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Old 05-25-2005, 04:30 PM   #1
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Methadone plasma levels....

I remember reading years ago, before I even knew what a pain pill was all about, that there where drugs that made other drugs weaker or drugs that make other drugs stronger. Well I came across several medical sites that talk about interactions with methadone. What drugs make it weaker (contraindications) and what drugs make it stonger....so they advise if on this drug to take less methadone than one would usually without Drug A. Following? LOL
Well one common drug, or sorta common, that people dealing w/ chronic pain sometimes come to take is Elavil/amitriptyline. Come to find out amitriptyline (Elavil®, Endep®, Etrafon®, Limbitrol®, Triavil®) increases plasma levels of methadone. So it makes it's effects stronger and last longer. Now that is interesting news. There are also other drugs that increase Methadone plasma levels, including 'Tagamet'/cimetidine. Curious to know who here is taking Methadone and Elavil. And if so, did your physician mention this at all?

here are a few sites where it talks about Methadone and it's drug interactions (increase, decrease, etc.)

[url]http://www.coldwaterworld.com/methadone.html[/url]
[url]http://sdrl.com/tech_briefs/IncreaseMethadoneEffects.html[/url]
[url]http://www.atforum.com/SiteRoot/pages/current_pastissues/Vol6s97.shtml[/url]

 
Old 05-26-2005, 06:46 AM   #2
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Re: Methadone plasma levels....

Hey Libra your talking about drugs that undergo cytochrome p450 oxidative metabolism in the intestinal wall or liver. Certain meds, foods and supplements which have been demonstrated to affect the cytochrome p450(CYP) system (especially at isoenzymes CYP1A2, and CYP3A4) by binding to the isoenzyme as a substrate and impairing first-pass metabolism, either by direct inactivation or inhibition of the enzyme. The net effect on the CYP enzymes from this inhibition seems to be a selective down-regulation of CYP3A4 in the small intestine.

With meth your talking about minimal interaction where the other med used can be changed or the effect is so minimal you can simply adjust the dose. But the mere fact your taking a med that uses the same route of elimination doesn't mean folks should go to their doc and say I read meth is hindered by X and I need an increase to counter this effect. If the med was there during titration, nothing has really changed. If the med is newly introduced, patient reporting of changes in medication effectiveness should be evaluated and if adjustment is needed it can be. But simply knowing your taking a med that either hinders or increases the serum level isn't the risk it would be if you were dealing with meds that need absolute constants like Cumadin, anti rejection agents and some of the other crucial life preserving meds.

If you’re not getting relief see your doc. If a med increases the potency cut back on the meth. Maintaining that constant serum level is an inherent and unpredictable quality of meth and why it took a good 40 years to enter the market as a safe drug to manage chronic pain. After showing it can maintain a serum level after 30+ years of use in meth maint once the patient becomes accommodated and the dose response is seen.

It's good to know if you experience a drastic drop in effectiveness. My first doc that prescribed meth didn't use BT meds for any LA med. She would through everything including the kitchen sink at you, but no BT meds. When I leaned about cytochrome p450, I began using grapefruit as a breakthrough supplement. Half a grapefruit, which inhibits first pass metabolization would create enough of a serum increase for 3-4 hours that my need for BT meds were managed by using this method. Just a little FYI.

But these meds aren't making meth totally innefective or more dangerous than they already are. A 20% increase or decrease in meth serum level won't make the problem that a 20% flux + or - in Cumadin would create. In Cumadin it could make it wotrthless or make you have problems controlling bleeding. Were just talking about a small flux in serum level that the FDA allows when makng generic methadone. Switching from Roxanne meth to Mallinkrodt methadose will cause a greater changei n serum level than taking any of the other meds that are metabolized by CYP 450.

Some drugs have crucial serum levels to be effective, some drugs effectiveness are based solely on patient reporting. If a med is causing a problem with the pain relief you get from meth talk to your doc about increasing the dose, if it's causing an intolerable increase in serum levels, the dose can be decreased. It's good stuff to know but nothing to run to your doc about and demand an increase because you think one of your other meds may be inhibiting meths effectiveness.

Food and drug interactions are common ,but wait until you experience one to call your doc. There is a drug interaction with a warning for every drug that causes CNS depression, Opiates, muscle relaxers, sleeping meds, and benzo's, and were not running to the doc to have those doses decreased.

