Can ANY drug safe to take orally be injected?

[John_Burrows]

I crush and filter my dilaudid for IV, so the simpleton in me wonders if any pill safe enough to eat can be filtered and injected?

I've been taking amitriptyline orally for a few months and the results have been very inconsistent... I'd like to try it IV to get a "clean" dose, but obviously I'm not going to try it until I've done my homework...

 

[nowdubnvr6]

no it cannot take benzos for example most are not water soluble or safe to be IVed

 

[John_Burrows]

Well water solubility and safe to inject are separate issues... Assuming a drug can be dissolved and filtered into a clear solution, can someone explain why it wouldn't be safe to inject?

 

[phatass]

no it cannot take benzos for example most are not water soluble or safe to be IVed

what about midazolam or loprazolam which r water soluble.... it really depends on the product... i've never heard of IV amiltryptiline

 

[rickolasnice]

Why would you want to IV amitryptiline?

 

[John_Burrows]

My pain management doc gave me amitrip to potentiate my dilaudid (hard to believe a doc would be trying to help me potentiate, but I'm not arguing). Problem is when it works it works great, but the amitrip has been very inconsistent - sometimes it works, sometimes not, sometimes all I need is a low dose, sometimes more, etc.

I figure if I IV it, it will be a straight up, pure dose, and things like empty/full stomach, amount of time I take it before the dilaudid, etc, will play far less of a role.

IV I figure will be a lot more predictable. So I'd like to try it, but I want to find out if it would be safe to do so...

 

[3rd_I_blind]

Amitriptyline can safely be used for IV administration, although it's always questionable to manipulate orally administered tablets to IV administered solution yourself. Also, there is a bigger chance for extrapyramidal adverse effects with IV amitryptyline. Why don't you just take your problem to your doctor instead of playing doctor yourself? He seems like a well-informed guy, since he came op with the TCA-potentiation and is willing to prescribe you hydromorphone.

 

[3rd_I_blind]

Assuming a drug can be dissolved and filtered into a clear solution, can someone explain why it wouldn't be safe to inject?

I can think of a few reasons, but it's mostly theoretical.
- Drugs that are excessively protein bound (>90%') that need to be administered in a >100 mg bolus. This will cause precipitation of serum albumin and other bloodborne proteins...not good!
- Prodrugs that need to be metabolized in the stomach/gut/liver to form the active moiety. Although it might not lead to severe adverse effects, you would reach a much lower concentration of the active moiety with IV'ing.
- Drugs with relatively low or high pKa that need to be administered in a fairly high bolus might also alter solubility of bloodborne proteins, or cause some kind of shock-reaction upon injecting.
- Drugs that are known to double as a hapten. It is one thing to orally take penicillin in case of penicillin allergy, it's a whole different thing if you IV penicillin. Of course penicillin is not a typical drug you would IV yourself with, but there are numerous other drugs that are haptens.

 

[John_Burrows]

3rd Eye, kudos to you and your bunny suit for that wonderfully informed reply.

I've talked to my doc about the problem and his only suggestion is to up my dosage. He also said that I should take the ami AFTER the opiates, which makes no sense to me if it's meant to potentiate (and he never mentioned this before, even though we've discussed the Amitrip several times...

I suppose I can try a very small amount in a syringe full of water to see if it affects me adversely.

Not sure...

 

[3rd_I_blind]

I've talked to my doc about the problem and his only suggestion is to up my dosage. He also said that I should take the ami AFTER the opiates, which makes no sense to me if it's meant to potentiate (and he never mentioned this before, even though we've discussed the Amitrip several times...

From what I can find about it in a short search - and I don't have time for a long search now - TCAs potentiate opioid analgesia by enhancing 5-HT (serotonin) metabolism. Might be the case that administering TCA before taking hydromorphone has the well-known paradoxical effect of decreasing 5-HT metabolism before stimulating it. This dip could than increase the pain, especially so if you are talking back pain. Could also be a sort of 'locking in' mechanism (though there were definitely no articles - after my short search - to support this idea), in which the TCA secures hydromorphone in the receptor, thereby enhancing receptor activation.

Think of it this way: If it's counter-intuitive, it seems rather odd the good man would advice it unless he has a good reason. Furthermore, why don't ask him? I know it sounds smart-assy, but most docs would be pleasantly surprised if they encounter a patient with some interest in the workings. Provided you don't ask it in a 'WTF do you know, noob!?' tone.

