On Methadone Maintenace Therapy - Could Really Use Some Advice/Help

ro4eva

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Wall of text:

I don't usually post here so I'm not sure if there's a writing or description etiquette on or off-the-books I should be abiding by, therefore I apologize in advance if I (for example) share TMI, but anyways, here it goes:

I've been on MMT since January 7th, 2010. In terms of reducing cravings and destructive behavior in relation to my opiate/opioid habit (e.g. using, pawning my stuff to score enough cash for a fix, calling in sick to work because I'm dope sick) it has been a lifesaver. In terms of it helping with my fibromyalgia pain when no other doctor would even consider prescribing me a shorter acting opiate for such a condition, again, it's been fantastic. As a result of me not using anymore (I've been clean for over a year - everything including booze and tobacco, except caffeine), I've been much much more productive, especially financially - and I'm really happy about not waking up every morning and the first thing on my mind constantly being, "when, where and how am I gonna get my fix today?" This is the good news, there's a fair amount of bad, which I can't find any answers for, which is why I'm here in desperation.

Aside from the common side effects of methadone (constipation, sweating, water retention, bloating, some daytime drowsiness/sedation), there's a couple which I cannot seem to control, no mater how hard I try, and it's driving me to the brink of trying to quit cold turkey (at 180mg daily - like that's gonna work):

1) weight gain - I know some people don't gain weight on methadone, but for those who do, has anyone had any success in shedding off that added weight while still on MMT? I've tried eating right, several different diets, starving myself, daily exercise, supplements... nothing's working. The best I've been able to do is stop myself from gaining anymore weight. Since, I've gained about 100 pounds after 26 months, that's not very satisfactory or motivating. Before being on MMT, I was never this big - not even close. And if I wanted to shed some extra pounds, it was really easy.

2) morning sickness - Every single fucking morning I've woken up since starting MMT (with the exception of the first 3 days or so), I feel sick with somewhat flu-like symptoms. I have a nasty headache, my muscles ache, my limbs are swollen, I feel weak, I'm sweating, I feel depressed and anxious at the same time and I also get abdominal cramps below the stomach (small intestinal area). I've been tested for rapid metabolization, which apparently is normal. I also had my testosterone levels measured, since methadone lowers them in men and was found to be well below the normal range - this was about a year ago. Since then, I've been receiving monthly injections of testosterone, which has brought my levels back to normal, and as a result - during the daytime - I have more energy, stamina, agility, endurance, resilience and increased libido. However, it has done nothing to stem the symptoms I consistently wake up with. I've also bought a new, expensive mattress as well as two $70 pillows. I've also tried sleeping in different positions, eating something before going to bed, not eating anything before going to bed, and going to bed early (10pm) as well as late (3am). Nothing I've tried has lessened this "morning sickness." One last thing I did do of recent was trying to research it using google as a starting point and going from there. Again, nothing.

I'm so sick and tired of being sick and tired and not being able to come up with some sort of remedy that I've begun to think of euthanasia or suicide. I know it's a one way ticket and I'm never coming back but after two years of this, I'm starting to not care anymore. I just want one goddamn night in which I can get a good night's rest and wake up feeling good and rested - and I'm trying to keep an optimistic attitude/outlook - but, again, after two years of this shit, I fear I will never get that :(

Does anyone else here on MMT feel this way (morning sickness)? Or has anyone formerly on MMT experienced the aforementioned? More importantly, anyone know if there is there anything I can do/try which may help with either the weight gain or - more importantly - the constant feel-like-shit-mornings? I'm willing to try anything at this point :?

P.S. - Thank you for taking time out of your lives to read all this mumbling and sorry it's so much <3
 
2) morning sickness - Every single fucking
that was just part of the methadone program for me. i asked several times for them to split the dose so i could take half in the morning and half at night, but that's illegal... sigh
1) weight gain
you've already tried a lot it seems. all i can suggest is to have 5 meals a day, separated as evenly as possible, with at least a 5min walk each day.

it seems like you might want to try suboxone. the switch over would be hell, but you may not experience so much depression of mood and these other symptoms on suboxone. from 180mg, i doubt you will feel any indications that you're feeling the drug, on suboxone, and there may or may not be a trade off in terms of how much pain relief the opiates are giving you.

