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Question about switching pain meds

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Posted 6/9/2013 2:32 PM (GMT 0)
Hi All,

I have been taking Nucynta ER for a few months now. My PM Dr. has switched me to Butran patches and I am supposed to be starting them this coming week. While I was supposed to be tapering off of the Nucynta the past week or so but my pain has been pretty bad and I have been jumping back up on the dose lately (back to 200 mg).

My question is this: is it safe for me to start the Butran on Tuesday if I totally stop the Nucynta on Monday (cold turkey, if you will)? I have had to go without the Nucynta for a few days before and the withdrawl was unpleasant but not unbearable. I've also read that Butran can "override" the effects of other drug anyway.

Thought? Experience?
Posted 6/9/2013 2:57 PM (GMT 0)
Are you taking more of the Nucynta than what is prescribed? If you were supposed to be tapering off your dose, by the time you switched to the patches you should be fine. If you go from a high dose then to a lower dose of the patches, you might feel some W/Ds. It is safe to do this, but you should not have been taking more than what your doctor prescribed because if you had tapered down to a low dose of Nucynta and went to a patch, you should feel fine.

My point here is this: does your doctor know you have not been tapering off? Is he/she okay with this?
Posted 6/9/2013 3:13 PM (GMT 0)
No, I wasn't taking more than prescribed, just the normal dose I had been on before I started the taper.

Anyway, I called CVS and the Pharmacist said because of Nucynta ER's "unique" properties and the way the body processes it, it is safe to stop taking the Nucynta one day and start taking the Butran the next.

Thanks for the input!
Posted 6/11/2013 1:35 PM (GMT 0)
I recently tried the Butrans patch and had some issues with it. For about a year, I was taking oxycontin and decided to stop using it because I didn't like how awful I felt in the morning until I took the pill (i.e. the chemical dependence). So, eventually quit.

On my next PM visit (perhaps 2-3 weeks after quitting), my PM put me on the Butrans, 10mg. After about 5hrs, it started to give me a headache, which became a migraine by 10hrs. Not long after, I took it off.

However, it seemed to help with my back pain and so called my PM for a 5mg patch. That didn't cause me a headache and after a few weeks on it, moved back to 10mg. I found it VERY effective for a few days (the first day seemed possibly too strong), but by the 4th day or so, the patch seemed to wain and by the 6th day, it wasn't doing a thing.

I went through 5 or 6 10mg patches, and that was my experience with them all. Perhaps my skin absorbs too quickly, but for one reason or another, the dosing didn't seem stable over the week.

Since Nucynta also functions as a norepinephrine reuptake inhibitor, there may be effects from its discontinuation. However, I'm not sure how powerfully it affects that receptor or if you've taken it long enough for the receptors to have been significantly modified. There's a fair bit of discussion of SSRI discontinuation, but I'm not sure if you'll find much about NRI discontinuation.
Posted 6/11/2013 10:07 PM (GMT 0)
Hi again. I haven't heard of Nucynta but I believe there are different drugs here than you have there. I was on Tramadol and my doctor said to take the Tramadol for a couple of days until the butrans got into my system then to stop taking them as you shouldn't take them at the same time. I did this and had a week of flu like symptoms before stabilising. Doctor also prescribed anti sickness tablets but I rarely used them. They gradually increased the dose to 20. I do get occasionally very tired and feel they do last 6 days rather than 7 but so far they have changed my life. I have been on my current dose since January 2013. Occasionally I take additional paracetamol and ibuprofen but its much easier to manage now. Fingers crossed for you. :-)
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