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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 58. This is the beginning of the thread.
Posted by floatingbridge on April 4, 2011, at 13:42:51
Hi,
I am trying to get off norco (25-20mg presently) with the least possible adverse affects.
I am very, very sensitive to meds and have tried to get below 10mg, maybe it was 5mg, and had it pointed out to me that I was incurring withdrawal :(
I still have an old bottle of Ultram 200mg (tramadol hcl ER). Could I use that to taper off, and if so, how?
I do not want to trade over, just get off norco and reboot.
I am presently off any ssri/snri's and feel
better--more stable and better mood and cognition.Here's my dwindling pharma cocktail:
Xanax XR, 1mg daily taken in .5mg tabs.
(That's next to get the boot if possible.)Norco, 25-20mg daily in 10/325 scored tabs
Zanaflex 4mg daily
There is armor (thyroid) and supplements on board.
I don't see my gp for another 2 weeks, and am so tired of waiting for professional help with this. I have incredible rebound headaches! but want to keep my mood stability intact.
Thank you for any experience or theory or knowledge :)
fb
Posted by Phillipa on April 4, 2011, at 16:36:47
In reply to sensible help needed with norco, posted by floatingbridge on April 4, 2011, at 13:42:51
FB I didn't know you wanted to go off the norco? Not helping pain? Wouldn't a slow taper work the best? Hoping others chime in. Love Phillipa
Posted by floatingbridge on April 4, 2011, at 17:34:01
In reply to Re: sensible help needed with norco » floatingbridge, posted by Phillipa on April 4, 2011, at 16:36:47
As I begin to understand these meds and my own reactions to them, I realize (and have been told) that norco is short term treatment and has a rebound effect.
I really feel the rebound effect--I have a wicked headache right now :(
It's not the right treatment for my pain, even before the new dx. I still have spine damage. The norco works for that, but daily use creates headaches (!).
I don't know what to replace it with, but know it needs to be returned to it's former emergency med status at the back of my cupboard. I had a few tabs left over from my c-section 7+ years ago. When I started having 'pain episodes' after a trial of Strattera almost 1.5 years ago, I dusted it off. Then my ex-gp refilled. It seemed to help everything--mood, pain, anxiety. (My social anxiety was terrible--knotted stomach, etc.)
I've been looking for pain management help for that long now :(
Was accused of abusing tramadol; that doc wouldn't write out the scripts properly (short scrip--wouldn't check his math--hubris!), and was the one who really helped make a simple case of escalation (in retrospect) a naughty, NA type of event. And I was so freaked out about being an addict!
Anyways, I just need help off the norco. I am overly fearful of both med trials and tapers.
Just shave down every day you think?
I thought with the longer life, a little ultram could help.
Could I drop to 10 norco, or 5 norco, take Ultram for no more than four days?
Guess I need to know how long the norco withdrawal might last. And how long before real ultram dependence began.
Thanks.
Posted by sigismund on April 4, 2011, at 18:00:44
In reply to Re: sensible help needed with norco » Phillipa, posted by floatingbridge on April 4, 2011, at 17:34:01
>Could I drop to 10 norco, or 5 norco, take Ultram for no more than four days?
How long have you been taking this?
I think you are wanting to go way too fast.
But then there are the headaches.
But why will that get better if you go quicker?
Are you sure there is not some magical thinking going on just to get out of the trap in which you find yourself?
Posted by floatingbridge on April 4, 2011, at 21:06:23
In reply to Re: sensible help needed with norco, posted by sigismund on April 4, 2011, at 18:00:44
> >Could I drop to 10 norco, or 5 norco, take Ultram for no more than four days?
>
> How long have you been taking this?
>
> I think you are wanting to go way too fast.
>
> But then there are the headaches.
>:D I have a degree in magical thought.
Oh Gawd. O.k. so slow down. But I've been trying to dump it for months.
O.K. but just to see the way out.
Thanks Sigi for listening to my back and forth. This is how I felt about dex and cymbalta and pristiq. I just began to dread taking them. The ups and downs and sides, while I felt I was getting worse.
I suppose I have some claustrophobia going here--being trapped.
