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exitwound
01-28-2006, 09:39 AM
Seeing as how I had a fairly unpleasant result (considerable nausea and near vomiting) when I tried my first 10mg dose of Methadone, for the time being I'm putting it on my list of "backup/taper/w-d" supplies.

If at the end of my prescription cycle, I'm out of my mscontin and/or hydro, my first weapon of choice has to date been my bottle of Tramadol.

Would a combination of these two make any sense? Or should they be used separately?

Anyone combined them for an end-of-month taper to get by until the next script/score?

candy
01-28-2006, 11:43 AM
The use of Tramadol when taken with Methadone can cause withdrawal symptoms. Apparently is can displace Methadone on the u-opioid receptors and cause withdrawal.

Tramadol is a great analgesic, but I just would not use it with Methadone, especially if your in the process of detox, I would be really wary of using the two together.

exitwound
01-28-2006, 01:43 PM
I'm not in detox; in fact I'm a chronic pain patient; I'm just looking for ways to round out my toolbox is all.

Paregoric Kid
01-28-2006, 02:28 PM
I've never experienced withdrawal while taking tramadol and methadone. I know several chronic pain patients who are prescribed methadone and tramadol and do not experience any bad effects. if you look through all scientific literature on tramadol you will find it says it will add to the effects of other opioids and that it has NO mu receptor antagonist effects.

exitwound
01-28-2006, 03:40 PM
PK speaks....teh newbs listen! :D

I've read SO much conflicting information about whether tramadol blocks or boosts most other opiates.

In some places, such as Israel, Tramadol is used in place of methadone/bupe as a detox med and people in such recovery programs are told that the Tramadol will block or at least greatly reduce the effectiveness of other opiates....but as we know, that kind of statement is often bullhonkey.....

mkchll
01-28-2006, 04:26 PM
Ditto to what PG and exitwound said. Never had any problems. But I've seen the warnings in the literture at the methadone clinics. Could be just a theory some Pharm company had.

Tar_Baby
02-15-2006, 09:54 PM
Actually in the methadone package insert from mallinkrodt it says that tramadol makes body produce an enzyme that remove methadone from the body.

Paregoric Kid
02-15-2006, 11:54 PM
Actually in the methadone package insert from mallinkrodt it says that tramadol makes body produce an enzyme that remove methadone from the body.
enzyme inducing effects and opioid antagonist effects ("displacing methadone from mu receptors") are completly different effects.
for example, smoking cigarettes induces liver enzymes to an extent; so if the literature you're referencing says it may induce liver enzymes that metabolize methadone then that would be an effect completly different from tramadol having opioid antagonist effects. it may speed up the elimination of methadone to a small point (ie you're dose will wear off a little sooner than normal), but it shouldn't be strong enough to throw you into withdrawal any sooner than it takes your dose to normally wear off. they are not contraindicated. and since I haven't read what you are referencing it may have been information from a single study, which wouldn't even confirm that tramadol induces the enzyme.

ontario_opiophile
02-16-2006, 05:09 PM
I would be too terrified to even take the chance that I could go into withdrawal from taking them. If I get any new medications I always research their effects on methadone. I'm paranoid about withdrawal. Who knows what it will do. Maybe it will be good, maybe it will be bad? take a tiny bit of tramadol maybe to see how it reacts with the methadone if you're going to do it so you cn minimizxe the chances of a huge withdrawal if any withdrawal occurs.

candy
02-16-2006, 05:13 PM
Tramadol when taken with Methadone acts as a agonist-antagonist and should be avoided if possible.
Of course, not everyone is going to be affected when taking both drugs together, but if you have concerns and another analgesic is available, try that and avoid a potential complication.

Paregoric Kid
02-16-2006, 07:04 PM
Tramadol when taken with Methadone acts as a agonist-antagonist and should be avoided if possible.
Of course, not everyone is going to be affected when taking both drugs together, but if you have concerns and another analgesic is available, try that and avoid a potential complication.
could you please reference a SCIENTIFIC SOURCE for your information? because I've never read one scientific paper that showed tramadol to have agonist-antagonist properties. the best you've got to argue that tramadol throws a person into withdrawal is that it MIGHT speed up methadones metabolism and that is not agonist-antagonist activity or anything close to it.

no one has ever been able to show me a single scientific paper showing tramadol to have any opioid antagonist or mixed agonist-antagonist properties and it really pisses me off when people just try and pass hearsay off as scientific fact.

