Nicomorphinist
Bluelighter
- Joined
- Apr 18, 2019
- Messages
- 1,401
I was reading about Irritable Bowel Syndrome earlier and remembering back to when I had troubles with painful Cyclical or Diarrhoea-Predominant Irritable Bowel Syndrome when my pain from the spine and environs was much less and easier to deal with . . . after trying a whole bunch of things with diet, herbals, over the counter and prescription medications before finally finding relief with-- along with Sprite or Coca-Cola for stomach upset -- a regimen of dicycloverine (Bentyl), attapulgite (Kaopectate), and dihydrocodeine with paracetamol No 2 (16 mg & 150 mg with 30 mg caffeine.) with Tylenol With Codeine No 3 sometimes substituted . . . the things which would work the best, namely Deodourised Tincture of Opium, Paregoric, and Donnagel PG (paregoric+belladonna tincture+attapulgite) were not always available and the same went for ingredients for poppy pod and sea tea, and the pod tea especially did generate an initial paradoxical attack of diarrhoea forceful enough to create logistical problems at times.
There are resins, waxes, oils, chlorophyll, and other things which are not absorbed into the CNS from poppy decoctions, but certainly have anti-spasmodic, carminative, and stomach settling effects which make whole opium products the best for this kind of thing, with the active ingredient, in the end, being morphine.
The dihydrocodeine actually worked better than the codeine, and I took it with hydroxyzine at bed time. I made a serendipitous discovery that orphenadrine citrate (Norflex) worked with the dihydrocodeine mixture to essentially end the cramping I had with it. Orphenadrine hydrochloride (Disipal) and Artane/Sexy Trihexy (trihexyphenidyl hydrochloride) also had the same effect, and did not have a lot of the side effects (sought or unsought) of belladonna xor scopolamine. I added tablets of tripelennamine to all of the dihydrocodeine or codeine doses including the nighttime one with the hydroxyzine (Atarax) and I was good to go. The effect was different from and more reliable than loperamide, difenoxin, and diphenoxylate medications, which could also precipitate painful cramps in the hour after the dose and was not all that helpful for cyclical diarrheoa which alternates with painful cramping constipation.
All things considered, when I look at the history of gastrointestinal medicine and pharmacology and things like tianeptine, trimebutine, eluxadoline, fedotozine that try as humankind tries to find treatments for these problems, we have not been able to get away from μ opioid receptor agonism and muscarinic receptor antagonists as the key to combat with diarrhoea with cramping. Like trying to take the habituation and euphorigenic potential out of centrally-acting analgesics, a drug which really stops IBS symptoms and does so by an effect which is solely peripheral because the drug does not interact with the opioid receptors and partially because it cannot cross the blood-brain barrier may very well be another Philosophers' Stone.
So I propose the following third-line regimen for IBS-C and IBS-D: potentiated codeine or dihydrocodeine + an anticholinergic with analgesic effects like orphenadtrine (or even diphenhydramine) + anything from certain soft drinks to Pepto-Bismol to sodium bicarbonate and/or anti-gas medications if one is in a locale where the newer agents like tianeptine, trimebutine, &c and/or others are not available, does not want to jump through hoops to get Viberzi . . . YMMV as they say, but the anti-narcotic superstitions should not get in the way of trying to keep from shitting oneself to death. Where nefopam (Acupan) is available, one can add it for painful cramping and other GI disturbances . . . if not, add paracetamol by itself or using a combination of the other drugs with it like Panlor, Tylenol With Codeine, and/or Norgesic.
Or if you can get a whole opium product, bob's yer uncle -- take it neat or add an antihistamine to potentiate the codeine/DHC
There are resins, waxes, oils, chlorophyll, and other things which are not absorbed into the CNS from poppy decoctions, but certainly have anti-spasmodic, carminative, and stomach settling effects which make whole opium products the best for this kind of thing, with the active ingredient, in the end, being morphine.
The dihydrocodeine actually worked better than the codeine, and I took it with hydroxyzine at bed time. I made a serendipitous discovery that orphenadrine citrate (Norflex) worked with the dihydrocodeine mixture to essentially end the cramping I had with it. Orphenadrine hydrochloride (Disipal) and Artane/Sexy Trihexy (trihexyphenidyl hydrochloride) also had the same effect, and did not have a lot of the side effects (sought or unsought) of belladonna xor scopolamine. I added tablets of tripelennamine to all of the dihydrocodeine or codeine doses including the nighttime one with the hydroxyzine (Atarax) and I was good to go. The effect was different from and more reliable than loperamide, difenoxin, and diphenoxylate medications, which could also precipitate painful cramps in the hour after the dose and was not all that helpful for cyclical diarrheoa which alternates with painful cramping constipation.
All things considered, when I look at the history of gastrointestinal medicine and pharmacology and things like tianeptine, trimebutine, eluxadoline, fedotozine that try as humankind tries to find treatments for these problems, we have not been able to get away from μ opioid receptor agonism and muscarinic receptor antagonists as the key to combat with diarrhoea with cramping. Like trying to take the habituation and euphorigenic potential out of centrally-acting analgesics, a drug which really stops IBS symptoms and does so by an effect which is solely peripheral because the drug does not interact with the opioid receptors and partially because it cannot cross the blood-brain barrier may very well be another Philosophers' Stone.
So I propose the following third-line regimen for IBS-C and IBS-D: potentiated codeine or dihydrocodeine + an anticholinergic with analgesic effects like orphenadtrine (or even diphenhydramine) + anything from certain soft drinks to Pepto-Bismol to sodium bicarbonate and/or anti-gas medications if one is in a locale where the newer agents like tianeptine, trimebutine, &c and/or others are not available, does not want to jump through hoops to get Viberzi . . . YMMV as they say, but the anti-narcotic superstitions should not get in the way of trying to keep from shitting oneself to death. Where nefopam (Acupan) is available, one can add it for painful cramping and other GI disturbances . . . if not, add paracetamol by itself or using a combination of the other drugs with it like Panlor, Tylenol With Codeine, and/or Norgesic.
Or if you can get a whole opium product, bob's yer uncle -- take it neat or add an antihistamine to potentiate the codeine/DHC
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