but that switch over would take care of the weight issue, the morning sickness issue (you can split your suboxone tablet for half at night), and the probably depression issue for at least a while.
 
that was just part of the methadone program for me. i asked several times for them to split the dose so i could take half in the morning and half at night, but that's illegal... sigh

he has been at the clinic for over two years he is likely getting 7-14 days of take homes. splitting the dose is the first thing I thought of as well. whatever you do don't cold turkey 180mg.
 
i would have been able to do take homes, if pot didn't show up in me pee every single drug test ;) it's my remedy for CNS depressant induced depression. speaking of drug tests at the methadone clinic, once there was a false positive for cocaine or something and that caused me some problems. fucking drug tests... rant over lol.
 
yea i have noticed myself gaining weight easier than ever before and i know its due to the methadone. like if i just eat tons and dont work out it sticks right to me. never used to be like that. i am on 110 and had some of those same symptoms but they eventually went away as i became more tolerant to the 110mgs. DEF DO NOT cold turkey at a dose that high. maybe try bringing your dose down a little. im in the boat with all the other pot smokers who dont get takehomes, but fuck it i live 5 mins from the place and weed is better medicine than anything else for me, so they never give takehomes except on sat for sun. good luck to you, i know how bad deathadone can be in the beginning, but once you find the perfect dose there shouldnty be as many negative side effects
 
Topamax for weight gain perhaps? My doctor put me on it for Seroquel-associated weight gain and it is SLOWLY starting to work.

You could try Suboxone but I don't think it would be effective for your fibromylagia. Do you experience mostly nausea with the methadone? Ask the clinic doctor for an anti-emetic like sublingual Zofran (available as a generic: odansetron). What do your electrolytes look like? Did you receive a thorough work-up?
 
Sorry for the late reply :(

Topamax for weight gain perhaps? My doctor put me on it for Seroquel-associated weight gain and it is SLOWLY starting to work.

You could try Suboxone but I don't think it would be effective for your fibromylagia. Do you experience mostly nausea with the methadone? Ask the clinic doctor for an anti-emetic like sublingual Zofran (available as a generic: odansetron). What do your electrolytes look like? Did you receive a thorough work-up?

I would like to switch to Suboxone once I manage to taper my methadone dose down to 30mg and supplement that with either gabapentin or pregablin depending on if I can get pregablin covered by my insurance (they're marketing it here for Fibromyalgia as well afaik). I was on it for a couple of months and it made a difference in terms of muscle aches and abdominal cramps.

Nausea is not what I experience mostly on methadone but I get some mild - moderately severe cramps most frequently when I wake up in the morning. Plus the headaches, and worst of all, muscle aches in my knees, thighs, elbows, shoulders and underneath the back of my neck.

Unfortunately, odansetron is not available in Canada according to the federal government run Drug Product Online Database - http://webprod3.hc-sc.gc.ca/dpd-bdpp/start-debuter.do?lang=eng.

In terms of tests, I've been tested for pretty much everything - afaik - and my testosterone, prolactin, ck and hemoglobin have shown up as either abnormally high or low. Sodium/Potassium levels have always come back normal as well as (either urine or blood) PH levels.

Not sure about topamax, I'll bring it up next appointment.

Thanks for the suggestions.
 
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Sorry for the late reply :(



I would like to switch to Suboxone once I manage to taper my methadone dose down to 30mg and supplement that with either gabapentin or pregablin depending on if I can get pregablin covered by my insurance (they're marketing it here for Fibromyalgia as well afaik). I was on it for a couple of months and it made a difference in terms of muscle aches and abdominal cramps.

Nausea is not what I experience mostly on methadone but I get some mild - moderately severe cramps most frequently when I wake up in the morning. Plus the headaches, and worst of all, muscle aches in my knees, thighs, elbows, shoulders and underneath the back of my neck.

Unfortunately, odansetron is not available in Canada according to the federal government run Drug Product Online Database - http://webprod3.hc-sc.gc.ca/dpd-bdpp/start-debuter.do?lang=eng.

In terms of tests, I've been tested for pretty much everything - afaik - and my testosterone, prolactin, ck and hemoglobin have shown up as either abnormally high or low. Sodium/Potassium levels have always come back normal as well as (either urine or blood) PH levels.

Not sure about topamax, I'll bring it up next appointment.

Thanks for the suggestions.

