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Re: Effexor an opiate? Probably not. JANNBEAU

Posted by Elizabeth on December 12, 2001, at 15:29:04

In reply to Re: Effexor an opiate? dhldn, posted by JANNBEAU on December 12, 2001, at 11:53:16

> By the way, in the U.S., Ultram is NOT yet a controlled substance (although there are rumors that the FDA is moving that way--I figured out the narcotic properties of tramadol by reading the literature on the drug).

It's true; Ultram is an opioid agonist, albeit a very weak one. I think it will probably be placed in Schedule IV. (BTW: "narcotic" really is more of a legal term than a medical one and probably isn't appropriate to use in a medical context because of its ambiguity.)

> Is it possible that tramadol has some sort of "mixed" profile in that the parent drug may act primarily on serotonin, norepinephrine, and, perhaps, dopamine, while the principal metabolite has a higher affinity for the mu opioid receptors?

I don't know what contributions are made by tramadol itself vs. O-desmethyltramadol (M1), but Ultram does have weak effects on serotonin and norepinephrine reuptake (I've never seen anything suggesting it's also a dopamine reuptake inhibitor). It's unclear how clinically significant these effects are, however.

> Certainly, pain relief from tramadol seems to be delayed for several hours (6 hrs--the time it takes to get significant AUC for principal metabolite?).

The reports that I've heard have suggested it's more like three hours. Still quite a delay, though.

> If anything is deceiving, it is that the manufacturer of tramadol has claimed for five years that tramadol (Ultram in the U.S.) is not addictive! We've heard that one before, haven't we?

< g > Did you know that heroin was originally (when it was marketed as a cough syrup) supposed to be a less addictive form of morphine?

Personally, I don't get any mood elevation from tramadol at the doses that are accepted as safe. FWIW.

> You might not remember the hype when DARVON was first approved, but I do (I'm old!).

Yeah, you're really dating yourself here! :-)

> I resent it that I received NONE of this information for Effexor (venlafaxine) OR tramadol prescribed concomitantly.

I really doubt that Effexor is an opioid (or if it is, it's probably *extremely* weak), although it might be interesting to try to find out for sure. But there is a risk (of the "serotonin syndrome") when Effexor or SSRIs are prescribed with tramadol -- generally the combination isn't recommended. Again, this applies to SSRIs (and MAOIs, for that matter), not just Effexor. It definitely does not mean that Effexor is an opioid.

> I WOULD like to state that I noticed an immediated and dramatic reduction in my pain level when I started EFFEXOR XR (37.5 mg qd; I have chronic "intractable" pain from extensive degenerative changes in my cervical and thoracic spine, costochondral joints, knees, etc).

A lot of ADs relieve pain (tricyclics were the first ones used for this); it doesn't mean they're opioids. Nardil relieved my back pain completely for the entire time I was taking it. I didn't notice the effect (the pain has had a relapsing and remitting course) until I stopped taking Nardil the second time and the pain came back with a vengeance immediately.

> The structure and opiod [sic] properties of Effexor may, also, account for the stories of difficulty discontinuing Effexor.

No. Effexor withdrawal symptoms are not similar to opioid withdrawal. They do, however, resemble the withdrawal symptoms that are often reported with SSRIs (especially Paxil, but also sometimes others).

> The signs and symptoms are strangely similar to those of any narcotic withdrawal syndrome, are they not?

What withdrawal symptoms associated with Effexor do you think are similar to opioid withdrawal? I haven't heard of any such thing.





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