Opioids Tapering from Tramadol and wanting to start Mirtazapine (Remeron).

[XxJUSTSAYNOxX]

Many years ago I had a nasty opiate habit and ended up on Methadone, which I was able to kick from 100mg - 0. Took 4 years. This was 12 years ago. Skip to "HERE'S MY QUESTION" below to skip the preface.

Since then have stupidly dablled with opiates on and off, but never let them get a hold of me....until recently.

I'm living in South America now and Tramadol, 30mg Codeine, and Zopiclone are pretty easy to get from pharmacies without prescription. Here's where I'm at. Over the last couple years I've developed a habit of about 240mg Codeiene + 200mg Tramadol per-day + zopiclone of varying amounts, and between 375-750ml rum per day.

I just went through a horrible month or so, kicked the codeine cold turkey (240mg - 0) along with the alcohol and haven't looked back, but held on to the tramadol and upped the dose to 500mg from 200mg per day. That was a month ago. Since then, I've been slowly reducing my Tramadol dose by 50mg per week.

Currently I'm still alcohol and codeine free (1 month!) and my Tramadol dose has now been reduced to 300mg/day. So I'm on the right track I think. Plan is to drop to 250mg in a week, then 200, then 150, week by week, and then slow down the taper. I'm trying to avoid as much withdrawal as possible especially after ditching the alcohol and 240mg codeine cold turkey.

HERE'S MY QUESTION:

Currently tapering tramadol. Was at 500mg a day, one month later dropping 50mg per-week I am now at 300mg. It hasn't been too bad but very depressed. I am wanting to get onto Mirtazapine (Remeron) to get more stablizlied and help with my underlying issues of anxiety and depression.

I'm worried about mixing the two due to seretonin syndrome. At what point do you think it's safe to start taking the Mirtazapine? Must I have all tramadol out of my system or could I start once I reach a dose of 150mg Tramadol or so?

My other issue is Zopiclone, which since a month or so ago when I started the taper, and went off codeine and alcohol cold turkey, I have been taking more and more, sometimes during the day to help with anxiety. I'm up to about 4x7.5mg of the Zopiclone per day. It's the only way I can sleep now.

I just really want to get on this Mirtazapine and stick to it as the only drug that I take to remain stable. I chose it as I could use weight, the way it helps with sleep, and of course for depression and anxiety. I also understand it helps with some opiate cravings, and I've been on it before, prescribed by doctors during my Methadone withdrawal.

I figure once I can get on Mirtazapine, I can then look at decreasing my Zopiclone dose until Mirtazapine is the only drug I'm on.

Thoughts? When can I start this Mirtazapine safely, at what dose of Tramadol, or is it much safer to be finished with Tramadol 100% first.

I hope this is the last time I get myself into this mess.

 

[Jekyl Anhydride]

So I really like your plan and it's logical makeup. From everything I've come across, Mirtazapine is a docile and 'friendly' AD compared to other TCA / TeCA's. My advice would be to go as low as you can before switching, but I really doubt that 100mg of Tram is going to cause SS with Remeron. I would also trust that feeling that causes the hair on the back of your neck to stand up or feeling strangely wiry as a sign that you might have to wait longer and keep cutting out Tram. It would be a good idea to have someone with you when you first induce Remeron to be safe and if your not climbing the walls within 24 hours you're probably good to go with the continued taper. In My Opinion

It goes without saying that running this past a doctor wouldn't be a bad idea at all, but we can also opine on the matter since that's what we're doing. If it were another AD I would be screaming caution but Remeron is a kind AD.

Here's a thread you might want to check out:-Tramadol-and-Mirtazapine-thread

 

[XxJUSTSAYNOxX]

So I really like your plan and it's logical makeup. From everything I've come across, Mirtazapine is a docile and 'friendly' AD compared to other TCA / TeCA's. My advice would be to go as low as you can before switching, but I really doubt that 100mg of Tram is going to cause SS with Remeron. I would also trust that feeling that causes the hair on the back of your neck to stand up or feeling strangely wiry as a sign that you might have to wait longer and keep cutting out Tram. It would be a good idea to have someone with you when you first induce Remeron to be safe and if your not climbing the walls within 24 hours you're probably good to go with the continued taper. In My Opinion

It goes without saying that running this past a doctor wouldn't be a bad idea at all, but we can also opine on the matter since that's what we're doing. If it were another AD I would be screaming caution but Remeron is a kind AD.

Here's a thread you might want to check out:-Tramadol-and-Mirtazapine-thread

Thanks so much for the insight! I'm glad you like my plan. lol

Talking to a doctor is a bit of a problem as I moved from Canada to a tiny Rainforest village in South America and don't have health insurance. I COULD go to a doctor, but my Spanish isn't fluent enough to describe this type of thing, and honestly I doubt there is very much knowledge towards opiates and AD's here, as far as treatment goes. I could be wrong. I know it's not my fault, but I wish somehow it wasn't so easy to buy 20+ boxes of 30mg codeine, tramadol, and zopiclone at a time, from the same pharmacy! :O

Checking out the thread you posted now. Any other suggestions would be greatly welcomed. It's been a long time since I posted but I always come to Bluelight for my "research" and it has proven to be a great resource in the last 15 years or so I've been using it.