brianpain33
12-07-2007, 05:46 PM
I was curious if anyone knows if fentanyl affects any neurotransmitters like serotonin, dopamine, or norepinephrine. Since I am upping the patch I will be able to cut down or go completely off the Ultram but I don't want to do it cold turkey because of the anti-depressant effect although I did start on Effexor a week and a half ago so I might be able to cut out the Ultram faster. Any ideas?
Brian
Brian
Sponsor
videogamecrazed
12-07-2007, 09:18 PM
Hi there brianpain,
I am not 100% sure about the affects fentynal has on the receptors such as SSRI, dopamanergic, epi etc. But, I do know the following from my own experience. Ultram does affect the SSRI and is part of what helps to releive the pain along with the action on the MU receptors in the spinal chord. In my opinion you should be able to make the switch from Ultram to Duragesic with out a problem, especially since you have most recently gone on the Effexor. Effexor does differ from other anti depressant due to the fact that its not only an SSRI (Selective Seratonin Reuptake inhibitor) but also acts on those dopamanergic receptors (I forgot in which way but I think it ups them). Still important but last, you should not experience any withdray feelings in anyway since all of the meds you where once on and are going to be on now after the switch you should technically be on more and then some of everything. Hope this helps in some way, I am no DR but I do have experience with these meds.
God bless and good luck,
videogamecrazed :angel:
I am not 100% sure about the affects fentynal has on the receptors such as SSRI, dopamanergic, epi etc. But, I do know the following from my own experience. Ultram does affect the SSRI and is part of what helps to releive the pain along with the action on the MU receptors in the spinal chord. In my opinion you should be able to make the switch from Ultram to Duragesic with out a problem, especially since you have most recently gone on the Effexor. Effexor does differ from other anti depressant due to the fact that its not only an SSRI (Selective Seratonin Reuptake inhibitor) but also acts on those dopamanergic receptors (I forgot in which way but I think it ups them). Still important but last, you should not experience any withdray feelings in anyway since all of the meds you where once on and are going to be on now after the switch you should technically be on more and then some of everything. Hope this helps in some way, I am no DR but I do have experience with these meds.
God bless and good luck,
videogamecrazed :angel:
painaway
12-08-2007, 05:08 PM
Hey BP...I took Effexor XR for about 4 years, and it was great (I took it for anxiety). In my opinion, it will definitely help with the depression part, and along with the new dosage of Fent, I think you'll be set!! :cool: I started to see a great improvement with the Effexor after about 2 weeks.
Shoreline
12-08-2007, 11:55 PM
Hi brian, I think I asked before what the big deal with discontinuing Ultram. It seems your gaging your dose of duragesic based on whether or not you need the weakest oossible BT med available. If I shhot never to need BT meds, I would over medicated 60 % of the time. It may also lead to thinking if you need anything extra ypu will need your dose increased, The ultram is nothing compared to the fentanyll and it's already almost killed you once. If you were replacing 60-90 mgs of BT morphine a day with an increase in fent, it would make sense to increase. But the goal isn't complete relief all the time.
As far as effecting neurotransmitters. All I can say is my shrink whos oneof the best neuro pharamcologist in the area, hates the stuff. He's seen folks prefectly stable on psyych meds thrown into a veryy bad posion from fent. He's admitely against it. Not ot metion is is an NMDA receptor binder which is believed to cause rapid tolerance, decreased pain threshold and several other neuro chemical reactions. Fentnyl is hardly harmless compared to utram and back to a dose that could have killed you 4 months ago seems pretty rapid and based on the desire to DC all BT meds seeems a little unrealistic unless you pain is always constannt, meaning never worse at night, after activity, after working, in the am, etc. Btmeds allow you to keep your base dose to a minimum if used corectlty and responsably. They aren't always an indicator for an increase,and even if they were, it doesn't meet the criteria bassed on strength anor frequency. NMost docs would love to prescribe ulrtram rather an 30 mg Oxycdone or * mg didlauid for BT pain. I guess I don't understand your goal or coralation to ultram.
