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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by spoc on April 8, 2004, at 10:10:04
Hi,
I got some tramadol "off the books" last year after having read of its possible use for depression. I only took it a few times a month on really low and/or irritable days, at about 100 to 200 mg. per day, then stopped to try Ritalin prescribed by a pdoc who didn't work out for me (my jury is still out on the Ritalin; that's another story. And yes, tried SSRIs, etc.). I am now on no meds and between any kind of treatment, but had studied up and decided anyway that tramadol used more consistently was what I'd want to try next. Weighed the controversy and my history of never overusing any "tempting" meds or wanting to; and decided I agree that tolerance/withdrawal is tolerance/withdrawal, so what's the real difference.
Anyway, I planned to attempt to still just use it occasionally, but not quite as cautiously, maybe a few times a week. Mainly to get over the worst hump, and then if it didn't seem feasible to continue with, if necessary using prozac to get off it with fewer discontinuation symptoms.
So for the last three days I have taken about 100 mg/day, 50 mgs. at a time, leaving latitude to start low and go higher if necessary. What I am wondering about is the fact that I notice I get somewhat of a headache when a dose is wearing off. I don't recall if that happened when I was only taking it on random days in a month. I saw that someone who is allergic to codeine may not be able to take tramadol, and I indeed have a strong sensitivity to codeine, that may have followed this same pattern: when it was prescribed for pain in the past, I had been able to take it for quite awhile before it ever gave me headaches. But now it would every single time -- horrific ones.
SO! I'm wondering which is more likely: that what happened to me with codeine will eventually happen with tramadol; OR, if the headaches might just be a s/e like those experienced when beginning any psy drug (which tramadol does seem to be viewed as by some). I mean, if it has similar actions and withdrawal to those of Effexor, surely getting to a "steady state" could also have some bumps. Anyone have an opinion on that? Thing is, I need to decide now whether to get more and don't want to waste the money.
A second question would be, does anyone know if tramadol would actually need to be taken *every day* to have a consistent AD effect, or would taking it just a few times a week as I plan to also be feasible?
Thanks for any insight anyone can give on this, I really appreciate it! : )
Posted by spoc on April 8, 2004, at 10:13:49
In reply to Tramadol: headache at first or always? Ame, anyone, posted by spoc on April 8, 2004, at 10:10:04
Posted by Ame Sans Vie on April 8, 2004, at 16:33:54
In reply to Tramadol: headache at first or always? Ame, anyone, posted by spoc on April 8, 2004, at 10:10:04
> Anyway, I planned to attempt to still just use it occasionally, but not quite as cautiously, maybe a few times a week. Mainly to get over the worst hump, and then if it didn't seem feasible to continue with, if necessary using prozac to get off it with fewer discontinuation symptoms.
>
> So for the last three days I have taken about 100 mg/day, 50 mgs. at a time, leaving latitude to start low and go higher if necessary. What I am wondering about is the fact that I notice I get somewhat of a headache when a dose is wearing off. I don't recall if that happened when I was only taking it on random days in a month. I saw that someone who is allergic to codeine may not be able to take tramadol, and I indeed have a strong sensitivity to codeine, that may have followed this same pattern: when it was prescribed for pain in the past, I had been able to take it for quite awhile before it ever gave me headaches. But now it would every single time -- horrific ones.
>
> SO! I'm wondering which is more likely: that what happened to me with codeine will eventually happen with tramadol; OR, if the headaches might just be a s/e like those experienced when beginning any psy drug (which tramadol does seem to be viewed as by some). I mean, if it has similar actions and withdrawal to those of Effexor, surely getting to a "steady state" could also have some bumps. Anyone have an opinion on that? Thing is, I need to decide now whether to get more and don't want to waste the money.It sounds possible to me that you could be a poor CYPIID6 metabolizer. Codeine, hydrocodone, oxycodone, and tramadol are "activated" via this enzyme system by transformation into their respective prodrugs: morphine, hydromorphone (Dilaudid), oxymorphone (Nubain), and o-desmethyltramadol. A poor metabolizer would be more likely to have a build-up of the ingested drug lingering in their system, causing unwanted side effects when taken on a more regular basis as you describe. That is, you may have more tramadol in your system than the more active metabolite form which is considerably more potent a serotonin/norepinephrine reuptake inhibitor and mu-opioid agonist.
I would suggest that you be tested for this enzyme deficiency; I'm not sure of your ethnicity, but among caucasians it is extremely common (around 3-7%). Your doctor will administer a dose of dextromethorphan (DXM; the cough suppressant found in Vicks-44 and Robitussin) which is a drug that is metabolized by CYPIID6 into another similar drug, dextrorphan (DXO). He/she will measure the amount of DXM vs. DXO in your urine at various intervals to determine whether or not you are an efficient CYPIID6 metabolizer.
>
> A second question would be, does anyone know if tramadol would actually need to be taken *every day* to have a consistent AD effect, or would taking it just a few times a week as I plan to also be feasible?I'd say that, speaking in terms of opioid effect, 100mg of tramadol is roughly equivalent to 60mg codeine; hardly an opiate dose that would provide any significant relief from depression or other psychiatric woes. From my experience, it is this minor opioidergic effect *combined* with what I consider to be a very underrated SNRI effect that causes long-lasting relief. While a single dose every now and again may help, I feel it really should be taken on a regular basis to receive full benefit of the SNRI-activity, just as you would with Effexor. And, as you prudently noted, Prozac is very important to remember should the time come that you would like to withdraw from this drug.
