Tapering Reduction in Fentanal - Increased Heart Rate

[CindyinCR]

Hi,

I started my drop in fentanyl about four weeks ago. I dropped from 25mcgs to 12.5mcgs. I couldn't go lower, because of injury site pain that caused me to be on fentanyl to begin with. Anyway, I have been stable at 12.5 for three weeks now. The remaining problem is my resting heart rate is still 10 points higher then it was before and during the three years that I was at 25mcgs. Is there a good chance this is the reduction and it will go back to normal eventually? Or is it likely that I have damaged my heart in my taper?

Any and all input is appreciated.

thanks, Cindy

 

[Jabberwocky]

You should have this looked at, monitored and treated by your doctor. That said, this sounds like withdrawal, as opposed from something more serious. But we wouldn't be doing the due diligence thing if we didn't recommend you have your doctor check it out given your particular history etc.

 

[CindyinCR]

I understand about getting it checked. And I will if it continues. But I am wondering if three weeks after my drop to 12.5mcgs, I could still have a fast heart rate? Have you heard of others with this experience? It's not like I have no fentanyl just less, and so I would think that the taper symptoms (like fast heart rate) would be gone by now. It will be really stupid to find that tapering ruined my heart. No one warns of this! And as I understand it Paws is mostly psychological, as in depression or anxiety, neither of which I am experiencing. I appreciate your thoughts on this TD!

 

[Jabberwocky]

The issue is that fent is very short acting. Even with a patch, it will probably wear off before you put a new one on. That means that your body is constantly going back and forth between minor tapering related withdrawal and getting well when you redose. That is enough to cause stress on the body's various systems. It is why long acting opioids are faaaar more appropriate for tapering, as your body won't be going through so much of the ups and downs between dosing one day and the next.

There are other possibilities specific to your health and history however, which is why working with your doctor to help you manage what is going on is so important.

To some degree what you are experiencing is definitely a result of your reducing your fent dosage, particularly if you were on a higher dose for a long time, and it is one of the reasons why clonidine can be so helpful as a comfort med. An elevated heart rate and blood pressure is fairly par for the course when it comes to detoxing, and especially tapering using short acting opioids.

However, this could also be related to another health condition, and is just being triggered as you have reduced your opioid intake.

PAWS doesn't happen until a significant amount of time after you have become a student from all opioids. It is a largely psychosomatic condition, but it can very well have physiological systems outside depression and anxiety (such as insomnia, restlessness, fatigue, etc).

Other than the feedback I've given you hear, only your actual doctor (or another doctor who knows your medical history) can really help you explore and manage the symptoms in a safe way.

Can you let you doctor know what is going on with your heart, express your concerns and make an appointment to see them to get check out?

It is good you are monitoring this though, that will help them better do their job.

 

[CindyinCR]

It's difficult. I am disabled, so can no longer drive down these bumpy mountain roads here in Costa Rica, and my husband is in the US for another week. I should say that my ears are ringing too.

But I think I figured out what is wrong. I had increased my gabapentin, to help w fentanyl reduction (and it helped greatly), but now I am at least in part dealing w gabapentin reduction symptoms.

Last night I increased it to what I was taking during the fentanyl reduction and my increased heart rate went away. A very vicious cycle.

 

[Jabberwocky]

How much gabapentin were you taking prior versus more recently?