It's great to be aware of and should be considered if you notice a direct correlation when starting a new drug, but it can be compensated for or an alternative drug can be found. Patient reporting is still the only way to truly measure pain relief and side effects. The mere introduction of another CYP 450 metabolized drug doesn't require an immediate dose change in meth unless you actually have a problem with it.

It's been a while since we talked about the CYP 450 so it's good t o be aware but wait for a reaction before insisting compensation or an adjustment be made.

It's nice to see patients taking an interest and investigating their meds, nothing is more ridiculous than a poster that claimed they didn't know they would become physically dependent because the doc didn't tell them taking LA opiates around the clock for months or years causes dependence.
So keep reading and researching but don’t get hung up on every possibility.

Take care, Dave

 
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Old 05-26-2005, 09:16 AM   #3
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Re: Methadone plasma levels....

Yeah Dave, I remember flipping through and reading a quick second about CYP450, but didn't grasp much of it or maybe I just didn't care to, I dunno really, but I'm not on Elavil...I just thought it was interesting that chances are, some people are on the combo and the fact that Elavil would boost the effects of methadone. What it feels like, this 'boosting' I dunno, but nontheless...interesting. Actually I was on meth, norco and restoril. Well, Dave like you said before..., the 10mg hydro in camparasion to my 120mg of meth a day, was nothing...So I brought this to my Dr's attn., Told him that the Norco wasn't doing much and we decided to cut out the BT meds this time and up the meth by 40mg's a day, so instead of 40mg q8hrs, now 40mg q6hrs. If that doesn't work as far as having moments of BT (which I do, but thankfully they are far and few in between, 2-3 a day...if that) , then I will see how the oxycodone 15mg works for me. Now Dave, didn't I see you wright somewhere that the oxycodone (roxicodone?) 15-30mgs was cheaper than buying oxy/apap? Which if true, is just strange. A GOOD THING, but strange..for the obvious reasons. Anyways, back to the drug interactions...yeah, I'm just glad that I only have to deal with TWO medicines, the methadone and the Restoril...as of now, so my PM medicine schedule is easy breezy.

-James

Last edited by LibraBalancer; 05-26-2005 at 09:17 AM.

 
Old 05-26-2005, 10:17 AM   #4
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Re: Methadone plasma levels....

Hey james, That's a pretty healthy replacment to ct out minmal BT meds. I guess whatever docs are most comfortable with. No BT's looks good and with frewuewnt dosing you should feel the difference. Remeber 5 days untill your steady at the new dose, You may even fnd you have to do 20 mgs at a time unless you have lost of tme o doze. LOL

That's a healthy dose. I went from 120 to 12150 the last few mnths before the mplant, and just not being able to handle the increase was the final straw that made me go ahead with it. I relaly can't complain, I believe they are doing everything the can and everything i ask. But even with that, Untill my spine is stable, the most I expect is 50%, If I can have times in the 5 range I won't go insane. LOL

Unfortunately i hav to be sedentary and didn't do anything to active to egt there, Otherwise I just can tolerate the brain fog. Swthcing from meth to IT meds, really cleared my had and I don't want to go back.

Anyway, I hope the increase does it and it goes smooth.

As far as oxy prices. I get 120 30 mg tabs for 123 bucks. about a dollar a pill or 3 cnts a mg of Oxy. Even geeneric percs won't give yu that nstrength for your money.

What I was astounded by was the cost of generic 10 mg percs. I paid 90 bucks for 40 pills. I could get 120 5 mg percs for one quater the cost of 60 10 mg percs. 5mg percs aren't bad, but the 10's are absurd. You can get generic 5mg roxi or OXY IR, no tylenol for less than 5mg percs too, You have to shop price when you are a cash customer and Sam"s a buying club that's owned by walmart is
about 1/4 of what the big retailers like CVS,Rite aid, Eckerds, and Walgreens are. But there is one of those on every corner like a 7 eleven or a gas station, and only 1 Sams in all of VA beach. Sams would be like Costco and you don't need a membership to use their pharmacy.
Sounds like you can make it work.If the night is bad, just drop a day dose and add it at night, That should take care of BT pain, But wait untill your used to the new dose to do any tweaking.
Take care, Dave

 
Old 05-26-2005, 12:27 PM   #5
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Re: Methadone plasma levels....