I feel that maybe quicker would end the headaches faster. I mean (magical thinking) I feel better off the AD's (unless the headaches are a distantly timed affect of that.)
Oh-Boy. Thanks.
> But why will that get better if you go quicker?
>
> Are you sure there is not some magical thinking going on just to get out of the trap in which you find yourself?
Posted by Phillipa on April 4, 2011, at 21:23:05
In reply to Re: sensible help needed with norco, posted by floatingbridge on April 4, 2011, at 21:06:23
FB a lot of your own analysis going on think Sigi right taper down and don't go so fast? Love Phillipa
Posted by floatingbridge on April 4, 2011, at 21:39:32
In reply to Re: sensible help needed with norco » floatingbridge, posted by Phillipa on April 4, 2011, at 21:23:05
So slow taper.
Not a good idea to use ultram to taper? I mean, if I could just start over. Four days of withdrawal?
O.K. so slow down.
What would be a reasonable plan? (I like plans. To see a bit ahead with these
headaches. Can't blame me for a little wishing here and there.)10mg for a month?
Thanks.
Posted by Phillipa on April 4, 2011, at 21:56:40
In reply to Re: sensible help needed with norco » Phillipa, posted by floatingbridge on April 4, 2011, at 21:39:32
FB seriously I defer to Sigi I feel he knows more than me. He's a great person!!!! Love Phillipa ps you are sooooo brave!!!!!
Posted by floatingbridge on April 4, 2011, at 22:06:22
In reply to Re: sensible help needed with norco » floatingbridge, posted by Phillipa on April 4, 2011, at 21:56:40
You are very sweet. I agree about Sigi. I actually held sage-like and Sigi in the same thought. Myself, I think of as more desperate.
Ah, that Eagles' song. Desperado. I feel a bit teary now. Great.
Hey, good luck tomorrow.
And me, I'm pulling into the slow lane, but advice still (desperately) welcome. (Please.)
Posted by mtdewcmu on April 4, 2011, at 22:56:48
In reply to sensible help needed with norco, posted by floatingbridge on April 4, 2011, at 13:42:51
If you have been taking norco for a while, like months or longer, then you can expect to start feeling normal in about a week if you stop cold turkey. The worst will probably be day #2. After days 2 and 3, it will get better.
Ultram has a wicked withdrawal of its own, so switching to Ultram may not help.
If the problem is that norco wears off too soon and gives you a headache, you may want to consider switching to a longer-acting narcotic instead of stopping. You could switch to Oxycontin, or a small amount of methadone, or fentanyl patches (I'm not sure if they come in low doses). Maybe Suboxone or Subutex.
Quitting is probably going to be miserable, so you should think about whether you really want to quit, or just switch at your next doctor's visit.
Posted by sigismund on April 5, 2011, at 0:08:02
In reply to Re: sensible help needed with norco, posted by floatingbridge on April 4, 2011, at 21:06:23
I simply took forever to get off methadone.
Maybe I was on 0.25mg/d for a year?
It felt like it was the best I could do.
If you are slightly withdrawing and still on some hydrocodone, that is making progress.
There might be better ways, but I didn't find them, aside from herbal thingos.
Sometimes you will find more strength within yourself and you will be able to handle discomfort more easily.
Posted by bleauberry on April 5, 2011, at 4:35:22
In reply to sensible help needed with norco, posted by floatingbridge on April 4, 2011, at 13:42:51
There will be withdrawal no matter what. But you can make it as minor as it can be by withdrawing at a very slow pace and, more importantly, withdrawing in tiny steps. For example, 10mg down to 5mg is a huge step. That is much too big of a jump down. Not sure if you have tabs or caps. Either way, it will be extremely helpful to you to engage in the practice of making custom sized doses for yourself. For example, 10mg down to 9mg for a few days. Then 9mg down to 8mg. And so on. When you get to the trouble spot of 5mg, you'll have to make the steps even smaller. For example, 5mg down to 4.5mg. And so on.
When I withdrew from zyprexa, the hardest med I ever withdrew from, I was literally reducing the dose by crumbs each day. Tiny pieces. It took longer, but was as smooth as it could have been.
