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 Post subject: Ritalin for fatigue
PostPosted: Thu Nov 10, 2011 2:27 pm 
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Brief about me: 45+ male, I was a legal user of oxy 30's for over 4yrs, reached tolerance (180mg daily) went on Sub (6 mns ago) to get off opiates, stayed on Sub for pain relief...2mg 4 times a day (film)<p>

I was having extreme fatigue during the day and just had to sleep every morning for another 4+ hrs.
After relating this the past 2 months to my pain dr and he just prescribed Ritalin (10mg 1/2 2X) to see if it would help, I also take Zanaflex at night to help sleep through night. Anyone else have this or heard of this??


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PostPosted: Thu Nov 10, 2011 9:02 pm 
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If you have never been on ritalin for ADHD/ADD, I would think that's kind of eXtreme..? ya know, rather, he just gave ya a C11 for a problem that could be fixed maybe someother way. I dont know about these(ADD) meds,seems drastic/ oh, 4mg of skelacksin will pass a good man out. all those parafon forte and stronger muscle relaxers can take you for a loop....keep that in mind, now u r just throwin in speed?(shrug)


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 Post subject: Re: re:
PostPosted: Fri Nov 11, 2011 1:17 am 
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indigochild wrote:
If you have never been on ritalin for ADHD/ADD, I would think that's kind of eXtreme..? )


No, never been on the stuff before, don't have any ADHD/ADD....I trust this doc and he has always been right on with his diagnosis and meds. It was another doc that I went to (cause of insurance) that had me on the oxy 30 IR's and messed me up. I really don't like being on Sub.


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PostPosted: Fri Nov 11, 2011 8:57 am 
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I agree with indigo. You're taking zanaflex (Skelaxin is a different muscle relaxant) at night to sleep - that could easily be leaving you fatigued the next day! And your doctor is now giving you Ritalin to counter act the possible side effects of a different medication that you're on? That just doesn't make much sense to me. And the same doctor prescribed both of these meds to you?

Also, if you're taking 8 mg a day for pain, you could try bumping that down to 6 mg and see if that helps your fatigue also. It could be a side effect of suboxone and dropping your dose might help too. I just think going on an ADD/ADHD med (amphetamine) when you don't even have that diagnosis is foolish at best, especially when it's an addictive medication given to someone with a history of addiction. Please be careful.

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PostPosted: Fri Nov 11, 2011 1:38 pm 
Hi Sparky! Sorry you're not feeling your best and for what you've been through with the pain meds, etc.
I'm going to throw out a little bit different opinion that the others.....not that I think they're off base with their concerns about the Ritalin. It is a controlled substance and it does have a high potential for abuse.
However.....If I read you're intro correctly and if there's not a whole lot more to your story.....It sounds like you landed on Suboxone because of a physical dependence on opiate pain medication for a legitimate pain condition (tolerance kept going up, you'd get sick if you tried to get off, etc) as opposed to a full-blown addiction (no legit pain, acquiring meds illegally, running out early, cravings for the drugs and so forth.) If that's the case and you are not an addict or alcoholic, and are on Suboxone for dependence and chronic pain, your physician may not be out of line at all by prescribing you a trial of Ritalin.
You mentioned that you trust this doctor thus far and he seems to be trying to address your problems, so I don't think I'd rush to a poor judgment of him based upon this. In my opinion, one dose of Zanaflex at night (assuming it's a 'normal' dose) shouldn't cause your extreme fatigue, especially if you've taken the Zanaflex for a while and you don't take throughout the day.
The other thing I'm wondering is (as Hatmaker suggested) if perhaps you and your doctor might consider lowering your Sub dose....knock out one of those 2mg doses each day and see if that helps. In my opinion and based upon lots of other Sub user's accounts....after being on Sub for a number of months or sometimes years, we sometimes notice a lack of energy, fatigue, amotivation and such. So sometimes a lowering of dosage will help with that. I suppose in your particular case, your pain levels come into play as well.....will your pain be controlled on less Sub?
Also, it's not unheard of for doctors to prescribe Ritalin for problems other than ADD. It is used sometimes for chronic fatique patients and sometimes for other chronic medical conditions which effect concentration and cause drowsiness. Plus he's started you on 10mg/day in divided doses, which is a pretty low dose.
Anyway....just another viewpoint on your situation. Hope that helps you and hope things get better!


