Methadone: A Flicker Of Light In The Dark

Methadone: A Flicker Of Light In The Dark

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 How many of you are on a higher dose than 100mg?

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PostSubject: Re: How many of you are on a higher dose than 100mg?   Thu Jan 14, 2010 2:13 am

hey RuthAnn, Deborah, Dee, & everyone else!
sorry I haven't been on in a while! long story to do w/ searching for birthparents. anyways regarding split dosing...... I do that too. I am currently on 200mg (got moved up a couple months ago from 190) & my doctor has me split dosing. mine seemed to wear off about 7-8pm on once/day. so I kept taking it later in the day until i was taking it at 8pm. of course then it would wear off by the next morning. I also have severe endometriosis for those who don't know me .... sucks! anyways to help w/ pain & withdrawl my doctor started me split dosing. I have found it works best if in the morning around 10am I take 80mg & about 10pm I take 120mg. I am also an insomniac so this helps w/ my sleeping some (notice I am up at midnite -lol!). I have the freedom to try what was best w/ my dose b/c i go once/month. I told my doctor what seemed to work best & he supports me. Thank God for him. I am totally running on now so I will say that for me split dosing is the best option.
take care everyone!
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PostSubject: Real Methadone?   Mon Jan 18, 2010 4:31 pm

What is this about REAL METHADONE? The generic companies that manufacture methadone (I have worked in the pharmaceutic field as a Quality Control Specialist) are very few, and those that do have the highest rating possible for generics. I just wanted to get that out there. THe mind is very powerful, and if we believe something to be true, then to our brain, it is true no matter what (Separate realities). Consider this, in most clinical trials for antidepressants, there is is significant response to a placebo, that is, there is a significant # of people that will see an improvement in their depression during the trial simply by taking a sugar pill (placebo). That is not a myth, one can find this is true if you consult medical journals and read the actual studies. It just goes to show the power of the mind and what one believes to be true. I am not trying to start an argument by any means, as usual, I just want to spread the facts, truth. Read this:
Ensuring bioequivalence


Most nations require generic drug manufacturers to prove that their formulation exhibits bioequivalence to the innovator product.[16][17][18][19][19][20][21] In the U.S., the FDA must approve generic drugs just as innovator drugs must be approved.[citation needed] The FDA requires the bioequivalence of the generic product to be between 80% and 125% of that of the innovator product.[22]
This value range is part of a statistical calculation and does not
mean that FDA lets generic drugs differ from the brand name counterpart
by up to 45 percent. FDA recently evaluated 2,070 human studies
conducted between 1996 and 2007. These studies compared the absorption
of brand name and generic drugs into a person’s body. These studies
were submitted to FDA to support approval of generics. The average
difference in absorption into the body between the generic and the
brand name was 3.5 percent and is comparable to differencies between
two different batches of a brand drug [23] [24]
Bioequivalence, however, does not mean that generic drugs must be
exactly the same (“pharmaceutical equivalent”) as their innovator
product counterparts, as chemical differences may exist (different salt or ester – a “pharmaceutical alternative”).[citation needed]
A physician survey in the US found that only 17% of prescribing
physicians correctly identified the USFDA's standards for
bioequivalency of generic drugs.[8]
A latest development to address this issue enables interested doctors
and consumers to check generic drug interactions and outcomes detail to
the specific drug and drug company. [25]
The generic equivalent of name-brand warfarin has only been available under the trade name Coumadin
in North America until recently. Warfarin (either under the trade name
or the generic equivalent) has a narrow therapeutic window and requires
frequent blood tests to make sure patients do not have a subtherapeutic
or a toxic level. A study performed in the Canadian province of Ontario showed that replacing Coumadin with generic warfarin was considered safe.[26]
In spite of the study, many physicians are not comfortable in allowing
their patients to take the branded generic equivalent agents.[27]
As such, in countries such as Australia where warfarin is prescribed
under more than one brandname (Marevan in 1 mg, 3 mg, 5 mg respectively
and Coumadin in 1 mg, 2 mg, 5 mg respectively), the pharmacist may not
substitute brandnames.[citation needed]
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PostSubject: Re: How many of you are on a higher dose than 100mg?   Tue Feb 02, 2010 11:07 am

Thanks for sharing your experience with generic vs brand name halfmarathon, but I have to respectfully disagree that there is no difference.

