View Full Version : Dextromethorphan and Methadone??

03-17-2005, 07:39 AM
Has anyone ever heard about using dextromethorphan to help with methadone tolerance?? I am a claims manager for a medical insurance company and I was reviewing some medical notes for a patient who is on methadone for chronic pain. The patient was asking the doctor to increase her dosage of methadone because she felt that the dose she is on wasn't working as well as it used to. The doctor told her to take dextromethorphan with the methadone because it would help with tolerance. I have been on 100 mgs for almost a year now and I know I have built up a huge tolerance to the methadone. I hate to continue to increase my dosage and just wondered if anyone else had heard about using the dextro..to help with tolerance? Thanks for any help... :zhelp:

03-17-2005, 11:49 AM
DXM actually potentiates methadone (as well as other opiates.) Here's a link: http://sulcus.berkeley.edu/mcb/165_001/papers/manuscripts/_67.html

03-17-2005, 02:55 PM
bi11i....hey, thanks for the link!! I have only been able to find the dextro.. in cold medicines. It is usually stacked with a couple other drugs. Do you know if it is sold just by itself?? Thanks again for the help....:hangloose

Paregoric Kid
03-17-2005, 05:08 PM
it's NMDA antagonist properties are believed to be the cause of reduction of tolerance not just to opiates/opioids but also amphetamines as well
morphidex, a morphine/dxm combo was tested and several studies showed it was effective at keeping a low tolerance but after second phase III studies did not meet the primary endpoint, which was a significantly more effective analgesia with MorphiDex than morphine sulfate alone at equivalent doses, the second study also didn't meet its secondary endpoint, which was a reduction in tolerance to the agent, so maybe it is not as effective as we think it is. I take dxm all the time in order to help reduce tolerance. my question is, when do you start getting a tolerance to dextromethorphan? I'm seeing that some of my friends who abuse it for it's dissassociative ketamine/pcp-like qualities a lot more than I do are getting tolerances

MorphiDex (MS:DM) double-blind,
multiple-dose studies in chronic pain patients
Katz NP.
Brigham & Women's Hospital,
Pain and Management Center, Boston, MA 02115, USA.
J Pain Symptom Manage 2000 Jan;19 (1 Suppl): S37-41

Preclinical and double-blind single-dose placebo-controlled studies demonstrated that MorphiDex (MS:DM), a 1:1 ratio of morphine sulfate (MS) to dextromethorphan hydrobromide (DM), provides significantly greater analgesia than an equal dose of immediate release MS, with a faster onset, and a duration of > or = 8 h. The analgesic effect of MS:DM compared to MS was evaluated in 2 double-blind, multiple-dose studies in 321 patients with cancer and other chronic pain: a crossover study that consisted of two 2-wk periods and a 4-wk parallel study. As specified in the study protocols, patients took sufficient MS or MS:DM to achieve satisfactory pain control. In the crossover study, the MS:DM group required half as much morphine as the MS group to achieve satisfactory pain control (80 mg and 162 mg, respectively). The interval between doses and the time from the last dose of the day to the first dose of the next day were significantly longer for MS:DM compared to MS. In the parallel study, MS:DM also provided pain control at a significantly lower dose. After four weeks of treatment, the mean daily dose of MS increased, while there was little change in the MS:DM mean daily dose (P = 0.025) to maintain satisfactory pain control. More patients preferred MS:DM to run-in MS than preferred MS to run-in MS (P = 0.026). The addition of DM to MS did not increase the incidence of adverse events, which were those commonly associated with opioid use. These studies confirm that MS:DM provides satisfactory pain relief but at a significantly lower morphine daily dose.