if tramadol truly had the potential for antagonist activity it would be documented in scientific literature.

jab
02-17-2006, 10:01 AM
Some links..

http://opioids.com/tramadol/tramadol.html

http://en.wikipedia.org/wiki/Tramadol

There are many more if you google for "tramadol antagonist". I'm not saying that it will have a negative effect on someone using with methadone, but there is significant evidence to support that it can in some people. I say it's not worth the risk, but to each his own. And, as far as the argument that doctors prescribe both together so it's OK, I say bully. I've had doctors prescribe two meds that are known to affect each other negatively, simply because he wasn't aware.


could you please reference a SCIENTIFIC SOURCE for your information? because I've never read one scientific paper that showed tramadol to have agonist-antagonist properties. the best you've got to argue that tramadol throws a person into withdrawal is that it MIGHT speed up methadones metabolism and that is not agonist-antagonist activity or anything close to it.

no one has ever been able to show me a single scientific paper showing tramadol to have any opioid antagonist or mixed agonist-antagonist properties and it really pisses me off when people just try and pass hearsay off as scientific fact.

if tramadol truly had the potential for antagonist activity it would be documented in scientific literature.

candy
02-17-2006, 09:39 PM
Thanks Jab for putting up those links. I have seen the information regarding Tramadol and it's use with Methadone.

Not everyone will have an effect taking Tramadol and Methadone together. Some of the Benzos have been known to cause withdrawals in those taking Methadone. I imagine not everyone has this effect.

I agree that most practitioners, especially those not familiar with Methadone, might prescribe meds that could have interactions when taken with one another.

Hey I only give suggestions. I don't recommend that anyone do anything that may have potential unwanted reactions, but this is only out of concern for someone's safety and well being.

While Tramadol may not be life-threatening when taken with Methadone or even cause any ill effects, I only posted what I had read. Jab provided some links and when I have more time, I myself will provide some links as well.

Paregoric Kid
02-18-2006, 07:34 PM
Jab, neither link you provided had anything to do with tramadol and it's alleged potential for withdrawal when taking it with methadone. why would it just be methadone? come on get real if it was an antagonist it would be contraindicated with ALL opiates/opioids.
I've posted this question on bluelight before and the only information they posted back were papers saying it increased the analgesia when taken with other opioids
in a methadone drug interaction pdf I have the reference on tramadol is not under antagonist or mixed agonist-antagonist, but notes there were anecdotal reports, far from scientific proof.

Paregoric Kid
02-22-2006, 05:33 AM
Acute effects of tramadol in methadone-maintained volunteers.

Cami J (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Cami+J%22%5BAuthor%5D), Lamas X (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Lamas+X%22%5BAuthor%5D), Farre M (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Farre+M%22%5BAuthor%5D).

Department of Pharmacology and Toxicology, Institut Municipal d'Investigacio Medica, Universitat Autonoma, Barcelona, Spain.

The opioid agonist and antagonist properties of tramadol were assessed in 6 male opioid-dependent volunteers enrolled in a methadone maintenance programme. Subjects participated in 3 experimental sessions in which the effects of intramuscular tramadol 100 and 300 mg and placebo were evaluated. Tramadol neither produced morphine-like effects nor precipitated a withdrawal syndrome; its subjective, behavioural and physiological effects were not different from those of placebo. Although the results of this study suggest that tramadol has a low abuse liability in opioid-dependent subjects, higher doses should be tested to confirm these data.

jacky
02-22-2006, 09:24 AM
Ive taken tramadol to ween off of methadone, and used both drugs in conjunction for at least 10 days. I noticed no real side-effects.
the tramadol worked nicely for coming off of methadone, which is an extended withdrawl, though minor compared to abrupt herion withdrawl.

jab
02-22-2006, 10:08 AM
Hey, I'm not going to get into a pissing match.. My information about not combining with opiates came from the Tramadol insert that comes with the drug. Since I recall reading it I searched for the insert and was only able to find some pictures and you can see it in the link below..

http://www.sixthseal.com/2004/10/tramadol_experience_report.html

Look at the 9th picture down. It clearly states "Tramadol should not be used in patients with opiate dependancy. The use of Tramadol in such patients may result in opiate withdrawal symptoms"

This is not a "scientific website" but it is an image of the package insert that comes with Tramadol, and no offense, but I'll believe the manufacturer over someones word.

