Cross tolerance/Equivalent doses

[jambabomba]

Hi,

I have been using opioids on/off for about 20 years. I have had addiction to codeine, tramadol, buprenorphine and mildly to oxycodone. I have experienced withdrawals many times but my doses have never been seriously high.

Now I am using buprenorphine about 1,5-3mg/d. Sublingually.

I am now thinking about switching back to Tramadol but I am not quite sure about equivalent doses. Mainly I am concerned about my ability to work as I don't won't to be too long disabled or on sickleave.

I have used tramadol before 400mg/d. Those who have more experience regarding these two drugs can you estimate equivalent doses for 1,5mg-3mg of buprenorphine sublingually daily? What doses of tramadol would be enough to keep you healthy and going?

Thank you!

Edit: One thing I forgot to mention - there was strange warning about possible serotonin syndrome with buprenorphine. That it possibly might cause serotonin syndrome when combined with other serotonergic drugs (I didn't even know bupre has any serotonergic activity - and still don't know with what mechanism - but there is at least one case of serotonin syndrome mentioned in pubmed with buprenorphine). I have not heard anyone getting serotonin syndrome with buprenorphine&tramadol combined and I even have friend who has been prescribed both - buprenorphine&tramadol and he has not had any issues. Does anyone know is bupe really a serotonergic risk factor when combined with other serotonergic meds ex. Tramadol?

I have once experienced mild serotonin syndrome with DXM&Tramadol and do not want it again. I fear serotonin..

 

[jambabomba]

No one has any experience?

 

[anon.scientist]

I thought I replied to this.

Morphine is the golden standard. All conversion tables compare to Morphine.

Buprenorphine sublingual to Morphine is 1:40 and Morphine to Tramadol is 1:10. So you can estimate it like this: 2mg Buprenorphine sublingual x 40 = 80mg Morphine x 10 is 800mg Tramadol.

Google the conversion ratios for yourself, please do not trust this blindly.

As for serotonin storm, yes it is possible. I have read about this too. It is given as a warning for Sublocade patients.

 

[jambabomba]

I thought I replied to this.

Morphine is the golden standard. All conversion tables compare to Morphine.

Buprenorphine sublingual to Morphine is 1:40 and Morphine to Tramadol is 1:10. So you can estimate it like this: 2mg Buprenorphine sublingual x 40 = 80mg Morphine x 10 is 800mg Tramadol.

Google the conversion ratios for yourself, please do not trust this blindly.

As for serotonin storm, yes it is possible. I have read about this too. It is given as a warning for Sublocade patients.

Yes ok. Thanx for reply.

Serotonin syndrome is what I most fear. It is intense fear of feeling the actual process of dying. If I hadn't experienced that serotonin overdose before I wouldn't have this traumatic fear.

Anyway, because of that I think I will not use Tramadol until 7 days have passed since last bupre dose. As it has accumulated a lot.

I have then two (or maybe three or four) options left. Either I take Methadone or Oxycontin for a while or start experimenting with Naltrexone and high dose Vitamin C to treat withdrawals. Or take more Buprenorphine but I think I have done it enough and time to move on.

I would like to take Methadone but again - this Serotonin issue really worries mee. I think Oxycontin is safer in this regard. But I would not like to waste my oxy for just a withdrawal aid. So I think I will take Methadone tomorrow.. 12h after last buprenorphine. Do you have (or anyone?) experience if this is safe or dangerous combination regarding serotonin? I think methadone inhibits serotonin transporter and basically acts like an SSRI. Buprenorphine still in the system tomorrow so will serotonin be an issue? The fear of this serotonin is so intense that it even makes me rather willing to go through withdrawal cold turkey.

I guess Oxycodone isn't so much risk factor for serotonin but Tramadol at least is and Methadone might be, right? But to what extent? And with what doses?

Thank you for possible answers.

