Opioids Nightmares and Methadone half-life

[JackBurton89]

I started Methadone Maintenance three weeks ago this Friday. I started at 30 mg and went up ten mg a day until I went up to 80 mg. I was on that for about a week and decided to go up to 90 as I wasn't feeling well in the morning. I have been on 90 for five days and the last few nights I have horrible nightmares and last night I woke up and I was sweating really bad and felt dopesick. I went back to bed and woke up and felt much better. When I was detoxing in the past or dopesick I would have vivid dreams or nightmares.

I haven't been given any take homes as my clinic is open on Sunday so I routinely take my dose every 24 hours. Well yesterday my cab came late and I had to see my counselor and it was about 26 hours and I started to feel pretty sick. How long does it take until I can go say 36 hours or so without feeling like shit. My friend who has been on MMT for months and used to sell me his Sunday take home says if he doses Sat morning he doesn't feel like shit til early Monday morning so almost 48 hours.

 

[Lorne???]

There is really no right answer. It all depends on you're metabolism, as well as you're definition of feeling "fine".
With methadone it cake take up to 72 hours to feel full WD(some say longer), but that doesn't mean you'll feel great, say, 36 hours later. In fact, the majority don't feel great even 24 hours later. I myself was ok 24 hours, but could tell I needed a dose ASAP. My real problem was trouble sleeping, sometimes at night I still couldn't as I was used to doing opioids at night and passing out. After 36 hours, full WD symptoms, though it took 48-60 for pure hell to set in.

As for waking up in WD, then feeling fine, it wasn't really WD. Urine PH drops while you sleep. Methadone is a basic substance which is highly PH dependent; a decreased PH not only shortens half-life, but also decreases the amount of "free methadone" available in blood. You will often wake up feeling rough, but this can correct itself. Also, sweating is a side effect of methadone itself, and it would take longer for severe WD symptoms like that to set in.

Methadone can also cause vivid dreams, thus exacerbating nightmares. Opioids alone however, rarely cause the dreams to be negative. There is likely a psychological issue I cannot address, though it could very well have a pharmacological cause, which I very much could address

But after 5 days, you're near enough steady state. It won't really hold any better after this, though of course, a few more days it might be a wee bit stronger. But don't rush to up you're up; at this point, you'd just be jacking you're tolerance, and at 90mg, a slight won't make you feel any better, but will likely increase AE's. You could always consider split dosing, but I don't really think that is the issue here.

 

[JackBurton89]

Thank you for your response. I sent you a PM. Is there anyway to prevent you the PH from changing when you go to sleep? I have been taking stool softener and senokot to help the constipation, would this have any effect? I am also taking cinnamon about two hours after my dose and in the evening before or after dinner for the sweating. It seems to help but that may just be me getting used to the methadone. What do you mean by AE? I don't think my clinic offers split dosing. I know they used to be open in the evening as well, but I am not sure if they allow people to bring home the remaining part of their dose, especially not for the first three months I will have to ask. I was thinking about getting a peak and trough but what you said about night and the urine makes sense. Thank you

 

[speedballs_over]

Myself and many others have experienced night terrors for the first few weeks of methadone maintenance. It sucks but it should go away shortly.

 

[Erikmen]

I started Methadone Maintenance three weeks ago this Friday. I started at 30 mg and went up ten mg a day until I went up to 80 mg. I was on that for about a week and decided to go up to 90 as I wasn't feeling well in the morning. I have been on 90 for five days and the last few nights I have horrible nightmares and last night I woke up and I was sweating really bad and felt dopesick. I went back to bed and woke up and felt much better. When I was detoxing in the past or dopesick I would have vivid dreams or nightmares.

I haven't been given any take homes as my clinic is open on Sunday so I routinely take my dose every 24 hours. Well yesterday my cab came late and I had to see my counselor and it was about 26 hours and I started to feel pretty sick. How long does it take until I can go say 36 hours or so without feeling like shit. My friend who has been on MMT for months and used to sell me his Sunday take home says if he doses Sat morning he doesn't feel like shit til early Monday morning so almost 48 hours.

This nightmares will pass after a couple of weeks. Now, if you are committed to Methadone, you need to adapt yourself to use your dose daily no matter what.
I am on 70 mg for almost 8 years and have a normal life, but it took some time to adjust.
When you take methadone you can´t be without it for 36 hours unless you decrease you dosage by half tablet every 2 weeks until you are on or about 20 mg. Still you should expect withdraw symptoms which can last 10 days to detox, after MMT is out of your blood stream that is 72 hours approximately or more.

 

[crzydiamond]

Lorne, you had told me in another thread about urine pH, which finally explained to me why I always wake up feeling rough. I was so happy to finally understand why. I've been on 2 different clinics over the years and not one doctor or nurse ever explained it-- they were always " oh you need an increase". Which never helped--only made me more sedated during the day and still woke up feeling the same way whether on 50 mg or 90 mg.

My worst day is Monday because at the clinic they are only open in the morning on weekends so Sunday I dose at 8-930, then Monday I can't go in until 5 pm (if you owe them money you have to dose in afternoon during the week). That is over 30 hours and I hate it, I feel awful and they just don't get it. (Saturdays are kinda nice though, dose at 5 pm Friday and then like 8 am Saturday morning)

But anyway since I started the cimetidine it has made a difference, so thanks!

 

[Erikmen]

Does cimetidine makes opiates or/and benzos work better?

 

[crzydiamond]

With methadone it (cimetidine) affects both the enzyme that breaks down methadone and the urine pH (making urine less acidic) which leadsb to the methadone lasting longer (longer half life as the half life is extremely pH dependent) and higher bioavailability.

Most interesting thing I read was that the oral bioavailability is UP TO 90+%. Note the "up to". It is very pH dependent. You can actually pass up to a third of your dose unchanged through your urine if your system is too acidic. Literally pissing it away hah...

Reading that surprised me as you always hear about the high BA of methadone. It can be. But what isn't commonly talked about is that the BA can dip much lower

 

[Erikmen]

Does this also applies for Oxycontin BA?