Hi James,
In reading your post concerning your Methadone level and the BT meds, I wouldn't worry too much about it. Your Doc really gave you a bump when he increased your Meth. I've been on Methadone for about two years now and I've been at 180 mg for most of that time. I haven't had any BT meds at all and there really hasn't been too many times I can honestly say I needed them. So if you're at 160 now you should be just fine. When you get past the five days and your serum level evens out, you should definitely notice the difference. Just be careful, especially for a while at first, doing any menial tasks. I'm not sure if that's the correct term, but what I meant was driving, watching TV, and other things that don't stimulate your brain make you quite drowsy. Driving is still not too good for me. In fact if we're going very far, I cut back on my meds until we arrive where we're going. I take just enough to get by. Makes a road trip for vacation really kind of tough, but I've managed.

As far as the Oxys, I've taken both the 15's and the 30 Roxi's, but I really don't know the costs of them here in Washington (state), because I'm on Blue Cross and have a co-pay. I will tell you, I get 540, 10 mg Methadone tabs a month and my co-pay is $15. When I was taking Oxycontin, I got 180 of the 80 mg a month for $25. That was because it was a brand. I asked the pharmacist one time what the cost would be w/o insurance and if I remember right, it was about $1200 a month. Ouch!!!

You take care and I hope the new Meth dose works for you. I really think you will be ok without the BT meds.
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Old 05-26-2005, 03:57 PM   #6
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Re: Methadone plasma levels....

Thanks Dave and Director! I appreciate the words, truly. So far so good, it's day three of the q6hrs dosing. I do notice a difference, it's more even keeled so to speak. Before, around hour 7-8, thats when the pains would come back more fierce (pain from sitting or standing too long, etc. Sciatic pains), besides that...I'm having these little freaky moments when I sorta drift off (doze) I'll get this JERK and I snap back awake. It's insane! It's like this quick jolt of electric buzz. My body literally JERKS itself...kinda like when you dream your falling off a cliff and you hit the bottom you actually jerk yourself awake. It's strange...but it's the medicine I'm assuming, I just don't know if it means I'm taking too much, and if I am will it disepate after the 5 days ya'll mentioned? it only seems to happen when I drift off (doze), which methadone I know makes alot of people 'doze', but that never really effected me. The only time I did have the dozing sensation is when I'm dog tired. And of course meth gives me insomnia, well I can fall asleep if I try, it's STAYING asleep that's the trick. Thank god for santas little helpers (restoril), that's the only thing thus far that has helps me to sleep, since being on methadone. And I've tried it all. Melatonin, Valerian Root, ALL the OTC antahist/sleep aids. Oh well, leave it to the benzos. OH, so who has the answer to this little .... TICK/JERK? it's scarin me! LOL

I almost forgot Dave, yeah I went to Sams Club (on your advice once) to fill a Rx for Percocet 10/325 #40 (got that at the ER, was shocked that they actually gave me 40 tablets, usually it's only 15 or so anyways...) I had called Walgreens and they told me around 80 dollars, I was like WHAT?!?! So I called Sams , after you said to Dave, and they said they couldn't give prices or info any any Scheduled drugs, or Narcotics...something to that effect. But they did tell me they where cheaper than Walgreens on everything. So I went in and filled it (have a Sams that 5 min. away. There all over the place in Florida) I turned out to be 50 dollars. I was excited to be saving all that money, but yeah...when it comes to Oxycodone by itself....it's cheaper, even in the higher mg's huh? Thats just too much! It makes no sense at all, but hey...I won't argue the system on that one.
Take care guys,

-James

Last edited by LibraBalancer; 05-26-2005 at 04:04 PM.

 
Old 05-26-2005, 04:22 PM   #7
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Re: Methadone plasma levels....

James...I just wanted to tell you, I've had the jerking you describe ever since I went on Methadone two years ago. My doctor tried to tell me it was Restless Leg Syndrome, but I didn't have it when I was on Oxycontin or the Duragesic patch. I was on high levels on both of those and took BT meds too. Since I've gone to Meth, I get them all the time. If I doze off in the chair watching the tube, I have them. At night they're worse, plus some nights it keeps my wife awake. She has to work the next day, where I'm on SSD, so it's no biggie to me unless it's so bad or violent it wakes me. I take Ambien 10 mg for sleep, plus 2 mg of Klonopin. I tried Mirapex, no-go. Anyway, I just wanted to tell you, you're not alone. Check out the post by Lindawainwright on this board. She's having the same trouble.
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