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Misc Best antihistamine against opioid induced itching?

izo

izo

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Mar 22, 2006
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Any suggestions? I can’t stand diphenhydramine and doxylamine by now. So what would you guys suggest? Cetirizine or loratadine?
 
Cortisone is somewhat last resort, even topical iirc. You mean hydrocortisone. Thank you abbey.
 
Hydroxyzine possibly, it is a bit sedating but felt lighter than doxylamine (diphenhydramine does nothing for me). The pills they sell here are 10mg while a full sedating/prescription dose is 100mg so it has a huge dosage window.

Does an antihistamine need to be centrally active to work against opioid itch? Otherwise yeah cetirizine et.al.

AbbeyLee said:
Get a cream. You can get mild cortisone creams over-the-counter here.
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I'm curious about the effects of ingested cortisone. Do you have any experiences? I think remember to having read that corticosteroids increased stamina (in short time of course).
 
Strange, I kind of like the itching. It reminds me I'm high on an opioid. In fact, if i'm not itching like a madman then I know I didn't take quite enough.


AbbeyLee said:
Get a cream. You can get mild cortisone creams over-the-counter here.
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No so sure that would work for opioid induced itching given the central nature of this itching side-effect. Unless said itching only occurs in one spot.

izo said:
Are the sedating effects comparable to doxepin or prothipendyl? Anyone?
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No, the sedating effects of promethazine is very different and much heavier than doxepin.

Loratadine/cetirizine might work, never tried.
 
Yeah, I too liked the itching to some degree, but I think I got it only mild. Saw people after an IV shot of morphine almost scratching their skin off.

Wonder to what degree the histaminergic effects of opiates correlate with wakefulness promotion and possibly even euphoria. I mean central antihistaminergics are sedating and opiates, as long as tolerance is low, keep many users up. But then again many say that stuff like promethazine would potentiate opioid euphoria.
 
Traditional opiates dont really promote wakefulness though especially not with incidental use.
 
bingey said:
Traditional opiates dont really promote wakefulness though especially not with incidental use.
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Well the first time I did a bit of heroin it kept me up all night, and when I was on morphine maintenance and tapered down to 60mg, then taking 120-180mg would do the same. Actually it was the sort of effect from opiates I liked most. I might be atypical because I too never got any nausea but I read from others that opiates kept them up (initially) as well.
 
Well I agree that you dont really go to sleep when your high like you can with cannabis but to call them wakefulness promoting in general is a bit of a stretch when youre drifting in and out of consciousness , slumped over, only awake to scratch yourself or take a few drags off a cigarette.
 
negrogesic said:
No so sure that would work for opioid induced itching given the central nature of this itching side-effect. Unless said itching only occurs in one spot.
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Yeah I've had "smacky itches" plenty of times :) I've also had eczema all my life and always used cortisone creams. They aren't the greatest thing cos they thin the skin, but they're the only thing that ever worked. The OTC ones are much weaker though than what I've had prescribed.

Anyway with the opiate itching mine focuses on a few spots and I just use the cream there.
 
bingey said:
Well I agree that you dont really go to sleep when your high like you can with cannabis but to call them wakefulness promoting in general is a bit of a stretch when youre drifting in and out of consciousness , slumped over, only awake to scratch yourself or take a few drags off a cigarette.
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Granted. Not as wakefulness promoting as e.g. modafinil or stimulants of course but there is a dosage level where it was almost impossible to sleep, way below the dose required for a nod. I did this repeatedly, tapering down and then take a load of morphine to feel some euphoria and it always ended up with me skipping a night.
 
I'd be very interested in this, too!
I think the second-generation (AKA non-drowsy) ones work best. I always take Cyclizine with mine (first-generation, sedating antihistamine*) because it is EXCELLENT at potentiating opioids, but it's not so great at the opiitch.

Although also a 1st gen, I find Chlorphenamine (Chlorpheniramine if you're in the US) helps moderately.

Is there any second-gen you guys would recommend the most?

Are Doxepin and Prothipendyl Rx only or OTC?


*prescription only, second strongest one, after Hydroxyzine
 
Why do opioids cause itching?

Opiates have long been known to cause the release of histamine from mast cells, resulting in several undesirable effects, such as hypotension, urticaria, pruritus, and tachycardia. The mechanism of this opiate response has remained unclear, although it is known to be non-immunological in nature. A survey of the histamine-releasing properties of a variety of opiates shows that the pharmacology of opiate-induced histamine release from mast cells is distinct from that of known opiate receptors. Although functional opiate receptors may exist on mast cells and may be capable of modulating IgE-mediated histamine release, there is no evidence that these receptors account for opiate-induced histamine release. Since other basic compounds have been suggested to release histamine from mast cells by directly activating G-proteins, it seems possible that morphine and endogenous opiates may also share this mechanism.
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izo said:
Doxepin yes, sedating antidepressant. Prothipendyl is sold as a weak neuroleptic. Action almost identical, doxepin a little more solid I’d say.
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How does it help with itching? I was briefly on a tricyclic (Amitriptyline) and didn't know any anti-itching properties.
 
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