April 22, 2008 - 7:22pm
does ultram reduce the effects of opiates. I have a friend that attend a methadone clinic and in the papers they gave him on what drugs to avoid it says that ultram will reduce opiate effects of methadone
April 23, 2008 - 2:08pm
#2
ulteam and opiates
I really would like to know if ultram does the same thing to hydros or oxys. Help would be appreciated.
April 23, 2008 - 4:14pm
#3
Yes for some reason it does
Yes for some reason it does and i know from experience as i take oxycontin 40mg 2x day and sometimes run out if i dont call my pm doc in time and have to wait sometimes 3 days for a refill w/out them and will take tramadol/ultram same thing to help alleviate the wd,s and when i finally get my oxy script again they seem to do nothing for several days
April 23, 2008 - 5:57pm
#4
why?
Does anyone know why? Does it have to do with agonist/antagonist reasons? I am not even exactly sure what that means either.
April 24, 2008 - 9:03am
#5
ultram and mdone
i looked on the papers they gave us at the clinic about what drugs decrease the effects of the 'done or even put you into w/d, and it says for ultram: "synthetic analgesic (which we know) -not considered opioid antagonist, but does decrease level of opiates" Also on this list, it doesnt say anything about oxys or hydro doing the same thing, the other ones are like all the blockers (antagonists) like suboxone, and narcan etc. But there are a bunch of drugs on here that will lessen the effects of the 'done, and a bunch that will intensify the effects of it, so if u wanna know about any other one just ask and ill check the sheet.
April 24, 2008 - 1:57pm
#6
does or does not
so are you saying that ultram does reduce the opiate effects of hydrocodone or that it does not? I am prescribed 120, 7.5/500 hydrocodone and I still take ultram sometimes at bedtime. It seems the hydrocodone is less potent when I am taking ultram as opposed to when i don't.
April 24, 2008 - 3:25pm
#7
Heres a link to a patent
Heres a link to a patent received by Ortho-McNeil about mixing Tramadol with either Codeine,Hydrocodone or Oxycodone.When taken together you dont need to take as much of either medication to achieve the same amount analgesia from either medication when taken alone. So I guess it would be safe to say that when taking Tramadol with Codeine,Hydrocodone or Oxycodone they dont block each other but actually work synergistically.
April 29, 2008 - 4:02pm
#8
Does anyone have any
Does anyone have any reputable sources claiming that tramadol lowers plasma levels of methadone (I am assuming this would be the "decreased effect" being described).
I dont mean WebMD or a methadone clinic handout, but a medical journal or scientific journal? I have NEVER heard of anything like this, and there are only 2 reasons I can possibly fathom for such an issue. 1) Tramadol has slight SSRI and SNRI effects. There has been some evidence that strong SSRI/SNRI can reduce analgesia of narcotics. But, if this were the case, it should be minute, as the SSNRI-effects of tramadol are low.
2) Enzyme Competition in metabolism. Since tramadol is a prodrug, there is extensive hepatic enzymes involved in its metabolism to "M1". I believe they are CYP2D6, as well as CYP3A4. Methadone is not a prodrug, although I am pretty sure it has some active metabolites. I have heard of hepa-metabolic enzymes being "fought over" by two substances whom share their catayltic properties.
Solo, have you heard of this before? You seem to know alot about pharmacokinetcs/dynamics.
April 30, 2008 - 1:30am
#9
Ultram reducing effectivness of Methadone and others..
Yes Tramadol reduces the effectivness of most opiates and opioids, not just Methadone. I know from personal experience if i take a lot of Tramadol's because i am out of oxycodone , then days later resume my oxycodone and others I feel for the first day it takes a lot more than it uselly would. almost kind of like a Subbxone effect.
hope it helps
April 30, 2008 - 6:20am
#10
are you sure that you are
are you sure that you are really a doctor?
all thoughts and opinions expressed are those of my own and should not be mistaken for medical advice. i am not a doctor nor a pharmacist. all medical questions should be answered by a licensed pharmacist, doctor, or primary care manager.
April 30, 2008 - 11:01am
#11
I still cant find ANYTHING
I still cant find ANYTHING suggesting a possibility of decreased effects of full mu-receptor agonists when combined with tramadol (either the (+) or (-) enantiomers) or mono-o-desmethyltramadol.
I checked the 2005 USP-DI, the 2007 pocket PDR, monographs from various tramadol manufacturers, a PubMed search, and a New England Journal of Medicine search. I even checked wikipedia, which is not a reputable source, but is usually fairly accurate, and often times contains "word-of-mouth" claims about a subject. The only mention any of these sources have of adverse reactions between traditional narcotics and tramadol is the increased risk of CNS and respiratory depression.
Of the posters who say their methadone clinics' patient handouts contain this info, do these handouts site any sources for this claim?
I am not doubting it is contained within, but if this was a widely understood interaction, I would think there woulb be SOMETHING about it somewhere, especially the USP-DI, which is a professional, well respected publication.
Unless someone can post a reputable source for this claim, I am inclined to believe that this is either a) speculation of a theoretic interaction, which is irresponsible for a clinic to publish 2) a "deterrent " to keep people off of an atypical narcotic (by the 'done clinic) that is thought to be safe by many people c) a decrease in the subject "feel" of the narcotic being combined with tramadol, which seems the most likely. Alot of people have claimed that there is a decrease in analgesia when combining these substances, but the only 'proof' is that of self-report. My subjective experience in combining tramadol and oxycodone is a synergistic effect, heightening analgesia. The only reason methadone would differ is that it has some glutamate and NMDA antagonism.
If there is evidence of this however, the claim would be far from a "law" of medicine. If this was a common interaction, there would be documentation, especially in manufacturer monographs for tramadol and the narcotics it is most prone to interacting with.
yes hydro, you are exactly right. i also am a patient at a clinic and in the orientations you hafta attend, ultram is on the list of drugs that CAN put you into withdrawal if on methadone. as for oxys and others, im not sure, but with the 'done that is true. hope this helps.