Posted by Ame Sans Vie on April 8, 2004, at 16:33:54
In reply to Tramadol: headache at first or always? Ame, anyone, posted by spoc on April 8, 2004, at 10:10:04
> Anyway, I planned to attempt to still just use it occasionally, but not quite as cautiously, maybe a few times a week. Mainly to get over the worst hump, and then if it didn't seem feasible to continue with, if necessary using prozac to get off it with fewer discontinuation symptoms.
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> So for the last three days I have taken about 100 mg/day, 50 mgs. at a time, leaving latitude to start low and go higher if necessary. What I am wondering about is the fact that I notice I get somewhat of a headache when a dose is wearing off. I don't recall if that happened when I was only taking it on random days in a month. I saw that someone who is allergic to codeine may not be able to take tramadol, and I indeed have a strong sensitivity to codeine, that may have followed this same pattern: when it was prescribed for pain in the past, I had been able to take it for quite awhile before it ever gave me headaches. But now it would every single time -- horrific ones.
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> SO! I'm wondering which is more likely: that what happened to me with codeine will eventually happen with tramadol; OR, if the headaches might just be a s/e like those experienced when beginning any psy drug (which tramadol does seem to be viewed as by some). I mean, if it has similar actions and withdrawal to those of Effexor, surely getting to a "steady state" could also have some bumps. Anyone have an opinion on that? Thing is, I need to decide now whether to get more and don't want to waste the money.It sounds possible to me that you could be a poor CYPIID6 metabolizer. Codeine, hydrocodone, oxycodone, and tramadol are "activated" via this enzyme system by transformation into their respective prodrugs: morphine, hydromorphone (Dilaudid), oxymorphone (Nubain), and o-desmethyltramadol. A poor metabolizer would be more likely to have a build-up of the ingested drug lingering in their system, causing unwanted side effects when taken on a more regular basis as you describe. That is, you may have more tramadol in your system than the more active metabolite form which is considerably more potent a serotonin/norepinephrine reuptake inhibitor and mu-opioid agonist.
I would suggest that you be tested for this enzyme deficiency; I'm not sure of your ethnicity, but among caucasians it is extremely common (around 3-7%). Your doctor will administer a dose of dextromethorphan (DXM; the cough suppressant found in Vicks-44 and Robitussin) which is a drug that is metabolized by CYPIID6 into another similar drug, dextrorphan (DXO). He/she will measure the amount of DXM vs. DXO in your urine at various intervals to determine whether or not you are an efficient CYPIID6 metabolizer.
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> A second question would be, does anyone know if tramadol would actually need to be taken *every day* to have a consistent AD effect, or would taking it just a few times a week as I plan to also be feasible?I'd say that, speaking in terms of opioid effect, 100mg of tramadol is roughly equivalent to 60mg codeine; hardly an opiate dose that would provide any significant relief from depression or other psychiatric woes. From my experience, it is this minor opioidergic effect *combined* with what I consider to be a very underrated SNRI effect that causes long-lasting relief. While a single dose every now and again may help, I feel it really should be taken on a regular basis to receive full benefit of the SNRI-activity, just as you would with Effexor. And, as you prudently noted, Prozac is very important to remember should the time come that you would like to withdraw from this drug.
poster:Ame Sans Vie
thread:334061
URL: http://www.dr-bob.org/babble/20040407/msgs/334194.html