The only other option is to wean off as you have been doing, or go cold turkey, and just know you will have to weather a serious time before things smooth out. Brace for it it, mentally prepare for it, and know that it passes.
There are a handful of good supplements to replace xanax when you get to that point.
Ultram. I do not believe that would be a good option. The withdrawals from that are as harsh, or more so, than effexor or opiates. You would just be trading one miserable experience for another. The only bright side is that some people have accidentally discovered that ultram is the magic medicine they've been searching for their whole lives. It sounds like you've already tried it and it is not your magic, not sure. Anyway, for weaning off other meds, I do not see ultram as a wise choice.
Posted by SLS on April 5, 2011, at 5:31:34
In reply to sensible help needed with norco, posted by floatingbridge on April 4, 2011, at 13:42:51
Without getting too technical, withdrawal seems to be due, in part, to kindling. AEDs (anticonvulsants) would be a logical choice if this were true.
Look into:
Clonidine + AED (Trileptal or Topamax)
As an aside, Topamax 25-50 mg can be very effective for treating migraine. Trileptal can reduce nociception (pain).
Good luck.
- Scott
Posted by hyperfocus on April 5, 2011, at 6:06:59
In reply to sensible help needed with norco, posted by floatingbridge on April 4, 2011, at 13:42:51
The best advice is to go as slowly as you can. I never used opiates but I was taking benzos for a couple of years and getting off them was the worst. When stopping any drug that causes any level of psychic or physical habituation, you're going to have rebound symptoms i.e the symptoms of the thing you're treating are going to be (much) worse. Going slowly helps minimize the rebound and gives your body enough time to normalize itself. One major reason I would give up tapering is that the rebound anxiety was just too severe when I tried to go too quickly. It's even worse for drugs with a short half-like like hydrocodone and Xanax.
You can try find the next clinically significant dose lower than your current dose and start there. If you're on 25mg try 20mg for like a week and then 15mg etc. but this still might be too fast. You may have to decrease 2.5mg every week. You can take the smallest pill and use a very sharp knife to cut it into 4s and use the quarters to make up your dose. Yes this will take a while but it's no use stopping the taper because the symptoms are too bad and then have to start over. After the norco, Xanax should be done the same way.
However you do it it's going to be the pits though. Good luck to you. You always have PB to fall back on,
Posted by floatingbridge on April 5, 2011, at 12:20:38
In reply to Re: sensible help needed with norco, posted by bleauberry on April 5, 2011, at 4:35:22
Hey, thanks all--I feel like I have received a very helpful spectrum of advice and knowledge to draw from.
Today I'm going to just take a little less norco. I see the nurse practitioner of my gp tomorrow. I do not have a headache today, but it is early :p
I'll need to take some xanax and some
norco today. Sigh. I dislike the monkey on the back feeling, but here I am. I prefer a medical authority tell me what to take, but having a MI without a protocol, (c-ptsd plus), and now an shadowy physical dx (fibromyalgia plus), and I've had to become my own little authority. One script from a well-intentioned MD, (or uninformed instruction, like stopping cymbalta in four days--ah, to be able to live in such ignorance), and I have had some untoward, even lasting results. I know
I'm not the only one familiar with this experience.Super-thanks to everyone--It is nice, as Hyper Focus commented, to have some practical back-up here at PB.
fb
Posted by sigismund on April 5, 2011, at 13:57:42
In reply to Re: sensible help needed with norco » floatingbridge, posted by SLS on April 5, 2011, at 5:31:34
>Without getting too technical, withdrawal seems to be due, in part, to kindling. AEDs (anticonvulsants) would be a logical choice if this were true.
I am doubtful about the kindling theory, I suppose because it upsets the nice mathematical feel of so much pleasure given having to be paid back with precisely the same amount of pain. But you should see me stacking the dishwasher, so that's probably an OCD variant.
Nonetheless I know that gabapentin would be really useful in opiate withdrawal, just as it is so helpful for pain.
