Codeine and CWE Megathread - The long awaited!

[footscrazy]

If you like, tomorrow I can do some more in-depth research when I have access to eMIMS and more text books on pharmacology. Most of the texts I have are from the 70's... but you'd be surprised how little has changed in pharmacology since then.

Only if you can be bothered. I would've thought that something like tardive dyskinesia was usually associated with long term high dosage, so hopefully we'll all be good...

 

[bobbydarren]

Strangely, I have always found that eating beforehand reduces stomach ache, and even when stomach ache kicks in, eating a meal will reduce it.

Placebo effect?

I ain't interested in strongest possible effects anymore, but preserving my digestive tract. I've found eating before cwe as well as being on nexium20mg and taking zantac 300mg an hour after dose can result in no pain at all in the morning and rest of the day.

Before when i wasnt eating, and I wasnt' taking nexium I would wake up in pain in the morning, be in pain the rest of the day and Even drinking water first thing in the morning was agony. btw i'm not sure zantac does anything but I just take it anyway.

 

[drug_mentor]

^ I am curious what pain you describe. The last year or so I seem to suffer gastric reflux a hell of a lot, but I am also a pretty heavy daily drinker. I have sort of tied my gastric reflux to CWE but not sure if its paranoia at this point, I know that past carelessness has caused acid reflux as a direct consequence of over consumption of NSAIDs but perhaps the gastric reflux I am still experiencing is due to drinking and not my fairly occassional use of stricly para forumlation CWE?

I do feel like everytime I go on a little codeine binge I tend to notice gastric reflux the next day, sometimes 2 days later if I take zantac just prior to my CWE solution. On one hand I know atleast a couple people to go fucking mental on CWE and get liver function tests come back sweet, on the other I really do wonder how much the shit has fucked up my guts. It really probably is all the bourbon and vindaloo though... LOL

 

[pinkanga]

Bourbon and vindaloo... heh yeah that probably wouldnt help

 

[Mr Blonde]

D_M, I think ranitidine (Zantac) is a CYP2D6 inhibitor, not sure if you care or not.

Only if you can be bothered. I would've thought that something like tardive dyskinesia was usually associated with long term high dosage, so hopefully we'll all be good...

Diphenhydramine, as far as I have found, is not associated with tardive dyskinesia. Any anti-dopaminergic effects it has are no where near as strong as promethazine's. Promethazine is also only has mild antipsychotic properties, so tardive dyskinesia would definitely be associated with long term use or with conditions predisposing the individual to experience it. There are exceptions to the rules, but as long as you don't take it every day then I wouldn't worry.

 

[footscrazy]

Daily codeine use = daily antihistamine use for me for about 6 months I've now stopped using codeine for the most part so hopefully I've avoided any trouble... Thanks for researching that

 

[Mr Blonde]

^ No problems! I'm glad to put to good use all the pharmacology study and collecting I do.

What dose of codeine were you using daily?

 

[footscrazy]

It's an interesting subject. I recently brought out my year 12 chem book in hopes of reminding myself of some of the basics, but it's sat fairly well unread so far, haha.

I was using either 400-800mg a day, between one to two boxes of panafen. The low dose naltrexone I've been taking since before daily use really helped to keep my tolerance down and stick to those levels (and stick to just using codeine and not stronger opies, for the most part).

 

[Mr Blonde]

^ Did you think the naltrexone helped a lot? I saw a thread in OD where someone was doing an experiment with it, he was using it with oxycodone though if I remember correctly. I don't think he found it helped much, but that was only one person doing it themselves and perhaps not following a strict schedule with it.

 

[mangs]

I don't know much information on this topic but that strikes me as quite a low dose for daily use footscrazy. I have it about once a week and normally have 250-300mg. At these levels it can be hit or miss. Although after reading this thread I think I was having too much DXM, 40mL's. I had 350mg codeine earlier this week with my first antihistamine and a 10mL DXM and its the best I've felt for some time.

At what point does tolerance start to develop? Like x times per week/month.

