Amantadine for opiate tol. reversal

forginon

I would recommend getting your doctor's opinion and approval before trying something like this. Tolerance is only one reason why a medicine seems to stop working. If I were in your shoes I'd want to know more about why the meds seem less effective than before. Maybe your condition has changed and requires attention? Use of another med, especially something like this, should be doctor guided.

The research I've done does not support the use of amantadine for reversing opioid tolerance. Like methadone, amantadine is "an N-methyl-d-aspartate (NMDA) receptor antagonist," but patient reports of adverse side-effects (jitteriness, tremors, confusion, insomnia, and unsteadiness) appear to make its use unattractive. And, in studies with rats, amantadine did not reverse opioid tolerance.

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Cheers!

steve

mrcool812

Thanks Steve, it looks like I had only part of the equation, but not enough to see the big picture. What is your take on potentiators like grapefruit juice, tagament, others....that act on the cytochrome P450. Specifically the CYP3A4 and CYP2d6 alleles acting as inhibitors on the substrate hydrocodone, increasing effect and/or changing metabolism to keep it active longer in the body.
I'm just looking for anything that might make my medications work better for longer periods of time without having to increase dosages. I've also read that Provigil, through the opposite reactions to these alleles, cause opiates to metabolize faster thereby breaking down faster and reducing their effectiveness..

forginon

Potentiators - I've heard the grapefruit story before. For the most part I've poo-poohed it. But, you read prescribing instructions for many meds and they specifically say avoid grapefruit as it can reduce metabolism and you end up with to much drug in your system. A potentiator.

Most of my studying has been to identify those items that inhibit or potentiate methadone, which I use for chronic pain. Of course, there's loads of info surrounding cytochrome P450, the CYPs, etc. Read that stuff for too long and your head starts to spin. I also take an antidepressant and there's conflicting info on whether the SSRIs/tricyclics potentiate or inhibit methadone. Recently, when I discontinued Doxepin (a tricyclic), the methadone became instantly less effective. We had to raise my methadone dose from 65mg to 80mg per day.

My doctor believes strongly in Provigil, actually as a potentiator, and also good for the drowsiness methadone can cause. My insurance refused to cover Provigil so she prescribed Dexedrine. She actually allowed quite a bit and told me to try it along with the methadone to see if it helped potentiate it. Frankly, it gave me headaches taken that way. So I use a very small dose once per day and I do believe it enhances the methadone.

That's about it for my knowledgebase. Both my PCP and my pain dr are all for finding ways to potentiate the methadone before raising the dose itself. And I thank them for that. I avoid dose increases with a vengeance. I still urge you to take this up with your doctor - I believe he/she will be all for finding ways to make your hydrocodone go further.

Good Luck,

steve

forginon

BTW - how do you get to 80mg of hydrocodone? Is that daily? Hopefully it's the 10mg/tablet variety with the low, what is it, 325mg tylenol? Just be real careful with the tylenol. You're probably already well aware of the risk to your liver. We had a recent poster who was taking astronomical levels of vicodin daily and claimed his liver was healthy. All I know is the number of folks dying in the US nowadays from acetaminocin (SP?) overdose is rising quickly. Just be careful, OK?

mrcool812

I take Norco which is 10/325 X 8 a day so I'm good on tylenol. I take milk thistle anyway because I take a lot of meds that metabolize through the liver. It's supposed to help and it can't hurt so I take it.

dub1

i was on norco for about a year and when i asked for a higher dose i was told that 6 per day was the max. In cp patients 1950 mgs of tylenol is the highest they want to see it. This makes sense considering 4000 mgs is the max dose per day without od, however this number is used considering that a subject doesn't take tylenol daily. This is all according to my doc. Just be careful with the tylenol, it's more dangerous than people realize. Maybe try and lower your dose for a week to 4 per day to lower you serum levels. Just a suggestion. good luck

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Shoreline

My wife has had great success with Namenda (memantine) another NMDA receptor blocker and it's hardly in the clas of Ketamine or PCP as far as risk and much stronger than DXM for NMDA blocking. The end result was no side effcts at all and decreased need for opiates by 2/3rds. Our doc was usng it the day it hit the market and just to remind folks , all meds including opiates have or have the potential for some pretty nasty side effects. If we read enough about any med we can find a reason not to give it a try and zero in on a potential negative side effect.

It does work, I've seen living proof and she experienced no side efects. I would love to give it a try but I can't aford to take it monthly or daily untill It makes my insurance companies list of aproved drugs. There is agreater risk of becomeing a full blown addict from opiate use than there is of a p[sychotic break from Nemanda. It doesn't provide the imediate relief that opiates do, as in take a pill and feel better in 45 minutes, But with CP you can't be that short sighted. You don't have to replace nemanda for opiates, trying an adjunct med, not a potentiator "drug to make opiates stronger" only makes sense before stepping up to a stronger med or increasing a dose. I'm glad to hear all PM docs aren't simply increasing opiates without looking into other avenues to bring relief.

Give it a try, if it doesn't work, don't take it, If the you eperiemce side effects, they are reversable wehen you discontunue Nemanda unlike some of the scarier meds like Ketamaine.

cptpooface

I am having the same problems with opioid pain killers. I guess pretty much everybody that takes opioid pain killers have this problem. I have tried the grapefruit juice and it seems really random. Sometimes it helped a little and sometimes it didn't do anything. I don't do it anymore because it didn't seem to make a big difference even if it did work, and most of the time it didn't work.

I have been on MS Contin for over a year now. I started on 15mg twice daily, but now I am up to 45mg three times daily. I refuse to go up any higher, at least until I see a surgeon about my condition. Because of this my doctor decided to try something else. He is not a pain specialist, and he would never say he is an expert in opiate pain killers, but his idea seems to make sense. I don't know much about these drugs either, so this method may be well known to everybody, but I never knew about it so I guess I will just let you know about it, just in case you haven't heard about it.

My doctor told me this method is used sometimes for cancer patients or people who will be on pain killers for a long time. I was on MS Contin as I mentioned. So a few days ago I went into the doctor and he told me he would switch me to a different drug. He changed me from MS Contin, to Oxycontin. He said this would help lower my resistance to MS Contin, because the drugs are not in the same family, (these aren't his words, I am just trying to explain it the best I can with the limited knowledge I have, family may be the wrong word) so I will be on Oxycontin for a month or two, then switch back to MS Contin. Because I will not be taking MS Contin for a month or two my resistance to it will lower, but my resistance to Oxycontin will be raised. So you just keep going with the cycle, switching every few months as needed. I hope this helps, or at least gives you an idea of something to try. As I said, I don't know if "family" is the right word, and I'm not sure how to explain this method any better than I have. I also don't know if this is common knowledge or not, so I apologize if anything is wrong with this idea. Good luck.

Shoreline

Hi catpoo, You have a pretty sharp GP, Oxy and morphine are different classes of opiates, One being synthetic and morphine being an opium akaloy or opioid rather than an opiate. What he's doing is rotating opiates, It makes sense andd is recomeneded that morphine be rotated every 6 months because one of the metabolites of morphine breaks down into can cause restless leg syndrome if you don't allow the body to purge the metabolites. So it's a good idea.

Good luck, Dave