Morphine/Dextromethorphan - Endo: E 3231, Morphidex

Drugs R D 2003;4(1):55-56

Adis CommentsEndo is developing a fixed 1 : 1 combination of morphine and dextromethorphan [EN 3231, MorphiDex((R))] for the treatment of chronic pain, particularly chronic cancer pain. The product was originally being developed by Algos Pharmaceutical. In July 2000, Algos Pharmaceutical was acquired by Endo Pharmaceuticals Holdings and was renamed Endo Inc. Dextromethorphan is a NMDA antagonist that appears to block the tolerance that otherwise develops with long-term morphine therapy. Development: Endo received a non-approvable letter from the US FDA for use of MorphiDex((R)) for the treatment of moderate-to-severe cancer pain. The US NDA contained data from 14 clinical trials in >/=1500 patients. In the non-approvable letter, the FDA cited concerns related to the adequacy of a high-dose pharmacokinetic study and animal toxicology study. In June 2002, Endo Pharmaceuticals Holdings Inc. announced results from the first of its three phase III clinical trials for its development product, MorphiDex((R)). In October 2002, the second of these trials was completed. However, in both completed second phase III studies, MorphiDex((R)) did not meet the primary endpoint, which was a significantly more effective analgesia with MorphiDex((R)) than morphine sulfate alone at equivalent doses. The second study also didn't meet its secondary endpoint, which was a reduction in tolerance to the agent. Endo Pharmaceuticals expected to complete enrolment for the third trial in July 2002. The company stated that it would not resubmit the amended NDA for MorphiDex((R)) until the full analysis of the data from these trials. Patents and licences: Endo Pharmaceuticals licensed patents and pending patent applications concerning MorphiDex((R)) and other combinations of dextromethorphan with opioids from Virginia Commonwealth University. Under the terms of licensing agreement, Endo will pay royalties equal to 4% of sales of products resulting from the licensed patents. Additionally, Endo will pay Virginia Commonwealth University 50% of royalty payments received from any sublicensees. The licence is valid until patents expire.

04-12-2005, 01:13 AM
look into grapefruit juice for potentiating oral ops and also cimetidine (tagamet)

04-12-2005, 10:38 AM
the data provided is interesting. my own research with dxm and opiate tolerance leads me to believe that dxm can have profound affect on opioid tolerance.

Somni Divine
05-03-2005, 04:24 AM
IS there anything else besides cimetidine, grapefruit juice, and DXM that helps lower tolerance? I have heard cipro, can be very dangerous and cause methadone overdose, as with benzos, although many documented experiences I've read say otherwise.
Also, what is the ratio of DXM to methadone, to reduce tolerance, (if it had to be taken in cold medicine, how much would you take per mg of methadone)? Are there any other side effects?
ALSO: methadone seems to INCREASE torance to ALL other opiates, are there ANY that are USUALLY unaffected by methadone tolerance?
Hope someone knows all of this -- I'm new to these message boards, thanks for any input in advance ...

05-03-2005, 08:30 PM
From waht I understand ALL opiates are cross tolerant. If you take methadone you will be tolerant to heroin, oxy, hydro, codeine etc. and vice versa. From what I understand opiate use causes an increase in the number of opiate receptors meaning that you need more opiates to attatch to the greater number of receptors. Tolerance is also some what psychological. There are stories of people buying dope, breaking it into three even shots, doing one at 10 AM then doing another at 1:30 PM and overdosing. I've heard that most of these cases are because the person shot up under strange suecamstances. For example if you always cook up your shot just before you use it and always inject in the bathroom in your house but one day you have the shot cooked up ahead of time and shoot up in an alley behind a restaraunt your body wouldn't "gear up" for the opiates and you OD. Check out the Article Tolerance, Addiction, and Effective Pain Management by K. Trout, http://www.erowid.org/chemicals/opiates/opiates_info3.shtml, on erowids.

Feel free to critisize and or correct anything that dosn't sound quite right.

As for developing tolerance to DXM me and two of my friends use to take 250-1200 mg of DXM almost everday for about 5 months, and by the end of it 400 mg was a first plateau dose, which when we sarted we only needed 180 - 200 mg for the same affects.

Also if you decide to use DXM make sure it contains no other active ingrediants than the DEX, unles you plan on extracting in which case it's OK if you it contains Gaufasein. Small doses of other ingradiants won't hurt any one but if you triple or quadruple some of the other ingrediants it can be dangerouse especially if used for a long period of time. You can go to Walmart and buy an 8 oz bottle of TussinDM for less than three dollars, it contains DXM and Gaufasein, a bottle of clear ammonia is only $.99 and a large bottle of lighter fluid can be had for $2. Country time lemonade mix is only $3 - $4 and will last a long time. Off brand Zip lock bags to be used as kitchen chemistry Seperatory Funnels cost a dollar as well. The recipe is free and can be found on erowids and once you get the process down can be performed in a half hour or less. Your body, especially your liver, will thank you.