You may not want to switch to Suboxone if it means getting on another addictive substance (Lyrica).

How do you know that your symptoms are not related to your fibromylagia? I used your search engine and Zofran (odansetron) is available in Canada, but that doesn't sound like your issue.
 
You may not want to switch to Suboxone if it means getting on another addictive substance (Lyrica).

It's either a) stay on methadone; b) taper to ~30mg and switch to suboxone and see how it goes; c) quit the methadone all together and start using again

At this point, I'd like to see how things go if I switch to suboxone because I feel I have nothing to lose. What if it does work better for me than methadone? And if it doesn't - I don't know. A slug through the forehead - "that's all folks."

I've never felt better than when I was on Lyrica (along with my methadone) in relation to myalgia. I was on it for about 2 months and I didn't have any problems with misuse, abuse or dose escalation. I've also been on Xanax for a little over 6 years and I've never had problems with abuse with it either. Even after all this time, the antianxiety effect it exerts in the sympathetic nervous system is still effective at the same dosage I've been on since I started it back in November '05. My methadone doctor wouldn't grant me one carry - let alone a week's worth - of 180mg of 'done if I would be abusing the Xanax.

My abuse issues arose with opiates/opioids because of their ability to kill pain as well as induce euphoria. I've never felt euphoric on Xanax, nor on Lyrica. Just tired or sedated. At best, Xanax has made me feel comfortable and relieved after experiencing a panic attack because of how quick it works in reducing the symptoms associated with Panic Disorder - but I wouldn't call that euphoria.

Regardless, I've just been Rx'd Neurontin instead of Lyrica. I hope it'll make a difference.

How do you know that your symptoms are not related to your fibromylagia?

On the contrary, I do believe that my symptoms are related to fibromyalgia. I wonder though if the methadone has something to do with intensifying the disphoric state I find myself in every morning. In all honesty though, before it was confirmed that I am not a fast metabolizer of methadone, I thought the methadone was not lasting 24 hours.

I used your search engine and Zofran (odansetron) is available in Canada, but that doesn't sound like your issue.

My mistake - I don't know what I did wrong that it wouldn't show up.
 
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My one issue with methadone (I only take 30mg a day) is the weight gain. Its seriously annoying me. I walk ~2 miles a day and that really doesn't do anything for my weight. I need to get back to lifting weights or some stressful cardio to shed a little bit off . However, it is hard to get myself back into the level of work outs that I had before being on methadone. Gotta figure it out some how.

I couldn't consider switching to bupe because honestly even with just a 30mg a day methadone dose 8mg of bupe is much less worth while than the 30mg. I really don't get much from bupe besides holding of WDs. It doesn't help much if at all for my sleep/pain issues.
 
It's either a) stay on methadone; b) taper to ~30mg and switch to suboxone and see how it goes; c) quit the methadone all together and start using again

At this point, I'd like to see how things go if I switch to suboxone because I feel I have nothing to lose. What if it does work better for me than methadone? And if it doesn't - I don't know. A slug through the forehead - "that's all folks."

I've never felt better than when I was on Lyrica (along with my methadone) in relation to myalgia. I was on it for about 2 months and I didn't have any problems with misuse, abuse or dose escalation. I've also been on Xanax for a little over 6 years and I've never had problems with abuse with it either. Even after all this time, the antianxiety effect it exerts in the sympathetic nervous system is still effective at the same dosage I've been on since I started it back in November '05. My methadone doctor wouldn't grant me one carry - let alone a week's worth - of 180mg of 'done if I would be abusing the Xanax.

My abuse issues arose with opiates/opioids because of their ability to kill pain as well as induce euphoria. I've never felt euphoric on Xanax, nor on Lyrica. Just tired or sedated. At best, Xanax has made me feel comfortable and relieved after experiencing a panic attack because of how quick it works in reducing the symptoms associated with Panic Disorder - but I wouldn't call that euphoria.

Regardless, I've just been Rx'd Neurontin instead of Lyrica. I hope it'll make a difference.

Going back to using really isn't an option. I suspect that this is your fibromyalgia and not a methadone issue. Suboxone is not indicated for chronic pain and will not help you with your fibromyalgia (and its blockade effect will prevent you from using anything with it), so I would explore methadone/gabapentin/Lyrica/NSAIDS combos before you even consider that. If you switch to Suboxone, unless you can control your pain with Lyrica or gabapentin, you'll be miserable. But once again, this flu-like syndrome you are describing is not likely to be related to your methadone.

