Tagament and hyrdomorphone? Also Opana vs Oxy?

[ColoradoBoy90]

Please move to OTHER DRUGS, it will not let me post it there for some reason.

Okay so I know that tagament can potentiate hydrocodone/oxycodone, at least many claim it does. Some claim the opposite that by inhibiting CYPD26 that you will get none of the hydromorphone from the Hydrco and none of the oxymorphone from the oxycodone. Some claim ONLY inhibiting CYP3A4 has any benefit, as you can a boost+ they still metabolism into their bigger forms while once you mess with CYPD26 it messes with their ability to convert over to the stronger respective metabolites, although that's up for debate. But it does tie into my question. So here's my question (regarding taking it regularly only though, I know BA sucks) but here's my question:

If you take just a Hydromorphone or oxymorphone tablet/pill, orally, does it still metabolism via the CYPD26 enzyme? If so, would tagament theoritically boost them the same way they supposedly boost hydro/oxycodone? Or is it possible it could theoritically weaken hydromorphone/ or oxymorphone pills because inhibiting the CYP26 enzyme would mean the hydroMORPHONE and oxyMORPHONE tablets would not metabolism properly??

Sorry I'm confused just when it comes to the actual hydromorphone and oxymorphone and tagament. Would grapefruit juice work since supposedly it doesn't inhibit the CYPD26 enzyme as much?

Also I when taken orally, would anyone prefer Hydromorphone or oxymorphone?? I know Hydromorphone is technically stronger, roughly 33% stronger MG per MG than oxymorphone is.... Also Hydromorphone as higher oral bioavailability than oxymorphone does. So higher BA and stronger mg vs mg. And since they come in similar dosages it seems hydromorphone would always be stronger, no? Example: 8mg tablet of hydromorphone vs a 10mg oxymorphone tablet.. Technically the 8mg hydromorphone is stronger than 10mg oxymorphone is, and has better BA. BUT.... Even with all that said which would you prefer between the two, if dosages where equal strength wise??

And lastly if anyone could choose: OxyContin vs Opana?? According to conversion charts Opana isn't much stronger than OxyContin is, hardly much stronger really. Something like 15mg = 10mg, it's like comparing Vicodin vs Percs, there is a difference strength wise, but it's nothing "major". And also Opana seems to have poor BA, wbile Oxy ER has high BA, so talking it orally which is better??

btw sorry for any typing errors, my keypad is half broken and it's hard to type on this computer.

 

[Captain.Heroin]

Please move to OTHER DRUGS, it will not let me post it there for some reason.

Probably because you're trying to post using the mobile site on your phone...

if you use the full site link, you can select a prefix, then it will let you (I believe)

 

[Kittycat5]

Neither hydromorphone or oxymorphone are extensively metabolized by any CYP450 enzyme so Tagamet would be a waste.

 

[ColoradoBoy90]

I just for a second saw the "thread prefix"
Option appear for a second, then it's gone!! So I dunno how to get it back, maybe browser I'm using? Dunno either way sorry, whoever can please move this thread!

 

[PotatoMan]

Cd ---> od .

 

[SKR]

I personally would take Oxycodone orally over Oxymorphone orally, and probably over other ROA, if it were 10-20 years ago I would IV the Oxymorphone if I came across it with the intentions of just trying it out that one time (lol)

 

[ColoradoBoy90]

I'm only talking orally. Anyone else know? Will tagament inhibit hydromorphone from
Working better or does hydromorphone not metabolism via CYPD26 therefore it won't matter? Or does it go through that, and perhaps tagament will prolong it? Or will it most likely just mess it metabolizing it properly? From what I read it doesn't even metabolism via CYP450, and I cannot find if it even metabolizes via CYPD26 or not. I just read that Dialud metabolizes into some form that has no pain relief properties, so I guess hydromorphone is a pro-drug (or is it the opposite?) where all its effects are of the drug itself and none of its effects come from any of its metabolites.

