Oxy not holding me after Dilaudid + Relistor — goal is to stabilize, taper off, and feel balanced again

[pnillyg]

Hey everyone,

I’m trying to get some insight and feedback about my current med combo and how things have been feeling off lately. I’m working closely with my doctors, but I’d love to hear from people who’ve had similar experiences — especially around opiates, Relistor, and med changes.


Current Medications & Supplements

• Oxycodone: 15 mg × 3 daily (45 mg total, 5 mg tablets)
• Relistor: 150 mg, 1–3 pills every morning (for constipation)
• Linzess: 145 mcg daily (preferably on an empty stomach)
• MiraLAX: 1× daily or as needed
• Prazosin: 2 mg nightly
• Mirtazapine (Remeron): 15 mg nightly
• Alprazolam (Xanax): 0.5–1 mg daily for panic
• Diazepam (Valium): 5–10 mg, 1–2× daily for anxiety
• BPC-157 peptide
• NAD infusions: 250 mg weekly
• Ondansetron (Zofran): 4 mg, 1–3× daily as needed
• Docusate sodium: 250 mg daily
• Senokot: 1× daily
• Ketamine (sublingual): 300–900 mg daily

Recently discontinued or adjusted:

• Stopped Lunesta 2 mg (was on it for 3 years)
• Switched from Lexapro 10 mg → Mirtazapine 15 mg
• Got IV Dilaudid in the hospital a few weeks ago (for gallbladder complications)
• During flare-ups, I was also given:
  • Bentyl (Dicyclomine)
  • Famotidine
  • IM Toradol injections

Questions / Concerns

1. Ever since starting Relistor, my opiates don’t seem to work as well. Why would that be?
2. Since getting IV Dilaudid in the hospital, oxycodone doesn’t even hold me out of withdrawal anymore, even at 45 mg/day (my maintenance dose).
3. I’ve noticed that 20 mg hydrocodone/acetaminophen feels stronger and lasts longer than 20 mg oxycodone for both pain and withdrawal — any idea why?
4. Could switching from Lexapro to Mirtazapine, and stopping Lunesta, be contributing to these negative or unstable feelings I’ve been having lately?
5. Prazosin helps my night terrors a lot, but if I don’t fall asleep right away it makes me feel really weird — is that normal?
6. My doctors want me stabilized at 45 mg/day oxycodone within 4 days. Any tips or suggestions to help stabilize, minimize withdrawal, and manage side effects during this process?
7. I’ve also been feeling super low energy lately, and my doctors mentioned that a small dose of Adderall in the morning might help. I’m considering it since I’m trying to come off the ketamine — I want to feel good, but also stable and able to get things done, which the ketamine has started to interfere with.

Goal:

The plan is to stabilize for about 1–2 weeks, then begin tapering off the opiates first, followed by the benzodiazepines once things are more balanced.

Other meds I still have from past detoxes or current prescriptions:

Gabapentin, clonidine, hydroxyzine, Adderall, baclofen, methocarbamol.

Thanks in advance for any advice, experiences, or insight. Just trying to better understand how all this interacts and how to get through this stabilization phase as smoothly as possible.

 

[evo4ever]

Jesus your so over-medicated I wouldn't know where to start and I suspect other people think the same way. A Clinical Pharmacist is probably the best person to ask your questions.

 

[ageingpartyfiend]

Jesus your so over-medicated I wouldn't know where to start and I suspect other people think the same way. A Clinical Pharmacist is probably the best person to ask your questions.

This for sure

Don't start adding more/different stuff though mate - you definitely need to cut a lot of that out/down and it's gonna involve a whole lifestyle and mindset change most likely.

 

[4DQSAR]

Do you know how much Dilaudid (that's hydromorphine I think) you were being prescribed in hospital? I mean dose and frequency.

The thinking around oxycodone has changed over the last decade. For a long time it was known that around 10% of any oral dose of oxycodone was converted by liver enzymes into the much more potent oxymorphone. But while older paper suggested that the oxymorphone wasn't significant in the activity of oxycodone, more recent papers suggest that it IS significant and some even suggesting that it might represent about 50% of the analgesic activity.

As @ageingpartyfiend notes, don't add stuff if you can avoid it. I don't think anyone knows what interections could be going on if all that other stuff is mixed in. But some medications will alter the metabolism of oxycodone. Some increase oxymorphone levels, some reduce it.

That is a LOT of different medicines.

 

[helpingout]

All concerns of over medication aside, assuming that you are actually requiring these medicines, which I will do, I don’t presume to know your situation better than your medical team, nor would I take a look at someone’s medications and immediately consider them over prescribed, as that could cause undue harm to the individual, you, in question.

Anyways, to stay good while going down you need to look up the list of vitamins for opioid withdrawal. Everything except the gabapentin is non prescription over the counter and amazingly helpful.

Please don’t hesitate to use that list and get yourself down to forty five milligrams a day.

Trust your medical team, distrust people on the internet, because they don’t know your exact situation. For instance, you mentioned the meds you take but you didn’t mention your ailments. People just have knee jerk reactions to long lists of medicines.

Hope you’re well pnyllig

Miss you.

Oh and remember. It’s not going to feel good. In fact it will feel bad. And then it won’t anymore. It’ll just take time.

 

[pnillyg]

All concerns of over medication aside, assuming that you are actually requiring these medicines, which I will do, I don’t presume to know your situation better than your medical team, nor would I take a look at someone’s medications and immediately consider them over prescribed, as that could cause undue harm to the individual, you, in question.

Anyways, to stay good while going down you need to look up the list of vitamins for opioid withdrawal. Everything except the gabapentin is non prescription over the counter and amazingly helpful.

Please don’t hesitate to use that list and get yourself down to forty five milligrams a day.

Trust your medical team, distrust people on the internet, because they don’t know your exact situation. For instance, you mentioned the meds you take but you didn’t mention your ailments. People just have knee jerk reactions to long lists of medicines.

Hope you’re well pnyllig

Miss you.

Oh and remember. It’s not going to feel good. In fact it will feel bad. And then it won’t anymore. It’ll just take time.

Thank you so much. I’ve gotten off the lunesta and gabapentin now. So going to pull updates first with rapid burp taper, the opiates with either phenobarbital or just diazepam, then the remeron if needed but it seems to be helping me. Just doing a full med wash and will come back up the ladder if at all (hopefully i dont need anything but thats in an ideal world and im realistic.) yes these are all prescriptions and have a team of 3 and sometimes 4 people. A psychiatrist, a psychologist, and NP, and another NP. Ones going to distribute meds using comfort meds and hopefully we can get this done. They think no more than two weeks. Starting in a few days. Wish me luck!

And to everybody else. Yea maybe it’s more meds than you but im alive and happy and in great shape so… just doing the wash for me. Cause i want full sobriety. And cause IM ready. Peace and love