Have you seen a specialist?
 
Explain your situation in detail to another doctor and be completely honest. I do not see why you can't be on those meds still. Just because most people do not need xanax and lyrica, it doesn't mean you don't.

Suboxone is not that great for your situation imo. It wouldn't hurt to try it though, but still.
 
Have you seen a specialist?

Unfortunately no, not yet - I've been referred to a pain management specialist, but apparently he's so busy that I'm on a waiting list. That's the tradeoff up here for "free healthcare:" very long wait times. Frustrating, plus my hands are tied in that respect. I'm also on a waitlist for a government run sleep clinic. That's one test I've yet to have done.

I wanna thank you for taking time out of your day to try to help me - means a lot.

Edit - and Dexter too
 
Yes, that's the trade off to nationalized health care. You should pursue an evaluation by university/referral hospital where they see the less common cases in my opinion.
 
advice from someone on mmt for almost 6 years...

hi, ive been on mmt for a few mnths shy of 6 yrs. I know of what you are experiencing. First and foremost, the weight gain.. I have seen it in many, many people, but I would say it is almost 80% of them being female. Ive literally seen people gain almost 100 lbs! I would attribut e this to a lot of people becoming very lazy because of the sedation they experience and also the cravings that methadone induces. I know an overwhelming amount of people, including myself who crave sweets, chocolate & etc. I think the most important thing would be to eat right and stay active, just as with anyone who is overweight :\..

okay the important part... I can not believe that it is even legal for you to be on a dose of 180mgs. that is almost unheard of in the US, more specifically PA.. where I am from. (I am not judging you for it, just saying.) Have you ever thought of lowering your dosage? Your side effects will most likely go down or even disappear if you lower. The highest I've gone was 95. I was having constipation and I lowered and its subsided. The methadones primary goal is to act as an opiate and to cover your opiate receptors, fooling your brain into thinking you have used. There are studies that show that the vast majority of peoples receptors are completely covered at 60mgs, some people it was 80 mgs. Anywhere inbetween there is where the majority are steadied and anything over that, is just going to be a waste and induce more of the neg. side effects. I am aware that it may vary from person to person, especially like your situation, with the other illness & pain that you experience. But please keep that in mind and I would strongly advice you to atleast TRY lowering your dose. Especially before trying to go cold turkey!!! 8o Coming over 180mgs would be a nightmare and you will almost positively become that junkie again. I think that it is awesome that you have increased your ability to have a normal life.. most people think that methadone just replaces your old drug with another. Methadone is not suppose to give you another high. The way to think of it is like this.. You shouldnt even feel that you have taken the methadone.. it should just make you feel "normal" again. Like a diabetic who needs to take their insulin to regulate their body, know what i mean? If someone is to the point that they are feeling euphoria or a "high" from it, they clearly are on too high of a dose. These are the people who ruin it for the good ones who just want their life back and to feel "normal" again. So often I see people who go too high and they become drowsy and they then confuse this with a "high" because they nodd off... they are not feeling high, they are feeling sleepy. Ive seen sooo many people mix the methadone with benzos and all that they do all day is nodd off with their ciggs and burn things and themselves. 8)

Lastly, the sickness you are feeling... I believe it may be from your other illness or the fact that you are on too high of a dose. Do you ever remember that feeling on a morning after you had a night of getting it in? Like that hung over feeling that you had from using too much? That may be what your body is trying to tell you.. you are using too much. I believe that you said that you experience these feelings before you dose. I myself and an overwhelming amount of other people, feel sick right after dosing. (I have 6 day status, I get take homes for 6 days, only go to the clinic 1 day) and I will wake up and dose, then go back to sleep because my stomach ALWAYS gets sick. It wasnt like this at first, it became like this after a couple years. A lot of people have been experiencing GERD (acid reflux) and this is because of THE RED DYE! I dont know if your clinic uses colored methadone but I'll tell ya, that dye and the other "additives" DESTROY your stomach! I know tons and tons of other patients who experience this! Because of this, some of the other branches were offering the waffers instead of the liquid and a lot of peoples stomach issues have improve. Actually, this month my clinic is switching to the clear methadone that has no dyes and very little additives because sooo many ppl were having stomach issues. So that might be something to think about.