A "regular" 8mg tablet of hydromorphone is equal to 10.7mg of oxymorphone according to the first conversion chart I came across. So while mg per mg Hydromorphone is stronger, and has better bioavailability, does it actually come out as feeling stronger than oxymorphone? Most people think oxymorphone is stronger (just because oxycodone is slightly stronger than hydro), but when it comes to them being in the "morphone" forms the Hydro is actually stronger... But does it actually feel stronger? Talking in any way: pain relief, etc.

So a 10mg of Vicodin/Hydro= 2.4mg of dilaudid/hydromorphone... Is that really right? That means rougly half of a 4mg
Dilaudid (like 2.2mg) is almost equal to a 10mg Vicodin/Hydro..
Or that 4mg of Dilaudid= 16mg
of Vicodin..

Is this conversions taking into account the bioavability?? Since the Diluad only has what like 30% BA? Does it take that into account when comparing it to others, or no? As being only 30% BA, does that mean only roughly 30% of say a 4mg tablet is absorbed? If so, are these conversion charts basing it off it being a full 4mg or do they take into account that only roughly 30% of 4mg will be absorbed which comes out to like 1.2mg. So is the conversion that says 2.4mg of Dialid actually saying that once BA is factored in, and only
1.2mg of the hydromorphone is absorbed, it's equal to a 10mg Vicodin, which the Vicodin after BA is like 7 to 8.5mg? Or do conversions not take any of this into account? If not that's a HUGE DEAL... As 4mg hydromorphone tablet on paper vs in really only 1.2mg gets absorbed. Anyone know?


As for oxy (Extended release) it says that 10mg oxy ER = 5mg Opana/OxyMorphone. So it's showing twice as strong. Although Opana has been lower bioavability then hydromorphone does, so I wonder if it takes BA into account when claiming its twice as strong? If it doesn't take BA into account, then technically a 10mg oxy ER is stronger than an Opana ER, so I'm assuming they must take the BA into account for these conversions...

If you take say a 8mg hydromorphone tablet and put it in a very small amount of water (like 1/8th a cup full of water) and let it dissolve, would the BA of the hydromorphone increase? Or no? Again, I'm talking only taking it orally either just taking it as a pill, or possibly letting it dissolve in water and then drinking it. I'm not going to do any other methods, not going down that road, and I'm NOT chasing a high or anything. I've been taking pain meds for a long time where all they do is give me pain relief along with get rid of W/D.

LAST QUESTION: which would you choose (again, orally only):
8mg Dilaudid
Or
10mg Opana
Or
15 or 20mg of OxyContin?

Again I'm talking best for pain relief, but if one "boosts your mood" better than than the other then that's a plus. Also I'd rather be functional and more energized than feel like a Zombie on them. I take most during the day, so getting the "nod" what people call is NOT something I'm interested in. I remember years ago all opoiods used to give me energy and boost my mood in addition to relieve pain, now all energy boosts are totally gone.
Tolerance is evil. It's unlikely switching to a different opioid will suddenly bring any of that back, but, if one is more known for being more energizing vs the other than IMO that the better med.

 

[Hodor]

From what I understand, morphine/xMorphone are primarily metabolized via glucuronidation.

In essence, your body is trying to get rid of various drugs by oxidizing them to the point where your liver can slap some glucuronic acid on them, which instantly makes them so hydrophilic they'll readily dissolve in your urine as they enter your kidneys.

With morphine et al., however, your body can perform this glucuronidation right from the get-go, as the "naked" hydroxyl group that gives them their potency is also where it can attach the glucuronide.

In Codeine/xCodone, on the other hand, that hydroxyl is masked by a methyl group which needs to be snipped off by CYP2D6 for the drug to be converted into its more powerful metabolite; however, it also means that oral bioavailability increases as your body can no longer just attach the glucuronide cement shoes and dump it in your urine during first-pass-metabolism.

Long story short, I don't believe CYP2D6 plays a significant role in the metabolization of Opana/Dilaudid.

Not sure about other CYP450 enzymes though.

 

[Formidable]

the best high i've ever gotten from a single pill was from a 40mg opana, but i used tramadol to potentiate its effects, so maybe my feedback on that subject is a bit tainted.

