[Maria]

With permission of a friend posting her experience.
On Methadone 40mg/day, Neurontin 1200mg/day, and Fioricet up to 6 pills/day (sometimes more) and switched from Fiorinal because of aspirin component (can no longer take).

She had several episodes of becoming irritable, confused, talking but not making sense, slurring speech, very dizzy, falling. Was hospitalized the first 2 times tho no real diagnosis even tho medication list given. She says that she didn't think her lab testing included testing for prescription pain meds.

After first discharge from hospital seen in PM's office complaing of continued high pain levels despite current Methadone dose. She had lost 30 lbs w/in several weeks (was tested in hospital for various conditions that might explain weight loss and symptoms but all testing negative).

PM not there however NP covering office switched her to 10mg Methadone every 6 hours vs. every 12.

Monday she was diagnosed with overdosing on Methadone in ER.

I'm not a doctor and certainly not a PM however I was an NP for a number of years and have taken Methadone myself for 9 years. My recommendation would have been not to increase the interval/frequency however to perhaps after reviewing all labwork and history to increase her dose by 5mg intervals and keep medication at every 12 hours.

I'm sure there are persons that can be increased that much or that dose at least however I just don't think it prudent overall with a drug of this catagory and potential for resp. depression/side effects.

Personally I think she's taking too much Fioricet and as a friend I've advised her to "cut down" as she uses it for her back pain vs. migraines and her doctor prescribes up to 200 count which she has used all in one month. She was advised medically to cut down on the use of these as well. What she did cut down on tho I don't think was warrented was Neurontin as she has siginficant neuropathies but I'm not sure she was thinking clearly when making that decision in terms of self treating and thought it might her as it has helped me ( I'm not experiencing neuropathies or I would take it as I've explained to her a number of times but I think her comprehension had been affected).

This is an educated person who worked as a nurse all her working career however I think got caught up in pain control and self treating on her own schedule with some meds tho the lastest Methadone increase seemed wrong to me.

And BTW ~ she was using pill organizers so she would not take Methadone more that 4x/day. An increase of 20mg/day is alot to me and it's confusing to take it 4x/day vs. 2 as far as I'm concerned.

Talked to her yesterday and she's doing OK. Advised her to f/u with her PM STAT because they need to know what happened instead of waiting 3 months from now until she's seen again. I would hope this is not common practice in that office tho ??? Again maybe I'm incorrect but that didn't seem like a well thought out prescription increase/plan to me. In any event letting our physicians know the outcome of something that didn't work out well for us or could have had fatal or a very bad outcome definately has to happen~ that continues to be our responsibility as well as long as we're still breathing.