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Re: elizabeth about dosing on opiates/ anyone Chuckie

Posted by Ame Sans Vie on October 31, 2003, at 14:45:25

In reply to Re: elizabeth about dosing on opiates/ anyone, posted by Chuckie on October 31, 2003, at 13:21:20

> I'm glad you're finding relief w/Ultram.

Thanks, but unfortunately I had to discontinue it last week. It was worsening my fibro pain so much that I had trouble ever getting out of bed.

> I had big hopes for it since it's not properly an opioid and really represents a low risk of addiction. I mean I'm sure you can get dependent on it, but I think that's a small price to pay for the relief, whatever the drug. It would just be nice to be dependent on something that doesn't hurt so bad if you have to stop for some reason.

Well, the addiction risk is pretty low, you're right about that, but the withdrawal is insane. It's not opioid withdrawal -- there are none of the typical opioid abstinence symptoms. It feels exactly like Paxil or Luvox withdrawal, which makes me think that its "mild 5-HT/NE reuptake inhibition properties" aren't quite so mild as they think. I started taking Prozac and quit the Ultram that very day -- once I had the 5-HT/NE action of the Prozac in my system, the withdrawal was a piece of cake. The other times I tried to quit I was constantly contemplating suicide.

> Unfortunately it doesn't work for me, because it makes me feel yucky, among other bad things. It reminds me of tricyclic anti-depressants, which I took for ten years to no real effect except I got fat and felt yucky most of the time.
> It certainly doesn't provide the 'normalizing' effect that I was looking for. It does remove my craving for opiates, which is nice I guess, but wasn't really my point. Not much help if it doesn't help my depression and makes me feel bad as well.

That's too bad... one thing I've noticed myself is that lower doses can be more sluggish and tricyclic-feeling (yuck) while dosages of about 400mg/day (which I was taking) are more uplifting and activating. How large was your dose?

> >Gotta take DLPA and an NMDA antagonist with your opioids though... anything you can do to prevent tolerance.
> Great, now more stuff I need to research. This is a real chore... especially when I put a medication into Google and get 20,000 hits on websites where I can buy it for too much money. :(

lol, there are some posts on this board dealing with NMDA antagonists not very long ago. I'll dig them up and post the links. DLPA is a must, though, provided you can take it. the D- isomer of phenylalanine inhibits the enzyme which breaks down endorphins and enkephalins, raising levels of those substances in our brains, and the L-isomer primary goes on to form thyroid hormone, tyrosine, dopamine, norepinephrine, epinephrine and alpha-phenylethylamine. Plain DPA is available if you don't want the stimulating element of LPA.

> Still, since one of my goals must needs be to convince my Doc that I'm not going to abuse the drugs, I need to learn about whatever helps assure that.
> So, maybe he would just prescribe me hydrocodone, if he could prescribe an opiate antagonist at the same time? And would the medication still be effective?

Sure -- this is something that is actually just now catching on in pain clinics. An opioid (usually morphine) is prescribed along with a small dose of naltrexone; the morphine's action isn't inhibited and tolerance build-up is often very much delayed.

> I'm not a medical professional or a pharmacist, so I'm unsure how exactly the medication benefits me.

Well, I personally feel that depressed people who really, truly feel "right" on narcotic analgesics (as in not just "high") probably have some sort of endogenous disfunction/deficiency involved with opioid peptides. Not an original idea by far, but it's one that I've read quite a bit about and which seems to make plenty of sense.

> IOW, I was investigating the mixed agonist/antagonists because of their lower potential for addiction or abuse, mostly for the benefit of my Doc, so he wouldn't be so reluctant. Personally, I know I can take care of myself and self-regulate, but he has to justify himself to the DEA. Anyway, to my limited knowledge, it just seems like an antagonist might cancel out the benefits. But then I can't rely on intuition when I'm asking for a treatment that most people find counterintuitive.

Like I said, not a problem whatsoever -- I believe that the antagonists don't actually begin to block binding of exogenous opioid agonists when taken orally except at doses somewhat larger than those used for tolerance prevention. But that raises the question, "how do they work at such low doses then"? I'll have to look into it, lol.

Also, the dextromethorphan I mentioned would probably be less expensive to use than naltrexone (I have no clue how much naltrexone costs; DXM is OTC at less than $20 for a month's supply. And probably is more effective. A morphine/dextromethorphan product called MorphiDex is being studied now, with good results.

> > Finally, just wanted to note that there is also a form of buprenorphine sublingual tablets available without the naloxone, called Subutex.
> Yah, but can a GP prescribe it for something other than addiction?

They can be prescribed for off-label usage, but the physician must have a special second DEA number which authorizes him/her to prescribe Subutex/Suboxone. Just curious, do you just see a GP -- not a psychiatrist?

> And I've heard the stuff is REALLY expensive. I can probably cope with something that costs maybe $100/mo., just because I would probably be $100/mo. more productive. Much more than that would maybe interfere with the bill-paying.

Oh yeah, I'm sure it's enormously expensive. There is the injectable form though (not sure about the price on it) which can be taken intranasally or sublingually to avoid injections.




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