 

[John_Burrows]

Oh believe me I have many curious questions for the good doctor, and I am always reverent...but he has a little bit of an ego problem and when I ask for details about why I shouod take the amitrip AFTER the opiates - especially when he previously (twice) advised me to take them BEFORE the dilaudid, he gets testy very easily and thinks I'm questioning him...

So I had a little trouble deciphering your thought process.., it sounds like you were making the case for BOTH scenarios,,, am I right?

Oh and if you do choose to do any more research, please let me know if you come across anything that helps make the case for trying it through injection... And I naturally obsolve you of all responsibility if I decide to try it.

I just want an informed guess if i'd be ok or is one syringe of the stuff likely to land me in the ER...

 

[3rd_I_blind]

Oh believe me I have many curious questions for the good doctor, and I am always reverent...but he has a little bit of an ego problem and when I ask for details about why I shouod take the amitrip AFTER the opiates - especially when he previously (twice) advised me to take them BEFORE the dilaudid, he gets testy very easily and thinks I'm questioning him...

Well, if the good doctor gives contradictory advice, I think you should confront him with that and explain that you are not saying you are questioning his skills, but that you honestly are confused. Of course, I am easy off giving this advice, since it is your doctor and you must rely on him for your pain medication - which is rather essential in case of severe pain.

So I had a little trouble deciphering your thought process.., it sounds like you were making the case for BOTH scenarios,,, am I right?

Well, I was trying to make the case for the 'take amitriptyline after hydromorphone', but since I failed...LOL. But I guess it's obvious the other scenario is extremely logical by 'gut feeling', so I don't have to come up with a scientific piece for that one. Perhaps you could think of it as alcohol potentiation by benzodiazepines. It is usually best to take the benzo's first and then drink alcohol.

And I naturally obsolve you of all responsibility if I decide to try it.

That's very nice of you, but as a decent human being I have my own moral position, although I am not operating under Hippocrates' Oath. So you might relieve me of legal responsibility, but I still would have my own feeling of discomfort by giving you advice that is likely to do more bad than good in the long run...

I just want an informed guess if i'd be ok or is one syringe of the stuff likely to land me in the ER...

This can't really be said in advance. There is no telling what the effects will be, and it is even more problematic to estimate the severity of possible adverse effects and how hazardous these adverse effects will be for you in the situation you are in at that moment. What I can say is that I imagine extrapyramidal symptoms after IV'ing amitriptyline can be quite severe - where with severe I mean relatively severe compared to extrapyramidal symptoms after oral administration - although the chance you get them is probably in the 10-20% range. You should look up the EPS on Wiki or somewhere else to decide how bad this is, where you must keep in mind your condition of pain - how will your pain behave if you get a dystonic reaction or restlessness; bradykinesia might mean you can't drive or are more prone to fall down stairs, for instance.

 

[delta_9]

no it cannot take benzos for example most are not water soluble or safe to be IVed

Benzos are administered in hospital/clinical settings when needed. The solvent is just not saline though. I think it's propylene glycol(correct me if I'm wrong)

 

[3rd_I_blind]

I think it's propylene glycol(correct me if I'm wrong)

Propylene glycol would be likely yes, or ethanol - though not in a 100% solution; usually diluted with saline. Sometimes they also add NaOH, HCl or another acid/base/buffer to influence the solubility, or specially developed surfactants. The main conclusion should be that it's bullshit they cannot inject a substance if it is not water soluble.

I still wonder why people feel the need to answer these kind of questions in one sentence, especially if they illustrate by doing so that they don't even have 5% of the knowledge it takes to give a decent answer. It's not like you're helping anyone by doing so, and it is irritating that even the most basic UTFSE (benzo + IV) would suffice to prove your answer wrong. These kind of questions are about harm reduction, not about try-to-guess-the-answer-and-look-smart-and-score-kudos-and-be-BFF.

[EDIT: This last section was directed at post #2; most other one sentence posts in this thread are decent.]

 

[delta_9]

I very much hope that was not directed at me. And even if it wasn't, it was in poor taste and wholly unnecessary.

Why do you feel the need to make long posts and prove how smart you are by telling everyone else how dumb they are? And it's not just in this thread I've seen that avatar of yours tooting your own horn plenty of times. We get it, you know your shit.

You're being condescending and it's just not warranted and not nice. Not everyone is as smart as you and knows as much as you. If you have useful, factual information, then please post it and only it.

Edit - It was not my intent to start a flame war. I have nothing against you personally in fact I respect the knowledge you have. It's just the way you go about posting sometimes that seems rude. This is probably not your intention but it is how I have perceived it.