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PostPosted: Fri Nov 11, 2011 3:16 pm 
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For once i agree with indigo, this is rather extreme for something like fatigue. I mean before putting you on legal speed should he of tried something a lil less extreme? I mean shit drink a red bull before you start taking uppers that strong.

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PostPosted: Fri Nov 11, 2011 3:24 pm 
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your doc sounds like a quack no offense but ritalin for a side effect of another medication is usually one of the last resorts. Have you tried dopamine/norepinephrine/epinephrine precursors? This should drastically help (I would know as I was having troubles with over-sedation but started taking supps for it). I recommend DLPA and/or l-tyrosine to help with the drowsiness. Also astragalus is an herb that can help as well as rhodiola. I take a product called SynaptaGenX which has all of these these herbs/amino acids in it.

The only downside is its quite pricey. Here's the link if you are interested. Natural Dopaminergic Activator

Here is a list of the ingredients if you choose to try some of the things in it:

"Thiamine,15 mg (1033% of Daily Value); Vitamin B6, 10 mg (500%); Chromium polynicotinate (as ChromeMate®) 200 mcg (166%); a fixed dose combination of amino acids and herbs called Synaptose™ , which contains DL-Phenylalanine, L-Tyrosine, Passion Flower Extract; a Metalloglycoside™ Complex containing Arabinogalactans, N-Acetylglucosamine, Astragalus, Aloe Vera, Frankincense Resin, White Pine Bark Extract, and Spirulina; Rhodiola (as RhodiGen™; L-Glutamine; 5-Hydroxytroptophan (5-HTP); Thiamine Hydrochloride; Pyroxidal-5-phosphate; Pyridoxine HCl; and Chromium polynicotinate"


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 Post subject: Ritalin for Fatigue..
PostPosted: Sat Nov 12, 2011 3:27 am 
It is not unheard of to treat CFS or other sleep disorders with Ritalin or amphetamines. Ritalin by the way is not technically an amphetamine but closely resembles one. It's obviously a schedule II controlled substance and has almost identical precautions as amphetamines. 5mg twice daily is a low dose but at the same time it's a potent drug. Like all controlled substances less a couple, tolerance develops and the dosage becomes less effective after time also. Stimulant medications are used to treat fatigue, but I don't think they are the most effective or typically the first choice. If it were me, I would ask about and try other options before I tried Ritalin. Obviously your doctor is privy to information no one here is, though. At the very least I would ask him/her to explain to me the rationale for being placed on this medication before trying anything else.

-Travis


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PostPosted: Sat Nov 12, 2011 3:40 am 
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setmefree wrote:
I'm going to throw out a little bit different opinion that the others.....not that I think they're off base with their concerns about the Ritalin. It is a controlled substance and it does have a high potential for abuse.
However.....If I read you're intro correctly and if there's not a whole lot more to your story.....It sounds like you landed on Suboxone because of a physical dependence on opiate pain medication for a legitimate pain condition (tolerance kept going up, you'd get sick if you tried to get off, etc) as opposed to a full-blown addiction (no legit pain, acquiring meds illegally, running out early, cravings for the drugs and so forth.) If that's the case and you are not an addict or alcoholic, and are on Suboxone for dependence and chronic pain, your physician may not be out of line at all by prescribing you a trial of Ritalin.
You mentioned that you trust this doctor thus far and he seems to be trying to address your problems, so I don't think I'd rush to a poor judgment of him based upon this. In my opinion, one dose of Zanaflex at night (assuming it's a 'normal' dose) shouldn't cause your extreme fatigue, especially if you've taken the Zanaflex for a while and you don't take throughout the day.......Anyway....just another viewpoint on your situation
.!


"setmefree" You are spot on with your analysis & insight....one of the great things about this forum is its diverse opinions, my intent was to see if any one else had experienced the same situation or had knowledge of it, so I appreciate opinions and thoughts of all.
That being said - OMG, I wish all I had to do was down a Red Bull or 5 hr Energy to be alert. I've tried them all, the fatigued is definitely opiate induced. I've been down to 1/8 film (1mg) per 8 hrs, but the pain (foot surgeries, back) way too intense for that dose. And the Zanaflex really knocks me out at night and controls the back spasms, but does not have the residual, hung over feeling like say Xanax may produce. I wish I could take the Zanaflex during the daytime, but I can't.

