If it matters any for 3 years now ive been at the varying dose of 244mg-400mg every 40 hours. This includes a buffer of 12 hours wait if need be. Ive noticed that varying the dose at these seemingly herculean levels for anyone else causes all types of benefits. Im 260pounds, 6', male and find these little bottles of 72, 120,200 pills allot less scary than i once did. Saying that hoever i dont suggest ANYONE do what im doing.
I was previously a network and systems engineer from 98-2011 when i was finally disabled due to lymphoma. Enter a cadre of mild manner opiates and ending with prescribed oxymorphone and hydromorphone (120 each) which only covered about half the month anyway. I worked allot and well ive been told. 12-16hr days without worry.
My problem was simple: the DEA shut down my doc. Hmm..that was not fun. Not at all. Of course diamorphine shows up without fail and im humming along on a 250/day habit. At the time i wasproducing 400/day so i saw it the way a diabetic sees an expensive insulin regime: expensive but there is zero play without it. Funny enough thats when i noticed that my habit would get shittonne worse if i kept the same dose every day.
At this point i use loperamide exclusively opioid-wise as ANY other opioid with binding strength less than loperamide itself (whatever its Ki values are) initiates some WD unpleasentness. Examples are: stopping lope for four days with 60 tramadol to give a break - and then worried about serotonin syndrome. Result: 20% withdrawl all the time even with taking 3A4 inhibitors to induce 2D6 to make M1 (o-desmethyl-tram). One pain doc gave me 120 10mg hydrocodone/norcos which then the following month he switched to 10mg oxys. Result: some receptor sites simply were not happy at not being binded to is my guess (forgive this engineer for trying to figure everything out - its my worst failing) as 60-120mg hydro OR oxy (yeah APAP - CWE) did the kindness of working for 2-3hrs and put me yet again in opiate purgatory with 20% withdrawl symptoms. I stopped going to the costly pain management doc as in the end all a short acting opioid did was make me WORSE. I would use them as forced loperamide vacations. Suddenly anything less potent than dilaudid (at 16mg IV i get what in my monster using days would take 24-32mg - that has me "content" not euphoric (never got that anyway at ANY dose - just serenity and energy) - but whatever - i dont beleive in happiness as long as the DEA causes so much pain.
I would love to do a AMA on loperamide. I wonder if id be a good case study. Oh any my heart? No super elongated QT cycle - i get that checked every 6 months - but one close to concerning: 450ms. From my understanding if interred in a hospital they dont let u go unless your 500 or below. Presentations with lop OD have been as high at 700ms requiring some temporal pacemaker action.
Now if i DONT vary the dosage milligram at the 30-35hr mark - then ALL the OPs and your symptoms are mine: from blurred peripheral vision; eyes feel "stuck" slightly at times, if i pick up anything over 100 pounds (even me from a chair) then i most certainly will have temp. WD for about 30-45 seconds set in the form of pins/needles. I just painted myself into a corner. Smart enough to be dangerous? Heck the fuck yeah. Dont be me kids.
Basically im using varying doses of loperamide at 244-400mg with piperidine (water/3g black pepper), 5,000mg of tumeric, grapefruit juice and cycling milk thistle for liver support periodically. Principally im inhibiting to a greater (mechanisim based) or lower (chemical) base extent CYP3A4, P-gp, CYP2C8, as well enhancing the whole operation by taking chemical breaks.
I dont have any other choice given the opiate climate. But hey - it could be worse. It can always be worse.
Cordially,
Alastasian/i4004
RIP alt.drugs.hard (2005-2010)
Still love you MobiusDick
Jose you still suck lol
PS: Cytotoxic in literature or not ive been on it for years now with the method above. theories aside i shit normally - right after morning dose. no toxic megacolon, no felt tachycardias (...yet), no EKG with excessive prolonged QT intervals due to hERG channel antagonization, no issues apart from slight tolerance. The DEA makes everything apart from this a problem; and i really don't see a pain doc willing to prescribe >24mg of hydromorphone a day apart from hospice or dark web - and in both a professional user will get fucked over with time aka IMHO not sustainable long term. Living with theses needs, all the while life demanding everything now: and starting over isnt an option type shit. High dose short term opioids agonists are next to impossible to acquire outside a rap video in the current "Doctors are Businessmen First" climate (q42018) so i stick to what works and work around the systemic/cholinergic issues my mind can see. And boy so i feel like im driving blind with this at times...
if there were a study for pain management using loperamide alone i think id be an excellent candidate as i am not a polydrug user anymore and am an actual good example of the cycles following the high functioning opiate addict choosing high dose loperamide over short acting *anything*.