Methadone&Norco 4 neuropathy?

[Mambo#5]

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Has anyone seen methadone and Norco by the same doctor for peripheral neuropathy? Would you fill that?

 

[steveysmith54]

There are both out of stock. Sorry

 

[bacillus1]

Sure. I have seen opioids used when when all other measures fail. Methadone for long-acting pain control and norco for breakthrough pain. To be fair, I have access to patients' charts and would probably read more into it, but I don't think it's an entirely inappropriate use.

 

[sosoo]

also both methadone and norco can be prescribed for insomnia. they both work really well.

 

[Ackj]

Not that indication specifically, but I see the combination quite often in LTC. The methadone is scheduled with prn hydrocodone (or oxy) for breakthrough, as stated above.

 

[Mambo#5]

So, if you had two scripts (1)methadone 5mg #120, 1 tab q6 prn pain (2)norco 5/325mg #120, 1 tab q6 prn pain, from pain clinic and constantly gets it filled, you would fill it based on the premise that they've had it before and others have filled it. That's the rationale? And why is it they never see the same doctors in the pain clinic? Patients always say, it's from the same office.

 

[Ackj]

So, if you had two scripts (1)methadone 5mg #120, 1 tab q6 prn pain (2)norco 5/325mg #120, 1 tab q6 prn pain, from pain clinic and constantly gets it filled, you would fill it based on the premise that they've had it before and others have filled it. That's the rationale? And why is it they never see the same doctors in the pain clinic? Patients always say, it's from the same office.

I don't like having two prns without further detail, ie Norco prn pain scale 1-5, Methadone prn pain scale 6-10, or something like that. Two prns without any scheduled dose doesn't really make sense.

 

[radio frequency]

I wouldn't be pleased to see methadone used prn. I don't think I'd fill based on what you described. I also don't like filling things like this where I don't have patient charting available to me (I'm spoiled, clearly).

 

[Dred Pirate]

methadone works for nerve pain - I think I remember back to my days in school it was the preferred opioid for neuropathy - but should virtually never be taken prn - with its half life and pharmacokinetics, it simply makes no sense

 

[quickpic007]

Has anyone seen methadone and Norco by the same doctor for peripheral neuropathy? Would you fill that?

Maybe if I have a tip jar at the pick up window.

 

[BidingMyTime]

Yeah, a long-acting and a short-acting combo makes sense, that I would fill. Also, I guess it would depend on the clinic, but a lot of clinics geared towards low-income have rotating doctors either volunteering their time or they are being staffed with residents, so I also wouldn't be bothered by a different dr each time, if it's coming from the same clinic.
But the PRN methadone makes zero sense, it definitely sounds like the kind of thing that all the doctors coming after the 1st doctor to prescribe this kept doing, just because that was what the pt was on, and all the pharmacists after the 1st one kept filling it, because that was what the pt was on....but it makes zero sense. Of course, it sounds like the patient is taking it scheduled anyway. But why q 6 h? psychosomatic? is the patient an outlier who metabolizes it faster than everyone else? Seems like 10mg BID or even just 5mg TID would make more sense.