I've been on the dose (5mg morning & 2.5/5mg noon) for less than a week and I don't feel any effects of the Ritalin. I thought it was supposed to act quickly, so it might be too low of a dose. This is not a long term solution, but a trial to see if I can function as close to normal as possible until my next appointment.

Thanks again for everyone's input and thoughts on the matter....it has helped.


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PostPosted: Sat Nov 12, 2011 3:53 am 
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You know, I have chronic fatigue syndrome, too, and see a rheumatologist for it. Who manages that condition for you? Have they done blood work? What my doctor told me was that my levels of Carnitor/Carnitine, Vitamin D, and some Vitamin B's were low- normal and other doctors believed it to be fine. Well, according to him it was likely contributing to my fatigue. So he prescribed supplements to raised those levels, including a prescription for Levocarnitine that I continue to take. This supplement ALONE has done wonders for my fatigue (and BTW if I don't take it my fatigue comes crashing back).

This is just ONE thing that could at least be tried before other more drastic measures. That's all I'm talking about.

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 Post subject:
PostPosted: Sat Nov 12, 2011 4:21 am 
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sparkyinfla wrote:
"setmefree" You are spot on with your analysis & insight....one of the great things about this forum is its diverse opinions, my intent was to see if any one else had experienced the same situation or had knowledge of it, so I appreciate opinions and thoughts of all.
That being said - OMG, I wish all I had to do was down a Red Bull or 5 hr Energy to be alert. I've tried them all, the fatigued is definitely opiate induced. I've been down to 1/8 film (1mg) per 8 hrs, but the pain (foot surgeries, back) way too intense for that dose. And the Zanaflex really knocks me out at night and controls the back spasms, but does not have the residual, hung over feeling like say Xanax may produce. I wish I could take the Zanaflex during the daytime, but I can't.


Firstly, I just gotta say that it's unlikely people here know your doctor, and none of us can really write him off as a quack based on a few lines of text on a forum. He knows more about you and your history than any of us. Keep him as your no1 guide IMO.

I don't know much about Zanaflex, and only a little about Ritalin. But I read that Zanaflex has a half life of 2.5 hours, so it shouldn't really leave you groggy through the day.

I tell you, Suboxone does make me fatigued, in a weird way though. Sometimes I just get an attack of exhaustion. I'm finding it harder to work full time hours, and keeping in a routine, unless I spend a day of my weekend sleeping. Suboxone is weird like that. It stimulates me after I take it, and I find it hard to sleep, yet overall I need nearly 2 hours more sleep a night! Strange.

I know from personal experience that lowering one's dose makes us less fatigued, and in the long run. I'm no doctor, but it would have made more sense to me to drop your Suboxone dose a bit before resorting to the stimulants. When I was in the psychiatric circuit, I'd get put on a medication, then my doc would add another one to offset its side-effects, then another to fix its side effects, then another. At one stage I was taking a medicine cup full of pills (about 15-20) twice a day. I had to take some control back, say "WTF doctor, I'm feeling heaps worse than when I was on 2 medications". Now it's years later, I'm still on those two, and I feel much better. It's a trap some doctors fall into easily. Just thought that could help down the road.

Good luck!


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PostPosted: Fri Nov 18, 2011 11:00 am 
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you really should give those herbs/supplements that I mentioned earlier a try. I have been taking 2 every morning and I have been able to reduce my sub dose by HALF in a weeks time. I think I can go even lower too. I think DLPA is one of the most effective ones.


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PostPosted: Sat Nov 19, 2011 10:50 pm 
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tearj3rker wrote:
.....I tell you, Suboxone does make me fatigued, in a weird way though. Sometimes I just get an attack of exhaustion. I'm finding it harder to work full time hours, and keeping in a routine, unless I spend a day of my weekend sleeping. Suboxone is weird like that. It stimulates me after I take it, and I find it hard to sleep, yet overall I need nearly 2 hours more sleep a night! Strange.
I know from personal experience that lowering one's dose makes us less fatigued, and in the long run. I'm no doctor, but it would have made more sense to me to drop your Suboxone dose a bit before resorting to the stimulants...
...