Posted by spoc on April 8, 2004, at 17:48:47
In reply to Re: Tramadol: headache at first or always? Ame, anyone, posted by Ame Sans Vie on April 8, 2004, at 16:33:54
Wow, thanks a ton! I was indeed hoping to smoke you personally out amongst any responses! And might I add that I love your PB name. So melodic. Does it translate into anything? : )
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> It sounds possible to me that you could be a poor CYPIID6 metabolizer.... I would suggest that you be tested for this enzyme deficiency; I'm not sure of your ethnicity, but among caucasians it is extremely common (around 3-7%). >
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Yep, caucasian female. I haven't had problems with hydrocodone taken several days in a row after recurring dental work (with the remnants admittedly used up as special, one-dose treats for other aches and pains). But I guess those uses too might have been too infrequent to reveal such a deficiency.Is the available testing only for the purpose of discovering how a person metabolizes drugs in the class you mentioned? Or could a deficiency discovered there also translate to problems with other types of drugs -- even psy drugs (so that I could know not to bother with them)? Are there other things that this deficiency can state about a person; such as that irrespective of any ingested drugs, their bodies usually need the supplements x, y, and z? Or that this is actually their only real problem in life, and they can now proceed to move mountains, win friends and influence people on a large scale? (Ok, maybe I'm kidding about the last part). : )
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>... And, as you prudently noted, Prozac is very important to remember should the time come that you would like to withdraw from this drug. >
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Ahh, and the REASON I could prudently note that is because I read through all the archived threads on opiates as ADs; meaning a lot of your posts! It was all so very helpful in giving me well-rounded data and opinions. And, is exactly the kind of thing that inspired me to post on Admin that people should more often try searches/focused searches of Babble data.
Posted by Ame Sans Vie on April 8, 2004, at 19:59:40
In reply to Re: Tramadol: headache at first or always? » Ame Sans Vie, posted by spoc on April 8, 2004, at 17:48:47
> Wow, thanks a ton! I was indeed hoping to smoke you personally out amongst any responses! And might I add that I love your PB name. So melodic. Does it translate into anything? : )
I'm glad to hear you got something out of my posts. :-)
Ame Sans Vie = Lifeless Soul (French); hardly an appropriate moniker considering my current happy frame of mind, but it's what everyone knows me by so I guess it stays. <shrug>
> Is the available testing only for the purpose of discovering how a person metabolizes drugs in the class you mentioned? Or could a deficiency discovered there also translate to problems with other types of drugs -- even psy drugs (so that I could know not to bother with them)?
Well, there's really no way of saying that a particular drug isn't worth trying until you've tried it; we all vary too much individually. But there are a few things to keep in mind; here's a list of the more common drugs metabolized by CYPIID6 -- their activity may be increased (in most cases) or decreased (as for the opioids) if you are deficient:
codeine, dextromethorphan, dihydrocodeine, hydrocodone, oxycodone, tramadol, ethylmorphine, venlafaxine (Effexor), MCPP (a metabolite of nefazodone [Serzone]), trazodone (Desyrel), maprotiline (Ludiomil), metoprolol, alprenolol, bufuralol, labetalol, penbutolol, propranolol (Inderal), timolol, paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), norfluoxetine (a Prozac metabolite), N-desmethyl-sertraline (a metabolite of sertraline [Zoloft]), meth/amphetamine (Adderall, Dexedrine, DextroStat, Desoxyn), benztropine (Cogentin), amitriptyline (Elavil), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Tofranil), N-desmethyl-clomipramine (metabolite of Anafranil), nortriptyline (Aventyl/Pamelor), diphenhydramine (Benadryl), loratadine (Claritin), omeprazole (Prilosec), perphenazine (Trilafon), risperidone (Risperdal), chlorpromazine (Thorazine), clozapine (Clozaril), haloperidol (Haldol), thioridazine (Mellaril), ondansetron (Zofran), papaverine, atomoxetine (Strattera), yohimbine
There are also drugs which can inhibit or induce the activity of certain enzymes; induction of CYPIID6 could possibly allow you to better tolerate certain medications, but unfortunately it seems that this particular enzyme is uniquely uninduceable! So the main things to watch out for are the *inhibitors*, which will slow down further a process that may already be defunct in your body:
Prozac, Paxil, and quinidine are *very* potent inhibitors of IID6. Taking them along with certain meds metabolized by IID6 could alter the effect drastically.
Elavil, Celexa, Lexapro, Luvox, Remeron, Edronax, Risperdal, Zoloft, and Effexor are less potent inhibitors, but may cause undesired effects nonetheless.
> Are there other things that this deficiency can state about a person; such as that irrespective of any ingested drugs, their bodies usually need the supplements x, y, and z? Or that this is actually their only real problem in life, and they can now proceed to move mountains, win friends and influence people on a large scale? (Ok, maybe I'm kidding about the last part). : )
lol, well that's a bit outside my area of patient expertise. I'm not really sure what (if anything) can be done about inefficient CYPIID6 metabolizers other than avoiding or approaching with caution the drugs which mess around with it.
Just let me know if you need anything else! :-)
~Michael
Posted by spoc on April 8, 2004, at 20:40:02
In reply to Re: Tramadol: headache at first or always?, posted by Ame Sans Vie on April 8, 2004, at 19:59:40
This is the end of the thread.
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