Have you tried talking to the doctor about all this? Do you know that their is actually a test that they can give you to see if the dosage that you are on is correct? It is called a trough test, I believe. They take your blood in the morning before you dose so that they can see all your levels and somehow they can figure out, scientifically if the dose you are at is high enough, but in your case, too high. Dude, I really think thats it.. you are on too high of a dose man. Once again, I am not judging you because of this.. its just really what I believe. Sorry this is so long.. but i really hope it helps. Please try and stay positive... I think you are doing great, be proud of yourself that you are a productive member of society again and not pawning your shit. I am sorry you are experiencing all these ailments but please look into the advice I have given you. Good luck!!
 
^^ Thank you for your input.

I know an overwhelming amount of people, including myself who crave sweets, chocolate & etc.

I know what you mean - I get those cravings too at times, but I've been able to manage it.

I think the most important thing would be to eat right and stay active, just as with anyone who is overweight :\

Which is what I've been doing, but I haven't lost any weight. I've only been able to keep myself from gaining anymore.

I can not believe that it is even legal for you to be on a dose of 180mgs.

I agree with you that 180mg is too high - except perhaps in some rare exceptional cases, not including mine.

I've actually been tapering since the middle of October 2011 when I was taking 250mg daily. I've been doing it slowly 5mg/week or two so as to try to minimize the muscle aches as that's the one symptom that persists occasionally throughout the day (it comes and goes - all the other symptoms are isolated to the morning, which, again makes me point the finger at fibromyalgia).

I was on 250mg for about a year. I feel I was stupid to let it go so high. Every time I would see my methadone doctor, I would complain of the same symptoms and he would just continue to increase my dosage.

It wasn't until the end of September when I went to a rehab facility for 2 months because my methadone doctor recommended it to see if they can pinpoint what's really going on as I'll be monitored constantly and daily, that the methadone doctor there told me that in his 15 or so years of prescribing and dispensing methadone - that he has never prescribed more than 180mg to anyone (and the 180mg he Rx'd only once).

He strongly recommended I taper down to under 100mg and at first I refused - I told him what I told my usual methadone doctor (about my symptoms) and also that I need to find another way to treat feeling like shit every morning, but more importantly, the muscle aches I randomly get throughout the day, which, make me unable to function they are so severe.

You know the day after an intense workout? When you try to move around and your body is sore as hell? Well, that's what the muscle aches feel like, only they don't stop aching if I lie down and stop moving.

About 3 weeks into the rehab program, I met another doctor (I believe he was one of the facility's GPs). I explained my situation (morning sickness, muscle aches coming and going throughout the day) and he recommended I try Lyrica. I was skeptical at first because I wasn't at all familiar with the drug - but I eventually decided to give it a go and voilà - no more muscle aches! Plus, I was also waking up mornings feeling much better.

So after that, I told the methadone doctor that I'm ready to start tapering and here I am at 180mg and going down.

Ive seen sooo many people mix the methadone with benzos and all that they do all day is nodd off with their ciggs and burn things and themselves. 8)

LOL - so true! That's halirious - well, unless you're on the receiving end I suppose. I've seen it happen over here too LOL.

Do you ever remember that feeling on a morning after you had a night of getting it in? Like that hung over feeling that you had from using too much? That may be what your body is trying to tell you.. you are using too much.

That's an interesting hypothesis - I never thought of it like that. However, the morning sickness started when I was on only 30mg and persisted right up until 250mg.

A lot of people have been experiencing GERD (acid reflux) and this is because of THE RED DYE!

Over here they use orange Tang (water, sugar, coloring). I haven't had any problems in that regard.

Have you tried talking to the doctor about all this? Do you know that their is actually a test that they can give you to see if the dosage that you are on is correct? It is called a trough test, I believe.

Never heard of it - but I'll be sure to ask about it the next time I see him.

Please try and stay positive... I think you are doing great, be proud of yourself that you are a productive member of society again and not pawning your shit. I am sorry you are experiencing all these ailments but please look into the advice I have given you. Good luck!!

Thanks for your support - not pawning my shit anymore for a fix is one thing I'm most happy and proud about. I was just prescribed Neurontin (because my insurance company covers it, but doesn't cover Lyrica anymore). I'm supposed to start taking it Monday. I'm hoping it'll provide at least some relief, but I'm not worried - I've heard and read good things about it with respect to it being Rx'd off label for fibromyalgia.