 

[Tinker55]

I'm voting against oxy but that's because I really don't like the side effects.

 

[ColoradoBoy90]

Thanks Hodor. Anyone else know? It seems like this is a very little known topic which is why I ask on BL as many people here know A LOT. But hydromorphone and oxymorphone in general just seem to be well less known and studied. I'm sure many on here could go into super detail on how Vicodin or oxycodone actually works, but hydromorphone seems more unknown.

As for what's better between the 3:
8mg hydromorphone extended release/ER
15mg (possibly 20mg) OxyContin/ ER
10mg Opana ER

I ask because I was given a choice and don't know what's better.

 

[chronich]

I would go for the opana 10 mg er's if you're willing to put a little work in that is. You can buy a handheld dremel and grind it down into powder and snort it making the bio-availability go up so much more then orally. I forgot the exact numbers but it will make you feeling the best out of the three in my experience. I have taken all three and oxycontin er's at 20mg did nothing but tickle my receptors and the hydro was cool but it took 6-8mg to feel good but the duration is just too short. Snorting opana er's will drip and made me high for like 6 hrs.

 

[Kittycat5]

Let me try and answer some of your questions so you can make the decision on which drug you think would be best.

Opioid conversion tables are tables of equipotent dosages. This means how much would a person need to ingest of drug A and drug B to give the same desired response. The main factors determining potency is a drug's affinity for the receptor and its intrinsic ability to elicit a response, but pharmacokinetic parameters such as BA also must be considered. But you read the charts exactly as they are stated. For instance, 20mg oxycodone should give about the same result as 30mg of hydrocodone. You dont need to calculate BA first (you could but this would only change the ratio, not give you insight on actual dosage you need to take).

As I said in my first post, Tagamet is waste with either hydromorphone or oxymorphone as neither has any significant metabolism attributed to any CYP450 enzyme. They are primarily biotransformed via phase II metabolism, the glucoronidation Hodor spoke of in his post. You also cannot consider oxycodone or hydrocodone prodrugs (youy got it backwards) of oxymorphone and hydromorphone respectively, as while the latter two are indeed metabolites of the former, the former have activity of their own. Further, both are metabolized via CYP3A4 at least equally for hydrocodone and 5-10 fold greater for oxycodone than the pathway mediated via CYP2D6. These metabolites (nor-oxycodone and nor-hydrocodone) have shown to be active, albeit weak. So why the definition of prodrug isn't precise, generally it means a substance that needs to be biotransformed into the active substance, and practically, it is best if the prodrug has one pathway to one active drug. Oxycodone and hydrocodone don't fit in to any of these.

Now some may argue, and they have here on BL, that if you take Tagamet with oxycodone or hydrocodone, you can block 3A4 (true) and thus prevent the formation of the weaker metabolites and have more of the stronger ones formed. Few problems here. First, Tagamet also inhibits 2D6 and blocks both rather weakly. I do not think there would be noticeable effects, other than a placebo. Second, the literature shows that either ultra rapid metabolizers of 2D6 or inhibiting 2D6 with a strong inhibitor like quinidine leads to no appreciable increases in analgesia or side effects. So making either more or less of the more potent metabolite doesn't have clinical significance to most. I think this line of thinking stems from codeine >>> morphine metabolism which also utilizes 2D6 and there are increases in both effect and toxicity (including deaths) but while there are case reports of similar occurrences with hydrocodone or oxycodone (mostly oxy), they are few and far between.

Now, onto which would I choose. First let me add dissolving any of the tabs if they are IR won't enhance absorption and if they are CR, many cannot be defeated this way. I will always be partial to oxycodone in any form. Since what you listed are all about equal (at least for the IR forms), my vote goes to oxycodone. It gives the most energy of all the opioids in my opinion, you are functional, and it provides excellent pain relief. Keep in mind that the equivalence does not necessarily translate between IR and CR dosage forms, so for instance 20mg of Oxycontin would be more comparable to 8mg Dilaudid. Also, you probably need 20mg Oxycontin minimum for effects. 15 may be ok, but right in the labeling of Oxycontin, it states 10mg isn't better than placebo in clinical studies.

