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Re: Why do meds constantly stop working for me? undopaminergic

Posted by SLS on September 25, 2021, at 7:19:24

In reply to Re: Why do meds constantly stop working for me? SLS, posted by undopaminergic on September 25, 2021, at 0:55:27

> >
> > If there is any drug worse than Zyprexa (olanzapine) for producing weight gain, it would be clozapine (Clozaril), the original atypical antipsychotic.
> >
> Olanzapine (Zyprexa) is a little worse according to what I've read, at least as far as diabetes risk is concerned.

I didn't know that, but I very much trust your esoteric knowledge. <wink> Thank you.

> > I think the two drugs are chemically related, but I'm not sure.
> >
> They both have the three rings like TCAs, and one additional, piperazine, ring, making them tetracyclic.

Remember, adding a single chlorine atom turns imipramine into clomipramine (Anafranil). Sometimes, a very small change in chemical structure can make a huge difference in pharmacodynamic and clinical activity. Tramadol (Ultram) is labelled an "opioid". However, it does other things pharmacologically. Tramadol is a derivative on venlafaxine (Effexor), yet possesses some, but insufficient, antidepressant activity to be given an indication by the FDA to treat MDD or BD.

Tramadol is a only weak agonist at the opioid receptor compared to all other opioid analgesics. I didn't want to hit my mother's doctor with "esoteric" facts, but, like venlafaxine, tramadol is an SNRI if you discount its opioid receptor agonism. Of course, we can't, but it is conceivable to me that the inhibition of both the serotonin and norepinephrine transporters (reuptake inhibition) works synergistically with opioid agonism to produce a stronger analgesic. Duloxetine (Cymbalta), another SNRI, was touted as being particularly capable of reducing the sensation of pain (nociception) when it is used to treat depression. In fact, this property was the focus of mass-media advertisements by Johnson & Johnson.

The following is one of my many rants:

I have yet to hear of a single case of someone becoming physiologically dependent on tramadol. My guess is that if there are, they must be very few in number. I have not seen an avalanche of medical literature reporting such sequlae with tramadol. The point is that the clinicians who prescribe tramadol think of it as an addictive opioid to be avoided if possible. And then, they are very reluctant to prescribe it as a long-term treatment as an analgesic. Many people get significantly greater pain relief from tramadol than they get from ibuprofen or naproxen monotherapy. I'm thinking that the weak opioid activity of tramadol is amplified by the extant reuptake inhibition of norepinephrine and serotonin (SNRI), leaving tramadol much less liable to produce opioid dependence and an opioid discontinuation withdrawal syndrome.

Tramadol is not one of the "evil" opioids that are invaluable, but now avoided because members of the public at large use it recreationally. Excuse me. F*ck the law-breaking, hedononistic members of the public who abuse this drug illegally, and therefore make opioids out to be in alliance with the Devil. Meanwhile, people in severe, and often chronic intractable pain can't find a doctor who is willing to mitigate their suffering. You can't blame doctors, though. Some legally prescribed opioids are extremely problematic when it comes to physiological dependence and severe withdrawal symptoms. Not everyone experiences euphoria, gets "high", when taking an opioid. I don't have any statistics to produce, but my guess is that a sizeable percentage, likely the majority, do not receive a euphoric effect from Percocet. Those who do are screwed, though.

Fentanyl is often the only substance that has the ability to relieve cancer patients of the severe pain they experience. To my knowledge, Fentanyl is the most powerful opioid analgesic in the world. Now, everyone is screwed. Damned public.

By the way, there is a new product that combines ibuprofen with acetaminophen (in one pill). Of course, it is much cheaper to buy the two generic products separately. It works stunningly well for my mother, for whom tramadol isn't always sufficient.

- Scott

Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.




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