Somni Divine
05-12-2005, 06:22 PM
I also read somewhere in this forum that "cat's claw" (I assume- and now that I think of it I HOPE- an herb?) is helpful at decreasing tolderance to methadone. And then, of course, you could up the dose.
Oh -- also in researching this subject further, it is written somewhere (sorry I can't remember my sources right now) that atarax, also called vistaril and hydroxyzine (an antihystimine/tranquilizer available only by prescription in the US to the best of my knowledge) increases the action of methadone by fifty percent.
Please feel free to correct me if I am wrong. At the clinic I go to they also have posted articles (with the intention of "scaring us straight") about how people have overdosed on their methadone by taking the antibiotic, Cipro (you know the one people were stockpiling during the anthrax scare) in conjunction with their normal methadone dose. I wonder why Cipro has that affect, it also increases the amount of caffeine in your system, if I remember right. If there are any chemists that read this post, I am really curious about WHY these herbs and drugs work the way they do, that is: why the synergizing of methadone with Cipro and DXM if any of you have time??
Thank you.

05-14-2005, 01:20 AM
yes, cats claw herb can inhibit opioids such as methadone and buprenorphine ( and I assume some other types) from being eliminated from the body....look at cats claw alkaloid content, and one will notice that some of them are very similiar in structure to mitragynine , an alkaloid found in kratom. I like the mix of cats claw, kratom, and ashwaghanda later at night. when mixing gabba with this combination I have felt some nausea.

05-14-2005, 01:22 AM
grapefruit, cats claw and other herbs and compounds inhibit certian enzymes that are components of the catabolic processes of the body

06-07-2005, 02:32 AM
Hi I am new here and I don't know too much about dxm but I do know it may may have something to do with the fact that if you look at the chemical diagram of dxm it is a mirror image of morphine meaning it is the same but backwards....

Paregoric Kid
06-07-2005, 03:52 AM
magnesium also works, similarly to dxm

Dr Benway
07-05-2005, 01:49 PM
PG Kid, what do you mean by magnesium? Do you mean the stuff in stomach medicines like "Milk of Magnesia"?

Paregoric Kid
07-05-2005, 02:57 PM
yeah, the element magnesium. you need to figure out the proper dose for yourself, I take between 100-250% daily recommended dose before and while I'm on opiates. if you take too much you will shit yourself which is one of milk of magnesias uses.

07-05-2005, 11:36 PM
I used magnesium and calcium pills before taking 210 milligrams of DXM.....man it hit me hard! I spent the rest of the night on my bed thinking about things. when I started to even out on the peak,and when I did not feel nauseous anymore, at the two and a half hour mark, I started feeling euphoria and analgesia.....the magnesium seemed to potentiate the peak, and most likely has a moderating effect on opiate effects. I like the combination of DXM and magn. for moving the bowels, and making opioids feel stronger...

07-19-2005, 08:47 AM
In my experience grapefruit juice does absolutely nothing to potentiate methadone. If anything, I have found citrus juices to take away from methadone...... DXM works fairly well, but seems to have a ceiling and 100mg might be a little high for it to be productive. Worth a shot though, try taking 2-3 times the recommended dose of DXM prior to dosing your 'done. Also, there are dxm-only gelcaps available in the US, as well as DXM only syrup. Robitussin makes both, as well as Walgreen's.....

07-27-2005, 06:15 PM
In Canada and maybe the US too, you can now buy DXM strips in fruity flavor. Its like a fruit rollup. They just came out this year. And they are sold even at gas stations beside the fishermans friend.

Whatever someone decides, try to stay away from Coriciden (sp) those red pills have killed people who took enough to get that PCP high from them. I guess taking one or two just to potentiate your real dope wouldnt be that bad.

(Just thought that way more people die from the pills we eat than DXM....)

07-28-2005, 09:36 AM
cats claw herb(uncaria tomentosa) contains chemicals that impede the bodys elimenation of methadone and buprenorphine (and possibly other opioids as well).
I have used cats claw herb for potentiation/extension of opioids effects.

looking into the chemistry of cats claw I notice some compounds that are shared by kratom.............

08-05-2005, 07:24 PM
After doing a bit of googling on the subject, it seems that a lot of stomach/ulcer medication, and acid reducing products are known potentiators. I found this very interesting as I have been taking Lansaprozole/Omeprazole and Tagamet for years on and off due to an ulcer, but have never noticed any effect on my daily Methadone.
Maybe you need a lot more than the recomended dose? (This is a guess, don't try it without research!!!)