The law of the land in the US is there can be a plus or minus 20% bioequivalence of the active ingredient. "FDA still uses the plus-or-minus-twenty percent test to determine blood serum bioavailability (i.e., the amount of active ingredient in the blood) over a period of time has to come within plus-or-minus twenty percent of that which is observed when the innovator’s drug is ingested." This is from an overview of the HATCH-WAXMAN Act of 1999, the last major overhaul to patents involving pharmaceuticals. I've been all over the FDA's Office of Generica Drug Site looking for that 20% figure myself, but all I could find were weasel words.

An overall review of this issue found several generic phychoactive medications to be less effective than their brand name counterparts. Many didn't meet their 20% bioequivalence standard.

The manufacturing processes can differ in a generic drug vs name brand drug. Inactive ingredients (i.e. dyes and fillers) can differ. Mostly the dyes. You can be fine with the coloring used by the original brand, or even used by the manufacturer of one generic, but not those used by another manufacturer. That problem is pointed out all over the place.

These dyes and fillers may also determine how fast your body metabolizes the medication. So for one medication it may "last" longer than the other.

Does that mean the brand name is better? Not always. Like everything else with these crazy meds, there are pros and cons with all things.

If you started out on a generic and don't have any problems with it, great! Stay with it. Does a change to generic automatically mean you'll have a problem? Nope. At least not if the manufacturer is producing a quality product.

Several studies referenced below point out that problem as well.

Some examples from the world of consumer experience and scientific research showing how brand name medications are superior to their generic 'equivalents': (you can click the link and it will take you to the actual article)




  • A group of doctors found a whopping 31% reduction in the the amount of phenytonin in the systems of their patients after switching to the generic from brand Dilantin. Why did they notice? Because of the increase in the seizures those people were having. That's far below the 20% allowed under the Hatch-Waxman act of 1999. The seizures abated after the people were switched back to brand. Another study also reported different serum concentrations. Although vague "adverse effects" were mentioned, the differences in the amount of the drug in people's system were due to, are you ready? "...the reported difference in capsule content between the generic and brand-name lots used in this study." Bioequivalent? I think not.


  • People switched from brand Lamictal to generic lamotrigine also lost seizure control. As above, once switched back to the brand most of them regained their seizure control. If the lamotrigine in this case was manufactured by Apotex, my guess is the differences in bioequivalence, bioavailability and/or pharmacological equivalence, which don't have a strict numbers that I could find anywhere on the Byzantine Health Canada site, were just enough to set people off. This Danish study gives some hard numbers from their manufacturer. As per this Canadian study on the use of generic anticonvulsants in epilepsy, when it comes to drugs that have a a narrow therapeutic index, "Although generic AEDs [anti-epileptic drugs] are lower in price, possible increased side effects and morbidity and the need for closer monitoring could partially offset the cost savings. The results of our survey highlight significant unawareness of the process of generic substitution among both patients and neurologists and reveal a general level of discomfort among neurologists to prescribe generic AEDs."

    Of course when the names of the companies are involved you can tell who paid for the studies, and so you can see that some generics aren't that bad. Or at least meet that 20% variation, which will be good enough for some people. Here we have a study that shows two out of three named generic carbamazepine have the required bioequivalence as Tegretol. Note that even with the generics manufacturers paying for the study, which we all know that will skew the results in favor of the study's sponsor, one unnamed generic still failed! And this study was testing only for bioequivalence, and not how well they worked. Who knows how many people flipped out because of the wildly difference serum levels.


  • Again, I don't know what the standard is in Canada, but this study found that 13-20% of people with epilepsy were forced to switch back from the generic version of their anticonvulsants to the brand-name versions because of breakthrough seizures. I wonder if the two numbers are related? Probably not. The same wasn't true for other classes of medications.


  • In a survey of over six thousand neurologists in the United States had the same sad data. Only three hundred responded, so the results are likely to be skewed against generics. When switching from brand to generic 67%! of neurologists reported patients with breakthrough seizures. Fifty-six percent reported an increase in patient side effects. Most telling of all is the statistic of 231 neurologists who think that the 20% bioequivalence standard is a load of crap. The sad part is why aren't they doing anything about it.