 

[spacejunk]

if you maintain a steady dose, opiate use doesn't necessarily grow exponentially. that is my own experience, anyway.
sure, with access to large amounts of opiates it can certainly blow out to ridiculous levels - the combination of tolerance and addiction can be a pretty crazy thing, with people requiring what would be a fatal dose for an opiate naive person just to stay normal...but i maintained a habit of about 200-400mg of codeine daily for a couple of years at one point.

i suppose it depends on individual circumstances. i haven't done much codeine for the last few years, but i don't think that dose would do much for me these days.
it used to do the trick though, and i've always found high doses of codeine to be a little problematic or uncomfortable, more so than other opiates.

 

[Mr Blonde]

There is no set point at which tolerance sets in. And it changes between different people depending on biological makeup and previous tolerance; once a week rises my tolerance for some reason unfortunately.

 

[footscrazy]

I found the ultra low dose naltrexone to help a lot. I guess it's a bit hard to say since I have always been taking ultra low dose naltrexone whilst using codeine regularly, and I suppose it is possible I'm just very lucky and would've kept getting high off codeine regardless, but I do think the naltrexone has a lot to do with it.

Just recently I've stopped using codeine for the most part, going a week or more in between doses; I've also stopped taking naltrexone. I've actually found I'm getting less high on the occasions I do use now, despite having such long breaks in between. I'm wondering if I can atribute that to is not taking naltrexone anymore.

I took 5mcg naltrexone in the morning and 5mcg at night. Of course using any more than an ultra low dose while using opiates will put you into precipated withdrawal, which noone wants 8(

 

[opi8]

Hey footscrazy, got a question for you. I tried ULD naltrexone for a few days a couple of weeks ago without any major noticeable effects, I want to try again as my tolerance is getting out of hand.

I used a 3 litre milk container and crushed up half of a 60mg naltrexone tab, shook well and have kept it in the fridge since. This should still be fine to drink, after 2-3 weeks right?

I tried dosing anywhere from 1 - 20mcg at a time using a 1ml syringe (with the needle ripped off) twice daily, once in the morning and once before bed. Is this the right way to go about it?

 

[footscrazy]

Hey opi8, I'm shit at maths so I may be wrong, but I think you're using too much naltrexone. When I measure mine out, I mix 25mg of naltrexone in 25 mls water, so I have one mg per ml, then I take one ml of that mixture and add it to one litre of water to get one microgram per 1ml in the new mixture.

These days I put the 1ml/1mg of naltrexone in 200ml vodka so I have 5mcg per 1ml, makes it easier since I dose 5mcg in the morning and 5mcg at night. Also vodka just keeps better, you don't have to keep it in the fridge. When I've kept my naltrexone in water it seems to go off quickly even when I've kept it in the fridge. It gets this white powdery growth in the water which I'm pretty sure can't just be the naltrexone coming out of solution, as I don't think you'd even see 1mg in that much water/vodka. I've even kept a water/naltrexone mixture in a syringe to give to someone and after a few days this bad looking white shit has grown in there. So to be safe, I'd put it in vodka.

A few days is probably too short to really notice any effects anyway. I think the best effects come about if you use it long term. Also, I'm not sure whether it actually lowers tolerance, or just prevents it from getting any higher.

 

[opi8]

I suck at maths too, your method sounds like a much better and easier way of measuring it out.

I guess it would be best to throw out what I've got in the fridge out and start again. Putting it in alcohol is a good idea, I've got a full bottle of bacardi 151 sitting there which would be perfect.

Thanks for your help

 

[footscrazy]

No worries, ugh bacardi 151 is fire water, I struggle even taking a ml of vodka and usually end up mixing it in water, haha.

Now I'm trying to get up to a daily dose of 50mg naltrexone to prevent me getting high on opiates and also for alcohol, but I keep making the required week off opiates then using again and having to wait another week, gah...

 

[drug_mentor]

D_M, I think ranitidine (Zantac) is a CYP2D6 inhibitor, not sure if you care or not.



Diphenhydramine, as far as I have found, is not associated with tardive dyskinesia. Any anti-dopaminergic effects it has are no where near as strong as promethazine's. Promethazine is also only has mild antipsychotic properties, so tardive dyskinesia would definitely be associated with long term use or with conditions predisposing the individual to experience it. There are exceptions to the rules, but as long as you don't take it every day then I wouldn't worry.

