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Need to change from Tramadol to another Breakthrough pain med...suggestions?

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Posted 10/5/2014 5:39 AM (GMT -8)
So I've actually got my PMD treating my Panic Disorder until my primary doctor can get me on the right anti-depressant so that I don't need so much Klonopin...I'm taking 1mg 3x daily, but would prefer to get it down to 0.5mg 2-3x daily with the help of the right anti-depressant.

The only issue here is that there are interactions between all anti-depressants and Tramadol. My last appointment with my PMD I told her that I would like to get away from the Tramadol so that my primary doc could start trying some anti-depressants that I will actually take because I've been too scared to take them due to increased seizure risk and serotonin syndrome. Would it be reasonable to call up my PMD and ask for something other than Tramadol for BT pain and what might you guys suggest for BT pain when I am using 50mcg/hour Fentanyl patches?
Posted 10/5/2014 6:42 AM (GMT -8)
Hmm, I'm not sure. I'm taking 100mg of ER tramadol right now, and I take cymbalta. I know that there is an interaction - but there's also an interaction between narcotic medications and all benzos, so having the tramadol along with the anti-depressant doesn't seem like such a huge risk, since you said that you're taking klonopin which already is contra-indicated by narcotic pain relievers. Most people do it though and I'm not sure why but doctors don't seem concerned about that.

The risk involved with taking Tramadol along with an anti-depressant is for seratonin syndrome I think. it is super rare. I've taken both the ER and IR tramadol on and off for several years, with an anti-depressant, and no consequences.

That said, there's no reason you shouldn't ask for something else to minimize the risk of interaction.

This is just the list of rescue meds that I've tried: oxycontin, percocet, norco, opana, dilaudid, ms contin. Those are just the ones that come to mind right away. They've all had some success at some point or another, although for me I got really sick while taking dilaudid and being on a pain patch. I had to take Zofran a few times a day.
Posted 10/5/2014 7:42 AM (GMT -8)
I already had my appointment with my PMD on the 1st of October which is when I asked her to stop the Tramadol so that I can try out some anti-depressants. Would it be reasonable to call the office and ask for something different for BT pain other than Tramadol. I guess I didn't realize that the Tramadol was helping so much when my pain was breaking through the 50mcg/hr fentanyl patch. Or will I have to wait until next month when I go see her again?

I suppose it is worth a try calling and explaining the situation, if she can't do anything then I am in for a relatively bad month. I guess the job search will have to wait for another month if that is the case.

I can't take norco or any other hydrocodone med because it makes me extremely irritable. My wife said she would leave me if I was ever prescribed hydrocodone again. You listed oxycontin for rescue meds, didn't you mean something like roxicodone? MS Contin is also extended release not a rescue med.
Posted 10/5/2014 7:59 AM (GMT -8)
You never call a dr up and ask for medication over the phone. Make an appt & go in & discuss it with the dr. He/she should be able to come up with a medication that will help you out. Take care.

Good luck.
Posted 10/5/2014 8:15 AM (GMT -8)
So I can make another appointment before my monthly appointment is due?
Posted 10/5/2014 8:48 AM (GMT -8)
Like someone stated,don't call asking for a prescription.

Call and ask if you can come in early to discuss it.

It's not unusual that you would be missing the pain relief of tramadol.

I don't think they would think of it as unusual either.

eta:Probably a oxocodone compound such as Percocet or just oxocodone(roxycodone)It comes in 5 mg to 30 mg.

Posted 10/5/2014 8:59 AM (GMT -8)
Alright so it won't raise any red flags that I am calling in to make an early appointment to discuss the pain relief I have lost from stopping the Tramadol? It also won't raise any red flags that I don't want to go back on Tramadol because of the serotonin syndrome interaction?