  • It's not just in the United States and Canada. A survey of neurologists in France found most of the doctors uncomfortable with generics and, wow, reports of breakthrough seizures. A group of Spanish doctors reviewed the available literature and thinks that generic AEDs aren't that hot of an idea. Another group of Spanish doctors did a cost-benefit analysis. The results: generics may be cheaper, but you get what you pay for. They think it would wind up costing more because of breakthrough seizures and similar adverse reactions.

I know from my own experience w/a generic version of methadone and name brand version that there is a difference. Now if it is the fillers and dyes that cause the difference and not the "active ingredient", I can buy that, but there IS a noticiable difference.


RuthAnn
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PostSubject: generic drugs and the power of thought   Wed Feb 03, 2010 7:45 pm

If you read my post, my actual words, I do not say, anywhere, that all generics are equivalent to all branded medications, nor do I say the opposite. The information you used to back up your point, I admit, is valid. But, as a trained scientist I can see many reasons why these findings cannot be applied accross the board to any drug we choose. As far as I can find, there exists no double-blind, placebo controlled studies comparing generic methadone and branded methadone. This I can tell you, from direct experience with a buying agent at a pharmaceutical company, that many generic drugs are actually manufactured by the same manufacturer as the brand. This in addition to the fact that a brand manufacturer may bottle both the brand and the generic from the same run, they simply change the labels on the bottle. I cannot say for which drugs this is true for, but I can say that it does happen, more than one may think. Another fact to consider is this: with Lexapro, for example, there is no stastical significant difference between taking 10mg vs. 20 mg. Given this fact, one can conclude that if one is taking a generic form (of which there is none currently) at a dose of 20 mg, even if the absorption of the generic was 20% less than the brand, it would make no actual difference. So in this case, if an individual was to pay the extra $$$ for the brand, they would just be making the pharmaceutical company richer, that is all. And, using evidence of the differences between a generic and a brand of drug A and B in an attempt to say that generics are not the same as the brand drug A, C, D and so on, is junk science. One cannot apply the findings of a Diazepam study to amlodipine, and so on. I do agree that there are differences out there, but using anecdotal evidence to support this is also not good science. As previously stated, my intent is not to start an argument in regards to this, I can and do respect your thoughts and opinions and they are valued here. Please don't take this as an attack. In life I believe it is more important to be happy than right.
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PostSubject: Re: How many of you are on a higher dose than 100mg?   Wed Feb 03, 2010 8:03 pm

I don't take your reponse as an attack at all. We all have different opinions and experiences that we base those opinions on. If someone has made up thier mind to believe something a certain way, no amount of information or no matter what someone else says is going to change what taht person thinks.

Please don't ever feel like I am attacking what you say and if I came across that way in this instance, I apoligize. That was why I said I "respectfully disagree" with your opinion.

There is medical proof out there that could support both sides and I also have my own actual experience with generic methadone vs name brand methadone that I am basing my opinion on. You have your opinion based on the info that you have.

That is what this forum is for, sharing our own experiences and the info that we find, not to make someone else change what they believe or to start an arguement.


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PostSubject: Dose increase?   Wed Feb 10, 2010 7:18 pm

I have recently started a new clinic and after some struggling, I am at a dose of 105mg. This clinic (N. Charles in Somerville, MA.) uses the liquid methadone. Until recently I was on a different clinic (ATCNE in Brighton, MA) for 18 years, where they used 40mg. biscuits and my dose was 100mg. I can only speak for myself, but I'm finding that the liquid seems to wear off during the early evening, where the biscuits seemed to have a more consistant and lasting effect. I have spoken with several other clients who have similar feelings. Although I've been feeling that I now need a higher dose, I have to admit that I am nervous about this peak and trough test. I have been reading cases where these test results can actually work against clients and get their doses lowered rather than raised. After initial assessment, N. Charles only raises a client's dose 5mg. at a time. I was reluctant to even attempt to go from 100 to 105mg, as my therapist told me that I would have to get a peak and trough test to go above 100mg. I was fortunate that the doctor decided to let the increase go through without the test. Now I'm reluctant to try for another increase. I hate feeling scared that my treatment can be altered based on personal interpretation by the medical staff.
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PostSubject: Re: How many of you are on a higher dose than 100mg?   Wed Feb 10, 2010 8:42 pm

You are absolutely right the peak and trough may be a waste of your time and money! Half the time, they don't know how to interpret them right and/or the lab is the one who intereprets them and that is what the doc goes by.

