Targin and nausea

[Walmer3463]

I have been taking Targin (Oxycodone plus Naloxone) for about a year. I have experienced nausea for much of the time but not when I first started taking it. I take a low dose of either 5 or 10 mg Oxycodine (combined with 5 or 2.5 mg Naloxone) each night. Has anyone else experienced nausea on such a low dose of this opiod? The drug is effective in controlling my RLS.

[SueJohnson]

Nausea is a common side effect of opioids. Have you tried cannabis? Otherwise there are a number of anti nausea medicines that are safe for RLS. Kytril (Sustol, Granisetron, Sancuso), Anzemet (Dolasetron), Zofran (ondansetron) are the ones most commonly prescribed although there are others. Discuss these with your doctor.

[Walmer3463 in reply to SueJohnson]

Thanks Sue for your helpful advice on nausea and opioids.

I am now changing over to Lyrica and have a few queries. I understand you should increase the dose every few days. Should this increase be 25 or 50 gms and how high a dose should I take before concluding that this medication doesn't have an impact? I note that you are taking 250 gms. My RLs are not on the extreme, end of the scale, more medium level and mainly at night.

Last query is about Gabapentin. If Lyrica is not effective is it worth trying Gabapentin or is that drug likely to be ineffective too. I seem to remember you wrote that about a third of people don't respond to these drugs.

[SueJohnson in reply to Walmer3463]

Wait 3 weeks before increasing since it takes that long for it to be fully effective. After that increase by 25 mg every 2 days. Most of the side effects of pregabalin will disappear after a few weeks and the few that don't will usually lessen. Those that remain are usually worth it for the elimination of the RLS symptoms. . According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 200 to 300 mg pregabalin daily."

If pregabalin doesn't work, then it is extremely unlikely gabapentin would. The main reason to switch is that some people find that the side effects that bother them on one don't bother them on the other.

If you find it doesn't work then come off it slowly reducing by 25 mg every week or two to avoid withdrawal effects. If you do so, you won't have any.

I have no idea how many people don't respond to them. If one has been on dopamine agonists for a long time the dopamine receptors may be damaged and then one would not respond to gabapentin or pregabalin.

[Walmer3463 in reply to SueJohnson]

Thanks for the detailed reply Sue. When you say wait 3 weeks do you mean wait for this time after starting on an initial small dose of Lyrica. I am still taking 5 mg of targin, is this a problem? I haven’t been on dopamine agonists for 18 months.

[SueJohnson in reply to Walmer3463]

Wait 3 weeks after starting lyrica. I don't think there is any problem taking targin at the same time unless you have breathing problems.