If that is the case then I will call my PM doctor tomorrow and try to setup an appointment to see her.
Posted 10/5/2014 12:13 PM (GMT -8)
Hi MarkH,
I don't see why there would be any red flags, it was you who requested the break from the Tramadol. Now if it were the other way around, yes, there would be flags. Call to make an appt. and discuss it then. I have been taking Cymbalta, Duloxetine, for 7 years with Oxycodone, Roxicodone, fentanyl,and Fentora with no seratonin syndrome. As Tramadol does mess with the seratonin re uptake you are wise not to mix it with an A/D. I also take 2 mgs. of Xanax at night for sleep issues with no drug drug interactions. . . . Q
Posted 10/5/2014 1:09 PM (GMT -8)
Did they write you Tramadol on your last visit.If they wrote it and you've decided to stop taking it,after seeing them,I'd wait til next appointment.

If you discussed your concerns about the Tramadol and "serotonin syndrome" and they didn't prescribe it your last visit then I think it would be ok to let them know that you're in pain.

Of course waiting til your next appointment would probably be the best.

I'm not sure of all the facts so I hate to guess on something as important as your Pain Contract.

Rick

eta: My 500th Post. Yeh...... tongue yeah smilewinkgrin

Posted 10/5/2014 1:49 PM (GMT -8)
Yes, you can definitely call in for an earlier appointment! Especially if you're in a period of adjusting your meds. I think one time I saw my psychiatrist every two weeks for like two months trying to find the right combo for me.

ETA: Everyone else on here has way more experience than I do so you should listen to them before me, LOL.

Q, you take 2mgs of Xanax at once? Whoa. That certainly would help with sleep. ;)

Post Edited (Backtolife) : 10/5/2014 3:55:35 PM (GMT-6)

Posted 10/5/2014 1:51 PM (GMT -8)
Hey Mouse, is that when you become a Veteran member?
Posted 10/5/2014 2:29 PM (GMT -8)
…..ask your Dr about Nucynta at your visit. It's a two part med, one being a narcotic, and the other a nerve damage medication. It has been an awesome med for me, and I have been on the same dose for over two years now. It's much smoother to the peak, and also on the way down….unlike other meds such as Percocet.

Have him look it up and see if it may be a suitable trial for you. One thing I suggest, for all, is to make sure the conversion from one med to another is correct, and avoid giving up on a med too early. Many of them take time to be effective, and higher doses may be required as well to see results.

Always, coordinate with your Dr if you are experiencing severe side effects of any medication.

Good Luck!

SE
Posted 10/5/2014 11:07 PM (GMT -8)
Hey Quincy.I guess.I didn't notice it.Moving up in the world.

Rick
Posted 10/6/2014 6:41 AM (GMT -8)
Yes, I was the one that asked to not be prescribed the Tramadol anymore and I did not receive an RX for it this month. I went ahead and called the doctor's office to get a message to my doctor to see if she wants me to come back in for another appointment to straighten this out. We have a really good doctor/patient relationship going here and I really do think she trusts me so I'm hoping this won't be an issue.
Posted 10/6/2014 7:18 AM (GMT -8)
I am particularly sensitive to serotonin, but I only have to watch a few meds because of tramadol, which I have taken for years. The only med I absolutely can't take with it is Flexeril (cyclobenzaprine). Most people can take these together and just about everything else too.

If you know the symptoms of serotonin syndrome, including heavy sweating and turning beet red, you should be able to take just about anything and not worry until you actually get symptoms. The syndrome is reversible. Just get to a hospital and tell them what's happening and tell them it can be reversed with benzodiazepines. I've gotten it a few times, and with my doctor's OK, I took a Valium and it stopped. It's not horrible if you know what's going on!

I didn't know tramadol was for breakthrough. It's my regular pain med. I appreciate the feeling of having my serotonin raised a bit. Without it I am pretty grumpy. I like it because I haven't needed an increase in years and have gotten off without withdrawal (except for pain) when I had to for tests and surgeries.

I wouldn't stop tramadol just for fear of something that might happen. I would go with my doctor's recommendation and just be aware of possible problems, not terrified of something that probably won't happen.
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