I will try to be brief with my experience. I had been on 120mg for over 5 yrs, stable pt, no dirty UA's in over 7 yrs and was going through a very stressful time. I started having probs w/my dose and asked for an increase over the 120 and they made me do a P & T. My results were T 263 and P 508. The "lab" is the ones who made the determination and said that my results were more than adequate and the doc said NO INCREASE and not just that but they said according to what the lab said about adequate levels I was OVERMEDICATED and they reduced my dose! It didn't matter that I was presenting w/active w/drawal symptoms or that all the research on P & T said that my levels showed I should have an increase. I even got my info on P & T levels from the same website the owner/program director was quoting to me from the week before about the QT interval stuff and the doc STILL wouldn't even look at the info or even listen to me. Needless to say, I eventually hanged clinics where I did get an increase WITHOUT a P & T test. When I asked him what he did for pts like me that needed an increase but he wouldn't let them, he said if I couldn't be maintained at the 100 they reduced me to, then I needed to find another clinic or get off MMT!

Needless to say, I eventually changed clinics where I did get an increase WITHOUT a P & T test. The doc at the new clinic was surprised they did me the way they did at the old clinic and she says they do not use the P & T test as an indicator of if a person needs an increase or not.

So your fears are not for nothing. I would talk with them and find out how they interpret the P&T and at what levels they consider adequate before I commit to forking out the 100 bucks that most clinics charge for the P & T. They should go by the syptoms a pt is having as well as the length of time on the current dose (because you do build up a tolerance just like w/any other opiate med) and what stresses may be going on in the pts life and base it on that.

Good luck and keep us posted on how things go for you.


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PostSubject: Re: How many of you are on a higher dose than 100mg?   Mon Mar 22, 2010 11:36 am

i go to a clinic in syracuse new york and i have never even heard of the peak and trough (???). I am currently at 144 mgs of the pink methadose. I am so glad there is not much of an issue of getting raises at my clinic. I try not to get too many raises and usually hold off for awhile once I start getting symptoms. Because what goes up must come down at some point. There is some talk at the clinic I go to about the dosing at our clinic being inferior. People say when they guest at other places the dose is stronger. I find sometimes when I get a raise I still have withdrawal symptoms. I get a raise and feel the same, I feel like something isnt right.

I have to look up this peak and trough test now.
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PostSubject: Re: How many of you are on a higher dose than 100mg?   Tue May 25, 2010 6:12 pm

I used to be on 200mg aday, then I did a peek and troff, was toxic, now Im on 125mgs, and doing good.they said I was toxic because of
another medication I take (nexium) it wasnt the high dose. I went down anyway, thats the reason I did the p&t.
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PostSubject: Re: How many of you are on a higher dose than 100mg?   Tue Dec 28, 2010 5:34 am

I have been on 120 mg. of Methadone for about 10 years +...and it's NOT holding me anymore....
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PostSubject: Re: How many of you are on a higher dose than 100mg?   Tue Dec 28, 2010 9:14 pm

I am on 120mgs liquid for the last 6 months or so.
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PostSubject: Re: How many of you are on a higher dose than 100mg?   Wed Dec 29, 2010 2:09 am

UniquelyMe have you asked for an increase at your clinic? What did they say?

I too was on 120mg for over 10 yrs and it wasn't holding me. When I asked for an increase at the clinic I was going to it was a nightmare experience! It was a long story and if you want you can go read it under the IS YOUR DOSE HOLDING YOU topic and the title was HOW IS YOUR DOSE BY THE WAY and the date on it is May 25, 2009.

I ended up having to transfers clinics and while this doctor did give me an increase to 130mg I am STILL having trouble. My cravings are nuts! My husband has to keep my daily doses locked up in a safe that only he knows the combo to and he gives me my dose every single day (I get 27 takeouts) because if he didn't, I would gobble up all my take outs. I have taken 27 days worth of take outs in 14 days before when I would try to do it myself. Because of the nightmare experience I had trying to get an increase before I am terrified to ask for another one. When I mentioned to the nurse that the 130mg wasn't holding me she was like "well I don't know if the doc will agree to that without it turning into a big ordeal........." so I am terrified to say anything! I've had an ekg and at the old clinic I had a peak and trough test (they could interpret it however they wanted) and the results according to SAMHSA said I was eligible for an increase, but they didn't want to hear it. At the clinic I go to now where the nurse said it might be an ordeal, she was saying things like I might have to have another peak and trough (they cost 120.00) and I would have to come in every single day again IF they decided to increase so they could keep an eye on me (I drive 1 1/2 hrs one way as it is now) But of course I can't go on like this, it isn't fair to my husband and I want to do the program right. I will have been on MMT for 11 yrs this April.

