Variable Dose = Reduced Tolerance?

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sming Says:


Hi,

I'm taking 2x5mg oxycodone (mallinckrodt) 4 times a day (so effectively 10mg 4 times a day) for chronic abdominal pain, probably from adhesions.
- I dose 4 times a day since I get about 4 hours out of each dose.
- I take 2x5mg in order to get mallinckrodt since the pharmacy only has Zydus 10mg which is ineffective for me.

Question 1: let's say I can occasionally get away with 1x5mg for a 4 hour period instead of 2x5mg ("variable dosing"). Will this suppress tolerance build-up better than sticking to 2x5mg for every dose ("consistent dosing")?

An example. Is variable daily dosing like this:
5mg 10mg 10mg 5mg
10mg 5mg 5mg 10mg
10mg 10mg 5mg 5mg
...

less tolerance-building than consistent daily dosing like this:
10mg 10mg 10mg 10mg
10mg 10mg 10mg 10mg
10mg 10mg 10mg 10mg
...

Question 2: can variable dosing be more effective at pain management longer term? I could easily believe that either is best and that it's also idiosyncratic (i.e. YMMV), I'd just like someone knowledgeable to chime in on that.

Best wishes to all you fellow chronic pain folks and many MANY thanks, this forum is a life-saver.
Pete



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Mf Says:
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Prabably yes to both. Yes you will be less tolerant to the medicine if you reduce med when u can. But over every 24 hr period if u r taking 4 or 6 tablets daily you will need a prolonged reduction to get off the medicine. So when u can take less, but at some point, like every 8 hrs you will need to take a maintenance dose to keep a baseline going, until u can get down to 3 per day, preferably with a valium at night will help everything else. Half of the pain I feel is musculature in nature.

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VerFree Says:

Yes, some people can adjust their doses to help prevent tolerance from occurring. Some doctors even instruct their patients to occasionally take a medication holiday to help prevent it.

The FDA warns that Oxycodone carries the risk of being habit forming, and may cause side effects, such as nausea, dizziness, headahe, constipation, and dry mouth.

How effective it is depends on the person, since we are all different. I rarely take opiates, now, after having been on pain management for years, but when I did for a few days, after a bad fall on ice, they worked wonderfully, however, I someone I've been friends with for many years has never taken any of them regularly, and most of them do nothing for him, at all. The doctor once gave him Fentanyl patches, and when he tried them, he might as well have not been using anything. It's almost like he's immune to pain medications. This is why I say we are all different.

I am now dealing with arthritis in my left elbow, and I've noticed that if I mix up what I take for it, I get the best results, for example, one day I take Acetaminophen, then the next day Ibuprofen, then the next day Aleve. I also rarely take more than one a day, my doctor instructed me to also use Voltaren gel, and it helps a lot, but I only use it twice a day. I've gotten great efficacy this way, and it leaves me somewhere to go for relief, if the pain worsens with time. This type of thing may not work for everyone, though.

Has anyone else tried variable dosing?

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