Thanks heaps bro! I will grab some Mylanta (don't tell me that inhibits CYP2D6 too ) and see if that makes a difference. I haven't been using zantac long but I started after a break from opiates/codeine so its hard for to comment on whether it has impacted on my highs or not. I fuckin bet it has cause despite low tolerance I am only getting high like twice before it stops working and I take a week or two off. I also seem to recall thinking recently damn codeine never used to last this long... I can't believe I never thought to look it up.

One thing I will say for zantac is it does seem to have reduced the gastric reflux problems I have come to associate somewhat with CWE.

Seriously man you probably just improved my future codeine buzzes for which I cannot thank you enough. I will certainly let you know how it goes after my next dose. :D

Also, the stuff you said about dimenhydrinate is pretty interesting. I wonder how much of the effect codeine gives can be influenced by expectation? I have taken 'Travalcalm Original' (the one with dimenhydrinate in it) countless times with no problem but the only time I ever took diphenhydramine was 10 or 15 minutes into a codeine high and I felt it killed the high within 20 minites. I was aware at the time diphenhydramine was a CYP2D6 inhibitor and that is why I dosed it after the codeine and not before. Perhaps it was my own expectation that caused this experience since I have never had that happen from dimenhydrinate.

 

[opi8]

I keep making the required week off opiates then using again and having to wait another week, gah...

Tell me about it, I've managed to go 3 days (the first attempt) and 4 days (the second attempt) without using anything at all after doing a short bupe taper, get most of the worst physical symptoms out of the way, then fuck everything up and have to start the process all over again...

I'd like to be able to take a full dose of naltrexone to stop me from using as well, possibly even get it prescribed for alcoholism which I'm sure my Dr. would do. Once I experienced precipitated withdrawals though, it's no mean feat mustering up the courage to swallow those evil little fuckers. This time I'll be trying a codeine taper instead of bupe, hopefully ULD naltrexone will help some, can't hurt to try.

 

[Mr Blonde]

Nope, no CYP2D6 interactions there to be worried about.

Antacids, by neutralizing stomach acid levels, will allow codeine to absorb quicker as codeine has a weak base pKa. If you take DXM, this will also be affected as it's pKa is around the same level. Drugs with a basic pKa usually only start to be absorbed in the intestines and duodenum where the pH is higher and less acidic, whereas those with an acidic pKa (e.g. aspirin) are absorbed in the stomach where the pH is lower and more acidic.

If you have chronic reflux problems and want a solution I'd try something like pantoprazole (Somac). You need to take it everyday, and can get small packs OTC but it will work out cheaper to get a prescription and get the generic brand.

Man, sometimes I think codeine can be affected by mood, setting, expectations as much as any other drugs. When I am really stressed out (most of the time these days ) I find that codeine will work better then ever. If I am already in an OK mood and not really looking forward to the codeine to get stress relief but rather just for a high then it's not so good. As for medications and expectations, I agree your expectation of what a medicine can do is a powerful thing.

Thanks heaps bro! I will grab some Mylanta (don't tell me that inhibits CYP2D6 too ) and see if that makes a difference. I haven't been using zantac long but I started after a break from opiates/codeine so its hard for to comment on whether it has impacted on my highs or not. I fuckin bet it has cause despite low tolerance I am only getting high like twice before it stops working and I take a week or two off. I also seem to recall thinking recently damn codeine never used to last this long... I can't believe I never thought to look it up.

One thing I will say for zantac is it does seem to have reduced the gastric reflux problems I have come to associate somewhat with CWE.

Seriously man you probably just improved my future codeine buzzes for which I cannot thank you enough. I will certainly let you know how it goes after my next dose.

Also, the stuff you said about dimenhydrinate is pretty interesting. I wonder how much of the effect codeine gives can be influenced by expectation? I have taken 'Travalcalm Original' (the one with dimenhydrinate in it) countless times with no problem but the only time I ever took diphenhydramine was 10 or 15 minutes into a codeine high and I felt it killed the high within 20 minites. I was aware at the time diphenhydramine was a CYP2D6 inhibitor and that is why I dosed it after the codeine and not before. Perhaps it was my own expectation that caused this experience since I have never had that happen from dimenhydrinate.