Anyway, I was curious to see what experience you were having and if you had tried to get an increase.

HAPPYLADY: How is this dose holding you?


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PostSubject: Re: How many of you are on a higher dose than 100mg?   Wed Apr 06, 2011 2:33 pm

It sounds like you have had a peak and trough test done. (and maybe even more than one) My experience with the peak and trough was the doc using it how he wanted regardless of what all the experts said was a normal peak and trough level so I normally don't "trust" a doctor when it comes to a peak and trough test. However, it does sound like your doc may be reading them correctly and/or fairly.

One thing that they may be going by on your friend is her peak and trough test as well. They obviously had no probs with you going over 120mg and like you said were wanting to keep increasing you above the 180mg you were at. Obviously your peak and trough test showed this. Your friend may be saying she needs and increase but her peak and trough test may show she doesn't really need one.

Dose increasing is a very tough situation. It can be hard to determine if the patient is really in need of an increase or if they are "chasing the buzz" that they may experience after the first few days of a dose increase (or that they got when they first started taking methadone).

I'm usually all for supporting the patient that says they need a dose increase before I am supportive of a doc who does a peak and trough, BUT it does sound like they have done you fairly so I have to believe that they are trying to do her fairly as well.

From your other post about being able to bring in your research to get them to change the way they handle split dose patients, it sounds like you do have a very good clinic who does try to do what is best for the patient.


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PostSubject: Re: How many of you are on a higher dose than 100mg?   Thu Apr 07, 2011 2:51 pm

yeah, it sounds like you have a really good clinic so I can't help but think that there are other factors in play with your friend and her situation that may have them not wanting to go up on her dose so quickly. They also look at things like your withdrawals symptoms and such. They have a list they fill out and put in your chart and use what is called the COWL scale that they "rate" your symptoms with and it could just be that they don't think she really needs one OR they may want to try other things first before giving her an increase.

Like I said, your clinic sounds like one of the few really great clinics out there so I would trust their judgement. Now if it was other clinics I've heard about or dealt with myself, it might be a different thing.

How long has your clinic been open? I have also found that newer clinics haven't been open long enough and dealt with addicts long enough to become "jaded" yet. Over time, what started out as a really good clinic can start to lose focus of the real reason they are there (to help addicts) and other things come into play. They learn the hard way that not all pts receiving treatment are sincerely trying to work the program right, they get lied to, scammed, complaints filed on (legit or non legit) and some even start thinking the money is more important than the care of the pt and that is when you end up with a bad clinic. This isn't the case in all situations, but I was curious how long your clinic has been open.


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Job/hobbies : COUPONING & GEOCACHING are my favorite past times but I also love reading and spending time with my husband and kids
Humor : I don't have a sense of humor.............
Registration date : 2009-05-25

PostSubject: Re: How many of you are on a higher dose than 100mg?   Thu Apr 07, 2011 4:01 pm

Awesome! It's so good to hear good clinic stories because unfortunately all we ever hear about usually are the bad ones!


RuthAnn
aka lilgirllost

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JigSaw



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Age : 30
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Job/hobbies : Snowmobiling, four wheeling, playstation 3, reading
Humor : Working on getting my humor back
Registration date : 2011-02-17

PostSubject: Re: How many of you are on a higher dose than 100mg?   Sun Apr 10, 2011 8:15 am

Im on 150mg and a few people I have talked to said that they were shocked cause that is such a high dose, to me it isnt really a high dose but I dont know I guess alot of people stay around 100 or lower
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Digmon

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Age : 36
Location : South East Virginia
Job/hobbies : sport photography / football / basketball / fishing / anything outside
Registration date : 2011-04-05

PostSubject: Re: How many of you are on a higher dose than 100mg?   Sun Apr 10, 2011 1:50 pm