Again, I do not state that it WILL cause withdrawal, but the risk is real. If you search enough you'll even find people who compain of it happening. As with everything in the world of opiates everything is subjective and has different reactions in defferent individuals.

Here is another version of the Ultram (Tramadol) package insert..

http://tinyurl.com/pluvl

Which states "Patients Physically Dependent on Opioids ULTRAM is not recommended for patients who are dependent on opioids. Patients who have recently taken substantial amounts of opioids may experience withdrawal symptoms."

Good luck and be carefull.


Jab, neither link you provided had anything to do with tramadol and it's alleged potential for withdrawal when taking it with methadone. why would it just be methadone? come on get real if it was an antagonist it would be contraindicated with ALL opiates/opioids.
I've posted this question on bluelight before and the only information they posted back were papers saying it increased the analgesia when taken with other opioids
in a methadone drug interaction pdf I have the reference on tramadol is not under antagonist or mixed agonist-antagonist, but notes there were anecdotal reports, far from scientific proof.

Paregoric Kid
02-22-2006, 10:34 AM
it's not just "someones word" it is evidence that suggests there is no reason tramadol shouldn't be used with methadone.
I've read that before but they do not reference any research.
what do you mean this isn't a "scientific website?" anecdotal accounts don't mean anything in reality. you can believe in anything you want to but that doesn't mean it's true. the reference you made to the manufacturers insert is from early information on tramadol, I believe. the study came afterwards and shows it can be used with methadone.
for every anecdotal account that it causes withdrawal there are many times more accounts of it successfully working with opioids.
like I said, if this rumour were true it would be a well documented fact, but it is not.
can we even find someone that has experienced this themselves on here?

I think that there is an underlying cause to all of these claims.

shaunclo
02-22-2006, 10:40 AM
Hey, I'm not going to get into a pissing match.. My information about not combining with opiates came from the Tramadol insert that comes with the drug. Since I recall reading it I searched for the insert and was only able to find some pictures and you can see it in the link below

Anyone who has ever had any kind of experience taking tramadal with any other opiates knows that this is just like the suboxone warning. This warning goes like this...

suboxone has an ingredient in it (naloxone) to prevent anyone from snorting or shooting the pill. If the pill is crushed then snorted or shot, the patient will go into sudden w/d.......

From experience, this is bullshit, you do not go into sudden w/d when you snort a suboxone, just like you dont go into sudden w/d when you take tramadal with any other opiate. I cant even tell you how many people I know who have used tramadal to get off opiates. If this was true, than this would not work. Usaully first hand experience works better than some scientist's word who only has hypothetical experience.

jab
02-22-2006, 12:03 PM
what do you mean this isn't a "scientific website?"

You misunderstood me.. I meant the link I was posting was not a "scientific website", not this site.

I'm sure there are quite a few people who have done this combo and have not had any issues. I even stated in both my posts that I'm NOT saying you will go into sudden withdrawal.

My point is simple. There was a question asked, by the OP, and in the interests of having a rounded discussion I added my experience; which was having read the insert.

For the sake of harm reduction, I say it's just as important for the OP to know what the insert says, as it is for anyone here to report their own personal experiences.

Tar_Baby
03-11-2006, 01:57 PM
could you please reference a SCIENTIFIC SOURCE for your information? because I've never read one scientific paper that showed tramadol to have agonist-antagonist properties. the best you've got to argue that tramadol throws a person into withdrawal is that it MIGHT speed up methadones metabolism and that is not agonist-antagonist activity or anything close to it.

no one has ever been able to show me a single scientific paper showing tramadol to have any opioid antagonist or mixed agonist-antagonist properties and it really pisses me off when people just try and pass hearsay off as scientific fact.

if tramadol truly had the potential for antagonist activity it would be documented in scientific literature.

Its in the drug's package insert

psychotiKK
03-12-2006, 07:55 PM
You misunderstood me.. I meant the link I was posting was not a "scientific website", not this site.

I'm sure there are quite a few people who have done this combo and have not had any issues. I even stated in both my posts that I'm NOT saying you will go into sudden withdrawal.

My point is simple. There was a question asked, by the OP, and in the interests of having a rounded discussion I added my experience; which was having read the insert.

For the sake of harm reduction, I say it's just as important for the OP to know what the insert says, as it is for anyone here to report their own personal experiences.

"for the sake of harm reduction".. lol, you sound like a bluelighter

I've never heard of tramadol having any opioid antagonist activity or putting anyone into withdrawal.. I just know many use it to help with withdrawals