Thanks for your input....I can attest to your experience....The reason my Dr. supplied the Ritalin was that I am going back to work (after 2+yrs!) and needed something or I couldn't function very well. If I lower my Sub dose to counteract the fatigue then the pain is too intense, so it is a tradeoff. The Ritalin is not meant to be a long term solution, but something to help me as I go back to work. I start work Monday and its been about 10 days on the Ritalin, fatigue is a little better, but I don't want to increase the Ritalin dose right now. I'll just see how it goes the first week.

Speaking of going back to work, I took a UA for employment and was expecting to hear from the testing facility about the Sub and/or Ritalin. But I heard nothing and got called by employer for a start date. So those that say Sub does not show up on a UA drug screening are correct in my case.

Thanks again for everyone's input.


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 Post subject: Hey Sparkyinfla .......
PostPosted: Sun Nov 20, 2011 8:15 pm 
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I do have a lot of experience with Zanaflex, took it for yrs before my cervical fusion.. Add the fatigue from being on Suboxone to the morning somnolence ( big word for tired and not awake ) from the Zanalex and your ass will be dragging all day, been there done that.... Watch those sleep assit meds.... I hate that tired feeling sooooo much, Hell Nyqil is better than Zanaflex , another good drug to help with sleep so you dont feel like shit in the morning is is Zanex ER ( the smallest dose amount only ) that would be .05 mg .... I,m not a Dr but have been thru alot concerning this issue, best thing to do is to work on ways to sleep without any of these meds, Zanaflex will make you feel worse than waking up 2-3 times a nite


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PostPosted: Mon Nov 21, 2011 1:04 am 
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Painter wrote:
I do have a lot of experience with Zanaflex, took it for yrs before my cervical fusion.. Add the fatigue from being on Suboxone to the morning somnolence ( big word for tired and not awake ) from the Zanalex and your ass will be dragging all day, been there done that.... Watch those sleep assit meds.... I hate that tired feeling sooooo much, Hell Nyqil is better than Zanaflex , another good drug to help with sleep so you dont feel like shit in the morning is is Zanex ER ( the smallest dose amount only ) that would be .05 mg .... I,m not a Dr but have been thru alot concerning this issue, best thing to do is to work on ways to sleep without any of these meds, Zanaflex will make you feel worse than waking up 2-3 times a nite


I've had experience with several muscle relaxers & Zanaflex works best for me without morning after hangover, whereas
Xanax ER stayed with me the whole rest of the day had to stop taking it. It really depends on the individual it appears. Don't get me wrong, Zanaflex is not perfect, but it's working okay for me right now. The Sub caused fatigue seems to be responding to the Ritalin (as stated earlier).

Thanks so much for your information.


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PostPosted: Thu May 31, 2012 12:29 pm 
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The information is very interesting. It made me understand something, and it is that I never knew before.

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PostPosted: Wed Jan 16, 2013 10:13 am 
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Hey I have the same issue with fatigue on Subs Films. I sometimes get an overwhelming feeling of nodding off at school or any other time I am sedentary. I take a few 5 Hour Energy Shots a day extra strength and sometimes N.O-XPLODE. They help to a decent degree but I can tend to over do it. As for your situation I would say Ritalin is going a little too far before first trying other supplements. I had a problem with Adderall even though it's a little different it can have some negative mental side effects and get you all strung out. I'm not saying to rule it out but try less extreme ways to get that energy, Good luck with everything.


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PostPosted: Wed Jan 16, 2013 2:42 pm 
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After about 6 months on Suboxone my mood, focus, motivation all plummeted.

I thought taking Adderal would potentially help boost those things back up for me. For the first time in my life, Adderal had no effect. It didn't help with any of it.

Maybe It was just my body composition, but suboxone mixed with adderal never worked for me.

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 Post subject: No fatigue here
PostPosted: Fri Jan 18, 2013 11:38 am 
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This is an old thread, so old I even already added my two cents on the use of Ritalin for fatigue back then with my old screenname but it really just goes to show that everyone is effected differently by different substances. What effects John Doe one way may effect Jane Doe in a completely different way!

Since my original post on this thread I have actually begun taking Zanaflex (which is Tizanadine, btw) up to three times daily, at least once upon waking and have never noticed any fatigue associated with it. If I take one before bed I don't feel groggy in the morning. I also, obviously take Sub and have never felt fatigue associated with it less maybe the first couple days after induction.

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