Apologies for any rudeness I may have shown you but I stand by what I have said.

 

[3rd_I_blind]

I very much hope that was not directed at me. And even if it wasn't, it was in poor taste and wholly unnecessary.

It was definitely not directed at you, I edited my post to prevent this misunderstanding but seems I was too late. I understand your opinion on my general attitude, and I probably would feel the same if I saw someone else do it.
However, let me give you a few reasons why I do it - not necessarily good reasons:
- I honestly am irritated by people trying to give advice when it literally only takes 5 seconds on Google to see that they are saying something that does not make sense.
- Follows from above reason: It is not harm reduction if you give someone crappy advice or come with information that is blatantly wrong, in some situations it is even the opposite.
- I work at an institute were it is accepted to interact with eachother in this way. Perhaps it comes off as more violent through the Internet, but we have a good working climate here, were you can point out to someone they should not make decisions on something they don't know anything about.
- Probably, I am just a bit arrogant and need some affirmation that my contribution is valued. I spend a lot of time on the questions I do answer, and though it would be extra karma if it was all altruistic by nature, deep down inside I guess I need some acknowledgement.
- I am hungover from yesterday.

If you have seen the other threads in which I have acted this way, you will probably also have noticed that usually the tone gets better once the discussion is developing. That said, I will work on not doing this anymore when it's not appropriate.

Fair enough?

EDIT: I have read a lot of your contributions too, so I would never start a flame war with you.

 

[delta_9]

It was definitely not directed at you, I edited my post to prevent this misunderstanding but seems I was too late. I understand your opinion on my general attitude, and I probably would feel the same if I saw someone else do it.
However, let me give you a few reasons why I do it - not necessarily good reasons:
- I honestly am irritated by people trying to give advice when it literally only takes 5 seconds on Google to see that they are saying something that does not make sense.
- Follows from above reason: It is not harm reduction if you give someone crappy advice or come with information that is blatantly wrong, in some situations it is even the opposite.
- I work at an institute were it is accepted to interact with each other in this way. Perhaps it comes off as more violent through the Internet, but we have a good working climate here, were you can point out to someone they should not make decisions on something they don't know anything about.
- Probably, I am just a bit arrogant and need some affirmation that my contribution is valued. I spend a lot of time on the questions I do answer, and though it would be extra karma if it was all altruistic by nature, deep down inside I guess I need some acknowledgement.
- I am hungover from yesterday.

If you have seen the other threads in which I have acted this way, you will probably also have noticed that usually the tone gets better once the discussion is developing. That said, I will work on not doing this anymore when it's not appropriate.

Fair enough?

EDIT: I have read a lot of your contributions too, so I would never start a flame war with you.

Your reasons are entirely valid and I feel them as well. I see far too many posters who simply spout useless or potentially harmful information without a second though. It irritates me as well. What I choose to do though is simply not reply or report it as bad info or spam.
I believe the large bulk of the Bluelight community has common sense, and knows that most often these 1 sentence replies(which are usually not ever grammatically correct, which I've also always assumed was another red flag for our more intelligent posters) need to be taken with a grain of salt, as they are often wrong. I would say the biggest problem with these kinds of posts is OD, where the drugs being discussed and they ways in which they are being used(IV etc) can be very dangerous if used improperly. Fortunately, we have a very intelligent a plentiful OD staff who are quick to correct these errors and close these threads. I've thought for years that OD is the most well Modded forum.

Regarding other topics, yes I have indeed seen the general demeanor of the discussions you have been involved in become more positive as time goes on. And as I said I fully respect your knowledge and I do understand that sometimes it takes some tough love for people to learn it. There have just been a few incidents where I thought it may have gone too far. Perhaps it was just me assuming the other person was too sensitive or something, but I am certainly not trying to ask or tell you to censor yourself in any way. You post very valuable information and I have learned several things from you already.

Regarding your workplace environment, I was unaware of this and I cannot relate. So I am sorry if I somehow suggested you do things 'wrong'.

...Perhaps I jumped the gun with my first post. And I may have been a bit hypocritical as just yesterday I pretty much flipped out at someone who was pressing my button pretty hard in PD. I used some words with you which were a bit harsh and for that I apologize. You are indeed a smart person and your contributions are appreciated, at least by myself.

Please continue with your valued contributions and if possible forget I ever said anything. After all I don't harbor any negative feelings for you, I just got a little flustered.

If you could accept my apology I would feel much better and I hope to see more of your posts in the future