Good luck, hope I helped a bit and go with Oxy.

 

[ColoradoBoy90]

Thanks, yes that makes sense.

I must have made a typo, I meant hydro is not a prodrug, things like codeine is a prodrug. Codeine itself has no analgesic effects, so it has to be converted over to the bigger metabolite -- Morphine. I believe around 5% to 15% of it is converted over via CYP2D6. That's why it works better for some then others depending on how well they metabolize it via that liver enzyme. Therefore Codeine itself has zero effects, all it's pain releving effects and and "buzz" is all via CYP2D6 turning it into Morphine. Then morphine is glucuronidated, does what it does in the liver/kidneys, and then it's elminated.

So basically when people take Codeine they are basically taking Morphine just only around roughly 10% of depending on metabolism. Correct?
Or when Codeine converts via CYP2D6, and turns into Morphine which is then glucuronidared, does it actually only make it very very similar to taking only 10% of Morphine, due to somewhere in the metabolism process it doesn't convert over to "true morphine" as if you where taking true regular morphine (only 10%) though. Just wondering if the Morphine created via CYP2D6 by Codeine is the exact same as regular morphine?

Same question for Tramadol: since Tramadol itself is a prodrug converted by both CYP3A4 and CYP2D6 to O-desmethyltramadol, then.. Wait I'm confusing myself now. Technically tramadol itself does have weak mu affinity doesn't it? As desmethyltramadol just is much stronger affinity for mu-receptors.. I'm going off memory and sleep deprived so could be wrong.

But if anyone else wants to take the time, does my question if codeine is exactly equal to morphine (about 10%) does this apply for all drugs that convert into others being basically equal to what they convert into?

 

[Kid Amine]

Thanks Hodor. Anyone else know? It seems like this is a very little known topic which is why I ask on BL as many people here know A LOT. But hydromorphone and oxymorphone in general just seem to be well less known and studied. I'm sure many on here could go into super detail on how Vicodin or oxycodone actually works, but hydromorphone seems more unknown.

As for what's better between the 3:
8mg hydromorphone extended release/ER
15mg (possibly 20mg) OxyContin/ ER
10mg Opana ER

I ask because I was given a choice and don't know what's better.

Of the 3, only 8mg hydromorphone ER (Exalgo) can be easily defeated for a better high. I've heard generic Opana with the old Timer-X system are being made again; in that case, Id choose the generic opana. All three of these are worthless orally imo. Oxycodone has the highest oral BA but Oxycontin ER pills are crap as are most of the 'synths' out there to get the oxy free of its binders.

 

[tacodude]

Oxycodone is like oxymorphones opposite where the first is good for active pain when you need to function and the other for resting pain for when you need to sleep. Taking oxycodone leads to oxymorphone, but not the other way around.

Oxymorphone has a 7-9 hour half life so should be much longer acting while dilaudid is 1-3 hours, which is why it is notorious for a short term effect and the need to constantly redose.

The other questions are quite above my head

 

[ColoradoBoy90]

Here's another thing and question:

Is this true:
"Hydromorphone has a very large interpatient variability due to unpredictable bioavailability (29-95%)"

It doesn't state this for Oxymorphone oddly? I did the SAME cnversion for oxymorphone and it came up only with:

10mg Vicodin = 3.33mg to 7.5mg of OxyMorPHONE. Average: 6mg oxymorphone vs
10mg Vicodin = 2.5mg to 3.75mg HydroMorphone (Average 3mg).

So MG per MG Hydromorphone is quite a bit more potent than oxymorphone, but potent for what, pain relief, a "buzz"? Making you more sedated and tired?

And here's the weird thing: I took HALF a 4mg tablet of Hydromorphone, so 2mg,
which should be really equal to 6mg of Vicodin... Well, it's not. Not for me at least. I tested this by letting W/D kick in, and normally 5mg of Vicodin stops withdrawal. Well, 2mg of Hydrmorphone which is suppose to be STRONGER than 5mg Vicodin only partially helped the W/D! And then an hour later I felt the runny nose coming back pretty hard. I had to take a Vicodin to make it go away....