If the Neurontin can provide the relief (long term) that I felt while I was on Lyrica for 2 months before my insurance company wouldn't cover it anymore, I think I'm gonna eventually switch to Suboxone and see how it goes in terms of staying clean and attempting to lose some of this weight. If it doesn't work, I can switch back to methadone I suppose.
 
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You are aware that Lyrica is available as a generic, at least in the United States (pregbalin). Is that why you are not taking it? Have you priced the cost of the generic? Have you contacted the drug company for programs for those without insurance coverage? Pfizer is the manufacturer of Lyrica (the legend product), and they may be able to help you (but the program may not exist in Canada). Did you ask you physician to appeal the insurance company's decision?


The "trough test" is simply a measure of serum methadone levels at their lowest or "trough" levels.
 
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You are aware that Lyrica is available as a generic, at least in the United States (pregbalin). Is that why you are not taking it? Have you priced the cost of the generic? Have you contacted the drug company for programs for those without insurance coverage? Pfizer is the manufacturer of Lyrica (the legend product), and they may be able to help you (but the program may not exist in Canada). Did you ask you physician to appeal the insurance company's decision?

Lyrica is not available in Canada as a generic and I do not know when it will be. Source - http://webprod3.hc-sc.gc.ca/dpd-bdpp/dispatch-repartition.do?lang=eng

That's Health Canada's official website (Canadian FDA) - I trust their information.

At this time, I simply cannot afford it. One month's supply of Lyrica would cost me $165, which would bring the monthly cost of all my Rx meds combined up to $605.

I've done all I can to try to get it covered (I've asked for samples as well) to no avail - and my physician wants to see if I respond to gabapentin first. If not, we have what's called an EAP (Exceptional Access Program) form which a physician fills out as an appeal to the provincial government for coverage of a drug not in their Ontario Drug Benefits Formulary.

According to the following websites, a generic version of Lyrica won't be available in the U.S. until at least 2013 (and some say 2018 ):

http://en.wikipedia.org/wiki/Pregabalin
http://www.ihs.com/products/global-insight/industry-economic-report.aspx?id=106595561
http://epilepsy.emedtv.com/lyrica/generic-lyrica.html
http://www.sharecare.com/question/there-generic-version-of-lyrica

Quoted from - http://www.drugs.com/availability/generic-lyrica.html:

Has a generic version of Lyrica been approved?

-No. There is currently no therapeutically equivalent version of Lyrica available.

Note: Fraudulent online pharmacies may attempt to sell an illegal generic version of Lyrica. These medications may be counterfeit and potentially unsafe. If you purchase medications online, be sure you are buying from a reputable and valid online pharmacy. Ask your health care provider for advice if you are unsure about the online purchase of any medication.

Furthermore, your country's patent office official website has online records of two patents for Lyrica (6197819 - issued March 6th, 1999 / 6001876 - issued December 14th, 1999) which do not expire until December 30th, 2018.

Patent 6197819 - http://www.uspto.gov/web/offices/pac/dapp/opla/term/certs/6197819.pdf
Patent 6001876 - http://www.uspto.gov/web/offices/pac/dapp/opla/term/certs/6001876.pdf

I know there's a ton of online pharmacies on google which say something along the lines of, "Buy generic Lyrica here!" including one that is supposed to be 100% Canadian - yet their IP addresses are located in places such as Malaysia and Hong Kong. I'm willing to bet their "Lyrica" is actually generic gabapentin or some legal benzo such as etizolam.

I'm not trying to be a smartass about all this, and I apologize if I'm coming across as such. I'm just skeptical of these online pharmacies.

The "trough test" is simply a measure of serum methadone levels at their lowest or "trough" levels.

Is that not the same test done to check if a patient on MMT is a rapid metabolizer? If it is, I've had it done long ago.
 
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Sounds like the state of affairs in Canada isn't much better than it is here in the United States when it comes to the cost of prescription medications.

I would never recommend that you purchase pregabalin from an online pharmacy. If it is not available as a generic in your country, then I would reach out to the drug company to see if you qualify for their patient assistance program. Lyrica is made by Pfizer. Many people, however, do respond well to gabapentin which is relatively inexpensive (at least here).
 
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