 

[anon.scientist]

Yep, Methadone is a serotonin transporter (SERT) inhibitor and can mess with your serotonin level. Tramadol inhibits SERT while also stimulating the production of serotonin. So it makes you produce more while at the same time shuts the exit valve. Methadone is only know to do the latter, to my knowledge, so stands to reason is safer for you. Anecdotally, I haven’t heard of anyone experiencing serotonin toxicity from switching to/from methadone from/to buprenorphine. Given that you might be sensitive to this, oxycodone is your better bet. I would stay away from MDMA lol

 

[jambabomba]

Yep, Methadone is a serotonin transporter (SERT) inhibitor and can mess with your serotonin level. Tramadol inhibits SERT while also stimulating the production of serotonin. So it makes you produce more while at the same time shuts the exit valve. Methadone is only know to do the latter, to my knowledge, so stands to reason is safer for you. Anecdotally, I haven’t heard of anyone experiencing serotonin toxicity from switching to/from methadone from/to buprenorphine. Given that you might be sensitive to this, oxycodone is your better bet. I would stay away from MDMA lol

Oh my.. I took methadone today after about 14h from last buprenorphine dose and first I tought I take 5mg test dose but glad I took only 1,5mg. As allready that dose gave me panic attacks and other symptoms of too much serotonin.

Well luckily it didn't in the end cause much of serotonin after first 2 hours but anyway WHY there is not more warnings about methadone's serotonergic activity? It seems to be very strong serotonergic compound as allready that 1,5mg was felt within my serotonergic system. Glad I didn't take 5-10mg of it.

Now I am little bit hesitant to dose it again today.. maybe I take 1mg more after 5 hours have passed. Then if that goes okey then again 1mg.. then the total dose for today would be 3,5mg. Maybe tomorrow buprenorphine is mostly gone and I might test 2mg.

 

[someguyontheinternet]

Are you sure the panic attacks aren't just related to the anxiety of fearing serotonin syndrome? Usually SS has symptoms like tremors and cold sweats

 

[jambabomba]

Are you sure the panic attacks aren't just related to the anxiety of fearing serotonin syndrome? Usually SS has symptoms like tremors and cold sweats

You are correct. Also a little friendly correction, I did not say that I had serotonin syndrome from Methadone now but only that I think I felt serotonin raising even from that 1,5mg dose. I get that same kind of panics&feelings also from Tramadol and Dextromethorphan and MDMA if I haven't use them in 2 weeks.

But now I tested Oxycodone first 5mg and then 10mg and that did not cause any those kind of feelings. Also codeine does not cause.

Now the question is did it raise it a lot or am I just so sensitive to even a little raise on serotonin levels that I instantly overblown it and my mind makes it feel 10x stronger than it is in reality.

And you might be correct that my ego does in fact (because of negative memories associated with serotonin) replay some old "recorded video" instantly when mind recognizes even a little raise on serotonin. Serotonin triggers that video replay.

This same happens to me also regularly with Tramadol and Dextromethorphan every time I have had a break longer than 2 weeks from them. So yes, mind must make it stronger than it actually is but still, I felt that Methadone might increases serotonin allmost like Tramadol. Could it be so? Or could it be like Venlafaxine?

Thanks

Edit: Also, I might add that I am now especially sensitive to any raise in serotonin or excitatory neurotransmitters in general as I don't have enough benzos (or I mean that I have been tapering them down) and I am also now simultaneously tapering Gabapentin down to 2400mg from 4000mg/d. So I am quite sensitive because of that too.

 

[jambabomba]

Sadly, I did not get allmost any opioid feeling from Oxycodone. Before I used buprenorphine I at least felt something when I took 15mg. It was like taking 1 8mg/500mg codeine tablet when no tolerance.

Now I am not feeling nothing but mild withdrawals. Maybe tomorrow I can feel it. I think bupre is just so strong it blocks allmost everything. Even though I took Methadone only 1,5mg today I felt mild opioid activity for short time period. But Methadone has binding affinity equal to buprenorphine.