Bupe Precipitated Withdrawal from Loperamide and/or Tramadol?

[i are spectre]

Has anyone had experience with long term loperamide and/or tramadol use and switching to suboxone? Was there any noticeable precipitated withdrawal?

I've read several reports of some precipitation effects though they were from short term users of loperamide so perhaps methadone was still in the system.

I want to jump back on bupe and have been using loperamide and tramadol for quite a few months now. Concerned with side effects of high dose loperamide.

Thanks for responses

 

[Znegative]

Yeah there should definately be precipitated withdrawal if you don't wait long enough. From what I hear both tramadol and loperamide are long lasting opioids so you're going to probably have to wait longer to jump over than you would from say, oxycodone or heroin. Just wait until you're definately in withdrawal, and dose then.

 

[Oxide]

Loperamide is still a full-agonist, and it will cause precipitated withdrawal. Znegative hit the nail on the head here, the only way to be sure you will avoid precip withdrawals is to wait until you're 100% sure you are in moderate withdrawal before taking the bupe. The long half-lives are another important point and you will certainly have to wait much longer than you would with some of the other short-acting full-agonists.

 

[Miss Kirsty]

A friend of mine had horrible withdrawals when he got some bupe after being on about 800mg tramal a day...I was there, it was awful for him. And Loperamide is the worst outta the two, so ifn you aint in moderate withdrawal, DONT take it...Wait until at least 36 hrs IMO, wait until you have sweats and teary eyes. Not untill you FIRST start feeling you are in withdrawal, you need to be in withdrawal for hours...Good luck...

Saying that: Everyone is different....Moderate withdrawal is the key...

 

[i are spectre]

Thanks. Isn't it best to dose small amounts of bupe to 'test' for the precip?

I've heard of people taking doses under 1mg to verify the ability to switch comfortably. Does this work?

I plan on taking 0.25mg or 0.5mg and waiting. If WD gets significantly worse within 1 hour then you need to wait longer, correct?

It seems you not only have to wait for withdrawal, but be near the peak of withdrawal. For instance, when some methadone users that wait 36hours to dose, the actual peak of withdrawal has not been reached, so I assume the bupe takes it right to the bitter end, kicking off nearly all remaining methadone almost spontaneously once it is introduced, correct?

 

[Znegative]

Yea correct. 36 hours is way to short to switch to bupe from methadone IMO. When I was detoxing from methadone, it took about four days to even begin feeling the withdrawal

And yeah, it's probably a good idea to start off low with those doses, but I'm really no expert on this matter. All I can say is two mg was enough to put me into miserable precipitated withdrawal

 

[i are spectre]

I jumped to suboxone with absolutely no precipitated withdrawal.

I was taking 50mg to 200mg of loperamide a day for months.

24 hours after my last dose, i took 0.25mg of suboxone, waited half an hour, took another 0.25mg, waited a half an hour, took 0.5mg, waited half an hour, took 1mg, then a litre of diarrhea shot out of my ass, then took another 2mg.

I feel so much better. But hey, maybe this can help someone with that OR if you were on methadone maybe you could switch to loperamide for a week then suboxone. Or maybe I am not susceptable to the precipitation.

Also the doctor was pretty shocked when I told him I was using that much loperamide. He said there was atropine in it to stop people from abusing it. Old timers...

 

[Znegative]

The fact that a litre of diarrhea shot out of your ass is kind of a sign of precipitated withdrawal, though it seems you fared okay. Loperamide wouldn't be a horrible substitute to take while waiting to switch over to suboxone from methadone, but something shorter acting like morphine would probably be better

 

[DustnRoses]

It was my understanding that tramadol/suboxone can be taken before or after each other with no adverse effects. I did this myself about a year ago, I had a small habit, switched over to tramadol for about 2-3 days, then used sub, even with the tramadol, with no adverse effects. They actually go well together.

 

[Znegative]

Yeah you can use them together, but if you're taking a whole ton of tramadol, and then switch to suboxone, you'll still likely face precipitated withdrawals, even though tramadol is not a typical opioid. The reason that tramadol can be used on top of suboxone is because it has seretonergic effects as well as weak opioid effects, though those would be blocked by buprenorphine.

 

[i are spectre]

i think it also may have to do with the gradual addition of bupe to the system.

taking large doses (8mg) at once seems to be where i read about the precipitated withdrawals.

nonetheless, i am very fortunate to have made the transition. i've read some pretty scary stories of people using loperamide for a while because they cannot afford their suboxone script and switching over with some long lasting, nasty "pw".

 

[Znegative]

Yeah it's always best to induct yourself that way, especially when you're coming off another long acting opioid. That way if .25 mg puts you into precipitated withdrawal, it at least won't also block other opiates at that dose, though it would probably require a stronger or larger dose of another full agonist.

What I wonder though, is that when switching from tramadol (a weak opioid agonist) to bupe (an incredibly potent partial agonist) is, if you say dosed the suboxone (this is assuming that the dose of suboxone has ore opioid activity that the dosage of tramadol) only a few hours after the tramadol, if you would still experience very harsh precipitated withdrawals, as the buprenorphine is so much stronger, even though it is a partial agonist.

 

[Harmreduxadvocate]

I switched from 200mg of Loperamide daily to 16mg Subutex two weeks ago. I waited 24 hrs and was dope sick when I induced. I was induced on 4mg Suboxone and went into full on precip WD. I expected it and prepared for a full day of hell. Ultimately I titated up to 24 mgs Suboxone on day one and after about 6 hours post second 4mg dose the WDs eased up.