How in the world could Hydromorphone have been weaker for me than Vicodin? Maybe I'm at the bottom of the BA for absorption? Is BA is issue? Or I got a really crappy generic Hydrmorphone and a really good generic Vicodin? Or is it something else?

That's a HUGE difference of Hydrmorphone having 29% BA to 95% BA depending on the person.. Thats like saying if you take an Oxy it "might only be 5mg or it might be 30mg" depending on the person. That's a HUGE difference. Enough for non tolerant opiod people to easily OD on due to that crazy difference in BA... Assuming it's even accurate.


I'll try a full 4mg tablet and see how much different it is, it sure as heck better beat a 5mg Vicodin in stopping W/D or I'll be baffled.

So I guess that kinda leaves Hydrmorphone off the table, unless brand name Dialud is much superior? I heard it has the least fillers of any medication. And that brand name Opana vs generic oxymorphone even the FDA recognizes there IS a difference... Yet both are oxymorphone so why? Due to fillers, and not all generics are equal. And even per law the active ingrident can be slightly off for generics. That's a pure fact and had been proven in studies, and published in medical articles. But I'm not going to get into brand vs generic debate...


Oh, and if this makes any difference: high fatty meals MASSIVELY boost opiods for me, both oxycodone and hydrocodone. In fact so much of a difference that if I take say 10mg of Oxycodone with no food I could STILL be in WD (normally 5mg stops WD). Yet if I take 5mg with food it stops WD. Taking it WITHOUT FOOD literally makes oxycodone and hydrocodone NOT WORK for me. It's literally a 100% or more boost for me from eating food. I know "officially" fatty meals can boost it 25-30% but it literally is the difference between meds working and not working! So I wonder if me eating food with HydroMORPHONE is not the same as with Hydrocodone in terms of it getting a large boost from fatty meals? Maybe hydromorphone is the opposite? Or maybe cutting them in half is not suppose to be done as there is no line down the middle and maybe it's not evenly distributed? I... Don't know. I guess I'll have to try a full tablet I'm just trying to keep my tolerance super low and don't want to jack it up.

Heck even a 50mg tramadol probably helped more with W/D than half a 4mg Hydrmorphone tablet did.. Which is super odd.... Either my BA is like 2% for hydromorphone or maybe the generics suck, or maybe cutting them in half (IR though) messes with it as some generics are not evenly distributed throughout pill and aren't meant to be cut in half.

Anyone else have any other recommendations? On either IR or ER meds it don't matter.

 

[ColoradoBoy90]

Here's another thing and question:

Is this true:
"Hydromorphone has a very large interpatient variability due to unpredictable bioavailability (29-95%)"

It doesn't state this for Oxymorphone oddly? I did the SAME cnversion for oxymorphone and it came up only with:

10mg Vicodin = 3.33mg to 7.5mg of OxyMorPHONE. Average: 6mg oxymorphone vs
10mg Vicodin = 2.5mg to 3.75mg HydroMorphone (Average 3mg).

So MG per MG Hydromorphone is quite a bit more potent than oxymorphone, but potent for what, pain relief, a "buzz"? Making you more sedated and tired?

And here's the weird thing: I took HALF a 4mg tablet of Hydromorphone, so 2mg,
which should be really equal to 6mg of Vicodin... Well, it's not. Not for me at least. I tested this by letting W/D kick in, and normally 5mg of Vicodin stops withdrawal. Well, 2mg of Hydrmorphone which is suppose to be STRONGER than 5mg Vicodin only partially helped the W/D! And then an hour later I felt the runny nose coming back pretty hard. I had to take a Vicodin to make it go away....

How in the world could Hydromorphone have been weaker for me than Vicodin? Maybe I'm at the bottom of the BA for absorption? Is BA is issue? Or I got a really crappy generic Hydrmorphone and a really good generic Vicodin? Or is it something else?

That's a HUGE difference of Hydrmorphone having 29% BA to 95% BA depending on the person.. Thats like saying if you take an Oxy it "might only be 5mg or it might be 30mg" depending on the person. That's a HUGE difference. Enough for non tolerant opiod people to easily OD on due to that crazy difference in BA... Assuming it's even accurate.


