of your methadone will be diminished by the Butrans.  I don't think that all physicians are aware of how Butrans works, and you do appear to know more than your medications in this case than your Dr.   Ouch  Stevie

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Spinal Fusions L5-S1 and L4-L5. Recent changes now with diagnosis of Lumbar Stenosis with neurogenic claudication. To have multi-levl posterior fusion with laminectomy and decompression of L2-3 L3-4 and fusion and revision of L4-5 L5-1 with instrumentation. Cervical DDD, stenosis, spondylosis, spondylolisthesis and facet arthropathy throughout cervical spine from C3-C7. Thoracic Spine: dextroconvex curvature of the thoracic spine, centered at approximately T8.(Scoliosis with 20 degree curve). At T7-8, a disc bulge. Degenerative disc disease T7-T9. Disc dessication from T3-T11.


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Post Options Post Options   Thanks (0) Thanks(0)   Quote sara1 Quote  Post ReplyReply Direct Link To This Post Posted: Jun/10/2011 at 5:59pm
Hi TX-My Dr. wanted me to take Butrans but read up about it since I was unfamiliar with it being an Urgent Care Nurse out on disability haven't heard of it before so know it's fairly new as a patch and told my Dr. I think I'm okay with what I take. I've even weaned myself down from 120 Oxycontin to 60mg with a breakthrough med. 

A PM Dr. offered me Fentanyl and than she said she wasn't going to give it to me which is fine because I hear you can't take hot baths or I'm concerned about sweating a lot and possibly of releasing the med too quickly.  

If Methadone works for you that's good to hear and wouldn't mix Butrans and Methadone either because of the Butrans cancelling out the Methadone effects. I have heard of that when I looked it up. Take care and hope you get some pain relief. Sara

DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing Neck-reverse Lordosis of c-spine C6-C7 with impingement, numb hand and sore outer elbow. Bursitis to both knees. RN
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Post Options Post Options   Thanks (0) Thanks(0)   Quote TXBullet Quote  Post ReplyReply Direct Link To This Post Posted: Jun/10/2011 at 9:32pm
Thanks for the replies...I have a feeling the doc is going to give me Fentanyl next month, he is just starting with the Butran to qualify how much pain I am really in..That has been his MO ever since I started seeing him. I have told him my tolerance is WAY too high to be messing around with short acting opiates.
 
OK, so now this question: Methadone and Fentanyl....good combo? Will the Methadone block the Fent? Will I have to switch to a short acting Norco or Percocet for break thru pain vs the methadone? That will suck, as I hate short acting opiates with Tylenol.....
Degenerative Disc Disease, Mild Scoliois, 2 Back Surgeries, Leg Neuropathy.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Stevie Quote  Post ReplyReply Direct Link To This Post Posted: Jun/10/2011 at 11:13pm
This is one best left up to a Dr. who has a lot of experience with methadone---not all do.  Methadone builds up in the fatty organs of the body and has a long half life.  I am not familiar with combining it with a Fentanyl patch, and honestly do not know how the two would react together.

You don't have to take IR opiates with tylenol.  You can take Oxycodone (Percocet without the tylenol) is one that comes to mind.  Norco comes under many other names---Vicodin is one.  It is hydrocodone and tylenol, and that is one that to my knowledge only comes with tylenol.  So, if the methadone is working for you and you need something for BT---there are choices that do not have tylenol in them---you have been through so much that you may well have had some of them in the past.

Another great resource is your pharmacist.  They often know far more about drug interactions, and possibly prior to seeing your Dr next time you can ask for advice. 

I really hope that you get this worked out.  Keep us posted?  Hoping for the very best for you.  Stevie

Please donate to help Chronicpainsite.com continue to help others.


The information and articles provided on our website are designed to support, not replace the relationship between patients and physicians.

Spinal Fusions L5-S1 and L4-L5. Recent changes now with diagnosis of Lumbar Stenosis with neurogenic claudication. To have multi-levl posterior fusion with laminectomy and decompression of L2-3 L3-4 and fusion and revision of L4-5 L5-1 with instrumentation. Cervical DDD, stenosis, spondylosis, spondylolisthesis and facet arthropathy throughout cervical spine from C3-C7. Thoracic Spine: dextroconvex curvature of the thoracic spine, centered at approximately T8.(Scoliosis with 20 degree curve). At T7-8, a disc bulge. Degenerative disc disease T7-T9. Disc dessication from T3-T11.


NATIONAL SUICIDE HELPLINE 1-800-273-TALK (8255)
http://www.crisisclinic.org/
IN THE UK 0845790 90 90
http://www.samaritans.org/
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medic008 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote medic008 Quote  Post ReplyReply Direct Link To This Post Posted: Jun/16/2011 at 1:14pm
I am late coming into this discussion as I have been working almost non stop for the last month!

To answer a few of your questions(and Stevie has done a great job of that!),

The dose of Methadone that you are on is relatively low, that is the good news. As to the BuTrans, I read a journal article the other day at work. And after some research, it was proved that BuTrans should be started when the patient is opiate naive. When an opiate tolerant patient was RX'd BuTrans, it was very ineffective because of tolerance issues. They were saying that anyone taking over 40mg of oxycodone or the equivalent of other opiates, BuTrans would no longer be a viable option.

As to your 2nd question about the Methadone and fentanyl.I have seen it used before, but that was in a terminal patient that had an unbelievable high tolerance. Here would be my issue. And remember, I am not a Dr. Methadone is a long acting medication, like Stevie said, it is stored in the fat cells and slowly released. Fentanyl is also stored in the fat cells when taken transdermally and released over time. I think that you would have to be VERY careful in the amount you take because of the long term dosing.
I also remember reading somewhere that when taking methadone, other opiate effects are lowered when taking a dose over 40mg. Stevie had a great suggestion to talk to your Dr about, ask him/her about roxicodone. Oxycodone without the tylenol. I would think it would work in conjunction with your methadone.

Good luck and keep us updated!

Tyler
Left shoulder hemiplasty, needing a complete replacement.
Lower back problems still being sorted out.

I am a RN/EMT-P, any and all advice given is my opinion and not to be taken as medical advice. ALWAYS seek the guidance and expertise of your DR!
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