Just a different perpective than increasing based on what? Tolerance, poor pain relief, Bt pain? Where will you be in 2 years and what's going to keep you from being at 200 mgs as fast as you tolerate respirtory supression. If you start dipping into a stash of ulttam, it doesn't mean it's time for an increase. The first sign of toelrance is duation, and Ultram will ghardly carry you fan extra 12 hours whe you on the patch. Eventually everyone wil reach a level where the side efects ar no longer tolerable. It may be drowsiness for one person, urinary retention or impedence for another. Yes we an develop tolerance to any dose and it won't kill us, but it doesn't mean we can function normally at it. Tolerating and functioning are two different things, I guess i really don't get the Ultram thing.
I hope you can think about it without a quick response where you feel I'm questioning you., I'm trying to give you a different perspective and something to think about. No attack is intended, I just don't get the logic or how it takes 3 months to taper off Ultram. My post is simply meant to get you thinking about what your shooting for and your expectations. If there wrong, someone nees to point it out. The right dose of duragesic isn't one that requires no BT meds. That's just my opinion. I'm sure some docs believes the opisite, some would agree and others think you need to find other ways to manage BT pain like meditation, self hypnosis, bio feedack, stretching. Non opiate methods that can be tought and learned.
CP is a life long problem for most that need these meds and you have to look down the road.
Take care, Dave
As far as effecting neurotransmitters. All I can say is my shrink whos oneof the best neuro pharamcologist in the area, hates the stuff. He's seen folks prefectly stable on psyych meds thrown into a veryy bad posion from fent. He's admitely against it. Not ot metion is is an NMDA receptor binder which is believed to cause rapid tolerance, decreased pain threshold and several other neuro chemical reactions. Fentnyl is hardly harmless compared to utram and back to a dose that could have killed you 4 months ago seems pretty rapid and based on the desire to DC all BT meds seeems a little unrealistic unless you pain is always constannt, meaning never worse at night, after activity, after working, in the am, etc. Btmeds allow you to keep your base dose to a minimum if used corectlty and responsably. They aren't always an indicator for an increase,and even if they were, it doesn't meet the criteria bassed on strength anor frequency. NMost docs would love to prescribe ulrtram rather an 30 mg Oxycdone or * mg didlauid for BT pain. I guess I don't understand your goal or coralation to ultram.
Just a different perpective than increasing based on what? Tolerance, poor pain relief, Bt pain? Where will you be in 2 years and what's going to keep you from being at 200 mgs as fast as you tolerate respirtory supression. If you start dipping into a stash of ulttam, it doesn't mean it's time for an increase. The first sign of toelrance is duation, and Ultram will ghardly carry you fan extra 12 hours whe you on the patch. Eventually everyone wil reach a level where the side efects ar no longer tolerable. It may be drowsiness for one person, urinary retention or impedence for another. Yes we an develop tolerance to any dose and it won't kill us, but it doesn't mean we can function normally at it. Tolerating and functioning are two different things, I guess i really don't get the Ultram thing.
I hope you can think about it without a quick response where you feel I'm questioning you., I'm trying to give you a different perspective and something to think about. No attack is intended, I just don't get the logic or how it takes 3 months to taper off Ultram. My post is simply meant to get you thinking about what your shooting for and your expectations. If there wrong, someone nees to point it out. The right dose of duragesic isn't one that requires no BT meds. That's just my opinion. I'm sure some docs believes the opisite, some would agree and others think you need to find other ways to manage BT pain like meditation, self hypnosis, bio feedack, stretching. Non opiate methods that can be tought and learned.
CP is a life long problem for most that need these meds and you have to look down the road.