Jigsaw, a lot of ppl act like my dose of 200 is a lot, but it's not at all to me. Now my 200 is split to 120 am and 80 pm. I talked to a girl at my clinic and her dose was 390 Shocked and she said she couldn't feel it and it didn't help, I though that was crazy lol but I guess it just goes to show it really depends on the person taken tha dose as to if it's " high " or not. drunken I said something to my Dr. About being on a high dose and he said we shouldn't look at our dose as a number and if we or anybody thinks it's a high number, we should look at if it's helping us or not. So I guess that's a good way to look at it but ppl still look at me like I'm crazy when I tell them I'm taking 200mg of methadone a day lol. So I just try to keep that to myself if at all posable. Cool
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Lisa Anne



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Number of posts : 3
Location : SE Wisconsin
Job/hobbies : Registered Nurse
Registration date : 2011-03-11

PostSubject: Re: How many of you are on a higher dose than 100mg?   Sun Jul 03, 2011 3:33 am

I've been on a stable dose of 130mg daily for the last 18 months...Our clinic requires a trough at 100mg and once annually. Increasing doses isn't very difficult at our clinic after seeing the physician, and I have seen some clients on doses as high as 400mg and up.....I think its all very individualized and wish everyone would realize this, including MMT patients. It seems too many have their minds set with preconceived notions about what dose they should be on, and are reluctant to go above it, even if it may be in their best interest.....
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poohbear



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Number of posts : 4
Age : 37
Location : Burlington Ky.
Job/hobbies : enjoy the pools and playground with my kids
Registration date : 2011-08-01

PostSubject: 110   Mon Aug 01, 2011 5:41 pm

[i]how bad is that im at 110, cat


[right][i]Thanks Poohbear cat
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poohbear



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PostSubject: Re: How many of you are on a higher dose than 100mg?   Mon Aug 01, 2011 5:43 pm

well ok 110 is not bad


[right][i]Thanks Poohbear cat
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D
Admin
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Age : 59
Location : Vermont
Registration date : 2009-03-05

PostSubject: Re: How many of you are on a higher dose than 100mg?   Tue Aug 02, 2011 1:44 am

poohbear when you ask if your dose is bad, what do you mean?
If your dose is a dose that is working for you, it is not a bad dose.
Everyone is different. Some people do well at low doses and some at high doses.
It's just a matter of what works for you.


"I will let yesterday end so that today can begin"



Never take any online advice over that of a qualified healthcare provider
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gagirl30248



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Number of posts : 9
Age : 40
Location : Locust Grove, GA
Job/hobbies : Photographer, Methadone Advocate
Registration date : 2011-07-28

PostSubject: Re: How many of you are on a higher dose than 100mg?   Wed Aug 03, 2011 11:57 am

I am on 55mgs twice a day so thats 110mgs. I have been having alot of pain due to a birth defect in my right hip and today they asked if I wanted to go up 5mgs but I turned it down. Now after reading this thread I am thinking I should of went up. I just don't see how 5mgs will help much?
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D
Admin
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PostSubject: Re: How many of you are on a higher dose than 100mg?   Wed Aug 03, 2011 12:06 pm

It's not too late, if you want to go up. You should still be able to. When did they ask you? Talk to your clinic.
Sometimes 5mg can make a difference, it may or may not take a little more. There is nothing at all with going up and trying to find a dose that works for you. Methadone for pain should be taken more than just in the mornings though.
When taken for pain it is usually prescribed every four hours. I did send you the information that you requested. Check it out and see if it helps.
Good luck,
Dee


"I will let yesterday end so that today can begin"



Never take any online advice over that of a qualified healthcare provider
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gagirl30248



Female
Number of posts : 9
Age : 40
Location : Locust Grove, GA
Job/hobbies : Photographer, Methadone Advocate
Registration date : 2011-07-28

PostSubject: Re: How many of you are on a higher dose than 100mg?   Wed Aug 03, 2011 7:11 pm

I am onmethadone for addition. But on the other hand I knew one day pain would show up due to my dissablities. Thank you for the info.
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PostSubject: Re: How many of you are on a higher dose than 100mg?   Wed Aug 03, 2011 8:12 pm

Your most welcome. Anytime!


"I will let yesterday end so that today can begin"



Never take any online advice over that of a qualified healthcare provider
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