Methadone or Bupe: least [negative] impact(s) on the heart?

[TAR3]

I've used opiates for 50 years. The last 2 decades were (first decade) methadone (second decade) Subutex maintenance. I recently tapered off the bupe only to become seriously injured, treated with opiates (pain management) and, once again, found myself abusing the medications.

Long sigh...

Time to go back on maintenance.

One of the consequences of [my] long term "use" of opiates - & IV coke and crank during the '70's - is congestive heart failure; not too serious (now) but a reality, nevertheless.

Which of these two maintenance drugs will - likely - have the least impact on my heart? I will ask the Dr., but have learned the Dr. doesn't always have the correct information.

Thanks.

 

[laCster]

bupre because it is only a partial agonist (~30% for bupre, 100% for morphine), or in other words, bupre only releases 1/3 of the endorphins/dopamine/sert that morphine or methadone does. bupre's pharmacology is quite complex though so these are only estimates. generally the medical community accepts that bupre only causes half the side effects that morphine does (lessening of constipation, euphoria, miosis, ect..) and is thought to cause less side effects than a full-agonist like methadone or morphine

methadone is known for causing a steep drop in testosterone production, but opiates dont put much stress on the heart, well most dont. some opiates like darvocet and tramadol raise blood pressure and malevolently affect your heart, but classical opiates like morphine and codeine dont really affect the heart in a positive or negative fashion.

 

[TAR3]

bupre because it is only a partial agonist (~30% for bupre, 100% for morphine), or in other words, bupre only releases 1/3 of the endorphins/dopamine/sert that morphine or methadone does. bupre's pharmacology is quite complex though so these are only estimates. generally the medical community accepts that bupre only causes half the side effects that morphine does (lessening of constipation, euphoria, miosis, ect..) and is thought to cause less side effects than a full-agonist like methadone or morphine

methadone is known for causing a steep drop in testosterone production, but opiates dont put much stress on the heart, well most don't. some opiates like darvocet and tramadol raise blood pressure and malevolently affect your heart, but classical opiates like morphine and codeine don't really affect the heart in a positive or negative fashion.

I'm due to have both knees replaced in June. I don't see the (treatment) Dr. until Monday but have completed the intake. Have been told by treatment director that the Dr. will likely recommend methadone - due to upcoming surgery. Do you think it would be viable to suggest, perhaps, that I take methadone until surgery issues are completed and then switch to bupe? Last bupe Dr. never switched me to Suboxone; however, this Dr. will not follow that protocol.

Also, my best guess is all the coke and crank I shot in the 70's are what, essentially, damaged my heart - thank God I walked away from those chemicals just before 1980!

Thanks!

 

[pasha]

tramadol raise blood pressure and malevolently affect your heart, but classical opiates like morphine and codeine dont really affect the heart in a positive or negative fashion.

Tramadol does not increase blood pressure, respiration, heart rate, and has cardioprotective properties.

We have recently studied the effects of tramadol on blood pressure in anaesthetized rats. In the study, continuous infusion of tramadol had little effect on blood pressure (Nagaoka et al., 2002) [...] Thus, the lack of effects of tramadol on the blood pressure could be due to inhibition of NAT by tramadol. Another explanation is that in anaesthetized animals, the sympathetic nerve activity would be very low and synaptic transmission by ACh in the sympathetic ganglia might be so small that inhibition of nicotinic receptors by tramadol caused only a minimal effect.

Source:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1573343/

Moderate haemodynamic changes were observed in both the tramadol and morphine groups (with a maximum 20% decrease in mean blood pressure and a maximum 17% increase in heart rate) during the 72 hr period.

Source:http://www.ncbi.nlm.nih.gov/pubmed/9598258

Tramadol may protect myocardium against acute myocardial ischaemic injury and could reduce myocardial infarct size, which may be associated with the expression and activation of NF-kappaB.

Source:http://www.ncbi.nlm.nih.gov/pubmed/19829116

Tramadol provides a cardioprotective effect against myocardial ischemia-reperfusion in isolated rat heart.

Source:http://www.ncbi.nlm.nih.gov/pubmed/17680512

Compared to saline, tramadol caused no change in heart rate, step frequency or sweating score.

Source:http://www.ncbi.nlm.nih.gov/pubmed/19845931

In either case, I'm not going to allow this to stay open. I stay away from affairs of the heart. If you don't think your doctor is knowledgeable, find another one, specifically a cardiologist. It's a much better option than having strangers give you inaccurate, and unfounded advice on a fitting opioid when having heart disease. Doctors face legal ramifications on the recommendation they make, and ethical considerations as well. Where as on a forum, these things simply don't exist.

Closed. PM me if you need anything.