Take care, Dave
brianpain33
12-10-2007, 05:48 PM
Dave,
Thank you for the reply and it did give me quite a bit to think about. I was getting fairly effective pain relief when I first started on the patch usually my pain level was around 3-4. However, with the change in the weather and it getting colder my pain has increased quite a bit. I don't believe it is tolerance to the patch but who knows. I wanted to increase the dose on the patch to try to get a little bit better control of the pain and get it down to where it was after I first started on the patch. Am I wrong to assume that I can get the pain level down to a 3 or 4 again and keep it there?
I believe that I may need to try something else for BT pain. I started on the Effexor 2 weeks ago and I don't want to experience serotonin syndrome again so the Ultram really needs to go. I am not sure what to try for BT pain though? I am just getting frustrated and not sure what else to do. I am going to try the TENS unit and hopefully that will help especially when the pain does increase after activity. The pain always gets worse the more active I am especially being on my feet. I know that the Ultram and fentanyl have a Major drug interaction when I ran those 2 drugs through a drug interaction checker. Also, Ultram and Effexor have a Major druger interaction. I am just really concerned about being on all of them at the same time. Does anybody have some suggestions. I would definitely like some direction.
Brian
Thank you for the reply and it did give me quite a bit to think about. I was getting fairly effective pain relief when I first started on the patch usually my pain level was around 3-4. However, with the change in the weather and it getting colder my pain has increased quite a bit. I don't believe it is tolerance to the patch but who knows. I wanted to increase the dose on the patch to try to get a little bit better control of the pain and get it down to where it was after I first started on the patch. Am I wrong to assume that I can get the pain level down to a 3 or 4 again and keep it there?
I believe that I may need to try something else for BT pain. I started on the Effexor 2 weeks ago and I don't want to experience serotonin syndrome again so the Ultram really needs to go. I am not sure what to try for BT pain though? I am just getting frustrated and not sure what else to do. I am going to try the TENS unit and hopefully that will help especially when the pain does increase after activity. The pain always gets worse the more active I am especially being on my feet. I know that the Ultram and fentanyl have a Major drug interaction when I ran those 2 drugs through a drug interaction checker. Also, Ultram and Effexor have a Major druger interaction. I am just really concerned about being on all of them at the same time. Does anybody have some suggestions. I would definitely like some direction.
Brian
dietcoke
12-10-2007, 06:38 PM
Brian, hello.
From personal experience, I can only say that Ultram is an “M&M” (the candy) compared to Fentanyl, and I had no problem getting off of Ultram in 2 weeks when I switched to an opiod (I started with MS Contin).
Be very, very, very careful with the Fentanyl. It is a hammer for pain (as you know if you are taking it), but be wary of the potential side effects. Very, very wary.
I cannot take it because it lowered my blood pressure to the point that I literally passed-out, and, unfortunately, I have “paradoxical side effects” (adverse) from every opiod on the market, including the natural ones, the semi-synthetic ones, and the fully-synthetic ones (like Fentanyl, etc). :(
Again, be careful when you are upping the amount of Fentanyl you are taking. If you start to experience ANY of the adverse side effects as you increase the dosage, consult with your doctor asap.
Good luck, Brian, and be safe.
:wave:
From personal experience, I can only say that Ultram is an “M&M” (the candy) compared to Fentanyl, and I had no problem getting off of Ultram in 2 weeks when I switched to an opiod (I started with MS Contin).
Be very, very, very careful with the Fentanyl. It is a hammer for pain (as you know if you are taking it), but be wary of the potential side effects. Very, very wary.
I cannot take it because it lowered my blood pressure to the point that I literally passed-out, and, unfortunately, I have “paradoxical side effects” (adverse) from every opiod on the market, including the natural ones, the semi-synthetic ones, and the fully-synthetic ones (like Fentanyl, etc). :(
Again, be careful when you are upping the amount of Fentanyl you are taking. If you start to experience ANY of the adverse side effects as you increase the dosage, consult with your doctor asap.
Good luck, Brian, and be safe.
:wave: