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Addiction (Expert Forum)
Withdrawal from fentanly and dilaudid
Answered by
Jeffrey T Junig, MD PhD - Psychiatry, Addictions, Chronic Pain Treatment, Anesthesiology, Buprenorphine
Fond du Lac Psychiatry
Fond du Lac - WI
Questions in the Addiction forum are answered by a medical expert.
Withdrawal from fentanly and dilaudid
by Nikilee, Jun 01, 2009 12:43PM
I am a 55 year old female. On March 26, I fell from a ladder resulting in multiple (stable) fractures in my pelvis and 6 broken ribs. I was hospitalized for a week on a dilaudid pump, and they put a 75 mcg. fentanyl patch on me. (I have fibromyalgia and neuropathy problems, so was already wearing a 25 mcg. patch).
I was sent home with 2mg. dilaudid pills, with instructions to take 1-2 mg. 3x day for pain.
I started weaning that down about 3 weeks ago, and finally weaned off about a week ago.
I also started feeling some strange feelings that I attributed to the patch (a strange pressure in my ears and a feeling that I could not take a deep enough breath). The PA at my pain clinic was able to get prescriptions written for 2 -50mcg. patches and 2 - 12.5mg. patches, giving me the option to drop down to either 62.5mcg or to 50mcg before my pain appointment this Thursday. I opted to do jut the 50. I put on the 50mcg. patch this past Friday. I was doing well, in fact feeling pretty "normal" until last night (Sunday). I was up and active over the weekend. Then last night (Sunday night) I had a very hard time with feeling sort of agitated and it was hard to go to sleep.
This morning I woke up with my legs in pain, with my right leg (this is my injured side) in muscle spasms (I think)...it just sort of tightens up in a rythmic way and feels awful. I was cold for the first time since I came home from the hospital (I have been super-HOT). Just generally felt "bad". I gave in and took .5mg (1/4 tablet) of the dilaudid.
This is all very frightening to me. Are these normal withdrawal symptoms? I might add that during this recuperation time, I have been having trouble with migraines. Have had to take Imitrex several times each week. I am also on cymbalta. Do you see trouble here with any drug interactions that the doctors may not have told me? I have a pain doctor appt on Thursday.
Thank you for your help.
~nikilee
I
I was sent home with 2mg. dilaudid pills, with instructions to take 1-2 mg. 3x day for pain.
I started weaning that down about 3 weeks ago, and finally weaned off about a week ago.
I also started feeling some strange feelings that I attributed to the patch (a strange pressure in my ears and a feeling that I could not take a deep enough breath). The PA at my pain clinic was able to get prescriptions written for 2 -50mcg. patches and 2 - 12.5mg. patches, giving me the option to drop down to either 62.5mcg or to 50mcg before my pain appointment this Thursday. I opted to do jut the 50. I put on the 50mcg. patch this past Friday. I was doing well, in fact feeling pretty "normal" until last night (Sunday). I was up and active over the weekend. Then last night (Sunday night) I had a very hard time with feeling sort of agitated and it was hard to go to sleep.
This morning I woke up with my legs in pain, with my right leg (this is my injured side) in muscle spasms (I think)...it just sort of tightens up in a rythmic way and feels awful. I was cold for the first time since I came home from the hospital (I have been super-HOT). Just generally felt "bad". I gave in and took .5mg (1/4 tablet) of the dilaudid.
This is all very frightening to me. Are these normal withdrawal symptoms? I might add that during this recuperation time, I have been having trouble with migraines. Have had to take Imitrex several times each week. I am also on cymbalta. Do you see trouble here with any drug interactions that the doctors may not have told me? I have a pain doctor appt on Thursday.
Thank you for your help.
~nikilee
I
Doctor's Answer
by Jeffrey T Junig, MD PhD, Jun 07, 2009 08:06PM
, Jun 07, 2009 08:06PM
It can be difficult to sort out opiate effects and withdrawal-- as long as you are not taking demerol (meperidine), the pupils are a good indicator of overdose vs withdrawal. In general, nausea and pinpoint pupils are overdose, and diarrhea and big putpils are withdrawal. (demerol dilates pupils in high doses).
Withdrawal can certainly cause the symptoms you described, although the leg pain seems to be more severe than I would expect-- I presume you were having the muscle contractions that occur during withdrawal that make the legs kick ( as in 'kicking the habit'). As for the trouble breathing, fentanyl in particular will do that in high doses.. Tightness of chest wall muscles is a not-uncommon side effect during infusion of fentanyl at the start of heart cases. It generally will break after a few seconds, but it can be quite distressing.
Fentanyl patches are very difficult to use for acute pain, and have a black-box warning that they should NOT be used for post-op pain. The reason is because a few young people died from the patches after being on them a few days, after all of the 'fentanly stores' in the body filled up with the fentanyl, causing levels of fentanyl in the body to suddenly rise. I find it easiest to stick with the medication the person reularly takes, if possible, and to just increase it temporarily. Good luck!
I don't see specific interactions, but there COULD be some-- for example, if you are bipolar, opiates can precipitate mania, as can cymbalta. In general opiates have tons of side effects, sometimes 'euprhonric' ones, sometimes ' dysphoric'ones.
Withdrawal can certainly cause the symptoms you described, although the leg pain seems to be more severe than I would expect-- I presume you were having the muscle contractions that occur during withdrawal that make the legs kick ( as in 'kicking the habit'). As for the trouble breathing, fentanyl in particular will do that in high doses.. Tightness of chest wall muscles is a not-uncommon side effect during infusion of fentanyl at the start of heart cases. It generally will break after a few seconds, but it can be quite distressing.
Fentanyl patches are very difficult to use for acute pain, and have a black-box warning that they should NOT be used for post-op pain. The reason is because a few young people died from the patches after being on them a few days, after all of the 'fentanly stores' in the body filled up with the fentanyl, causing levels of fentanyl in the body to suddenly rise. I find it easiest to stick with the medication the person reularly takes, if possible, and to just increase it temporarily. Good luck!
I don't see specific interactions, but there COULD be some-- for example, if you are bipolar, opiates can precipitate mania, as can cymbalta. In general opiates have tons of side effects, sometimes 'euprhonric' ones, sometimes ' dysphoric'ones.