Posted by floatingbridge on April 5, 2011, at 16:03:35
In reply to Re: sensible help needed with norco, posted by sigismund on April 5, 2011, at 13:57:42
Sigi, its cousin, Lyrica, walked me through a pristiq/cymbalta taper. There were serious sides to the Lyrica for me, however, I think it's good to have out there in common knowledge as a tapering tool.
fb
Posted by sigismund on April 5, 2011, at 17:37:20
In reply to Re: sensible help needed with norco » sigismund, posted by floatingbridge on April 5, 2011, at 16:03:35
Yeah, Lyrica sounded too strong and too toxic for me.
I never used gabapentin to taper opiates, but I know enough and have read enough to know how useful that type of drug could be.
I have a mild case of shingles at the moment and that is what gabapentin is supposed to be for, isn't it? And it does help in a way that a benzo would not.
Posted by sigismund on April 5, 2011, at 18:13:07
In reply to Re: sensible help needed with norco » floatingbridge, posted by sigismund on April 5, 2011, at 17:37:20
The other thing I have found helpful is to see the pain as something you welcome. Since you don't welcome it, this presents problems. So you do some voodoo number on yourself where you say you do. I can do it with this pain I have now, but then it's not really bad either. I can say it is from God or like being touched by someone I love. I can say anything. It sort of helps to pass the time while it happens.
Posted by Phillipa on April 5, 2011, at 23:34:13
In reply to Re: sensible help needed with norco, posted by sigismund on April 5, 2011, at 18:13:07
Sigi there is a vaccine for shingles. Can't have it when active but if you had the chicken pox as you know shingles comes out after a certain unmentionable age. It could strike again and it's very painful. Hope it's starting to heal. PJ
Posted by floatingbridge on April 6, 2011, at 11:06:55
In reply to Re: sensible help needed with norco, posted by sigismund on April 5, 2011, at 18:13:07
Well, Sigi, sorry that you have had to learn secret methods for pain reduction whatever the reasons. Shingles can be awful from what I understand. The gabapenitin helped my MIL through a bout and isn't there evidence to suggest it helped post-hepatic nueralgia from more deeply engraving a pathway as well as give pain relief?
Thanks for the encouragement. After what happened on Lyrica (I started thinking I had stroke! Very odd thought for me), I am 2x shy about anything new. But I won't say never :|
Posted by sigismund on April 6, 2011, at 14:17:11
In reply to Re: sensible help needed with norco » sigismund, posted by Phillipa on April 5, 2011, at 23:34:13
>Sigi there is a vaccine for shingles
Really? I must get it when this is over. I can see it could be awful.
Posted by sigismund on April 6, 2011, at 14:21:52
In reply to Re: sensible help needed with norco » sigismund, posted by floatingbridge on April 6, 2011, at 11:06:55
>isn't there evidence to suggest it helped post-hepatic nueralgia from more deeply engraving a pathway as well as give pain relief?
I have heard that. A chemist was good enough to give me some Tagamet, an old heartburn antihistamine drug which helps in some way. And I actually have gabapetin.
If it is like herpes simplex, outbreaks may lead to more outbreaks too.
Posted by mtdewcmu on April 6, 2011, at 17:46:44
In reply to Re: sensible help needed with norco » Phillipa, posted by sigismund on April 6, 2011, at 14:17:11
I'm pretty sure there is no point in getting the vaccine if you've already had shingles.
http://www.cdc.gov/vaccines/vpd-vac/shingles/vacc-need-know.htm
Posted by floatingbridge on April 6, 2011, at 19:20:19
In reply to Re: sensible help needed with norco, posted by mtdewcmu on April 6, 2011, at 17:46:44
Yes, I agree with mtdew. Though my MIL was told that when an outbreak occurs, minimize it with some high-powered antiviral (forget the stateside name); darn little b*gger virus travels along its favorite neural pathways in layman's terms.
So for my MIL, her outbreak was along the scalp down towards the left eye. Doc was glad it stopped at the brow and did
not affect the left ear. Her blisters were minimal. Most commonly affects the trunk. Inhabits the spinal column, yes?Sorry sigi. Is this recent?
Weighing risks and benefits of vaccine for the kid, we went for the chicken pox shot just to minimize our bub's chances of shingles later. About 85% effective, the pox shot is, I've heard.
My hubby needs to get a shingles shot....
fb
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