I'll try a full 4mg tablet and see how much different it is, it sure as heck better beat a 5mg Vicodin in stopping W/D or I'll be baffled.

So I guess that kinda leaves Hydrmorphone off the table, unless brand name Dialud is much superior? I heard it has the least fillers of any medication. And that brand name Opana vs generic oxymorphone even the FDA recognizes there IS a difference... Yet both are oxymorphone so why? Due to fillers, and not all generics are equal. And even per law the active ingrident can be slightly off for generics. That's a pure fact and had been proven in studies, and published in medical articles. But I'm not going to get into brand vs generic debate...


Oh, and if this makes any difference: high fatty meals MASSIVELY boost opiods for me, both oxycodone and hydrocodone. In fact so much of a difference that if I take say 10mg of Oxycodone with no food I could STILL be in WD (normally 5mg stops WD). Yet if I take 5mg with food it stops WD. Taking it WITHOUT FOOD literally makes oxycodone and hydrocodone NOT WORK for me. It's literally a 100% or more boost for me from eating food. I know "officially" fatty meals can boost it 25-30% but it literally is the difference between meds working and not working! So I wonder if me eating food with HydroMORPHONE is not the same as with Hydrocodone in terms of it getting a large boost from fatty meals? Maybe hydromorphone is the opposite? Or maybe cutting them in half is not suppose to be done as there is no line down the middle and maybe it's not evenly distributed? I... Don't know. I guess I'll have to try a full tablet I'm just trying to keep my tolerance super low and don't want to jack it up.

Heck even a 50mg tramadol probably helped more with W/D than half a 4mg Hydrmorphone tablet did.. Which is super odd.... Either my BA is like 2% for hydromorphone or maybe the generics suck, or maybe cutting them in half (IR though) messes with it as some generics are not evenly distributed throughout pill and aren't meant to be cut in half.

Anyone else have any other recommendations? On either IR or ER meds it don't matter.

 

[ColoradoBoy90]

Okay, oral BA totally sucks on them and the conversion is wrong (for me at least).

As I can take a 4mg tablet and it will stop *most* of the WD, make me feel different than taking a hydro, maybe more sedated? Does anyone else think they are more sedating? But then the W/D of chills/etc seem to still be there, just lightly. It's weird, it's like I'm still in W/D but only maybe 10% of the feeling is left.
It won't fully stop W/D.
That's really WEIRD since it's much stronger than Vicodin. HydroMORPHONE is even stronger than Opana/oxymorphone mg per mg.... Hydrmorphone is the strongest pill out there technically. As a 8mg tablet of HydroMORPHONE is more potent than a 10mg tablet of Opana/OxyMorphone..
But I guess it's BA can really suck for many. But the BA for Opana is even worse I thought.i could google it but I'm being lazy lol.

But a 5mg of Vicodin stops W/D for me. So how can 4mg of HydroMORPHONE not? Is the generic to blame? I know fillers can water down the drug heavily and make it not absorb properly......I mean how that's even possible?

Snorting HALF (2mg) seem to stop W/D though. Snorting the other half 30 mins later pretty much fully stops W/D. But that's snorting it... Orally 4mg won't even stop W/D yet a 5mg Vicodin will. Weird..

 

[Formidable]

although people generally have the same reactions to drugs, there are several independent variables each person brings to the table that might negate or increase a certain drug's effects. things like BMI, having the MC1R gene, previous drug use, contraindications, use of potentiators, all of these things and many more can change the way your body reacts to a drug. also hydrocodone is derived from codeine while hydromorphone is derived from morphine. furthermore, oral hydrocodone is metabolized by the CYP450 enzymes while oral hydromorphone is metabolized in the liver, making the BA far less. the BA for hydromorphone increases with insufflation because it's not being metabolized by the liver.

so basically, if you're suffering from hydrocodone withdrawal, it makes sense for hydromorphone to only have minimal effects compared to redosing with hydrocodone.