Codeine withdrawal, with seroquel/trazodone

[3dmusic]

Hi

I wonder if someone can help me please?

I am prescribed the following medications below
Diazepam - 3mg a day (1mg every 8 hours)
Seroquel (quetiapine) 37.5mg a day, (112.5mg every 8 hours)
Trazodone 300mg a day (100mg every 8 hours)

I am not scientifically minded, but have learnt, due to my diazepam taper that I am currently doing, that trazodone and seroquel are inhibitors of cyp 450 3A4.

I was taking codeine and dihydrocodeine for five days on and one day off, and doing this for a year, without suffering withdrawals on the day off.
This week I took them for seven days and am now worried I have a habit.
My last dose was 180mg codeine and I took it approximately 24 hours ago, no withdrawals have kicked in yet.

My question is this. Will the withdrawals come on hard tomorrow or the day after, because the two cyp450 3A4 inhibiting drugs are delaying the onset?

I would be really grateful for some help on this.

Many thanks

 

[sekio]

this is not advanced discussion.

usually the withdrawals from opioids kick in 12-24 hours after your last dose. 180mg of codeine shouldn't still be in your body after 24h.
You may be so lucky that you won't get miserable withdrawals. less than 200mg codeine a day is pretty mild.

 

[flippinhippies]

Although it is mild it will still be difficult to stop. Although the physical symptoms of withdrawal may not extend past RLS or headaches (as heroin WD will suffer from far more nausea, pain and discomfort) the psycological addiction will be tough to deal with especially after a week or so has past. As far as WD after 2,3 days it probably wont be terrible if you plan to wait longer than 4 days you will probably be more edgy.

If you are trying to STOP using opiates I would recommend that you stop tapering your diazepam (talk to your GP) and get off opiates before tapering from benzos. doing both at once will be brutal.

 

[Hammilton]

Definitely don't do both at once.

Flippinhippies is wrong though. You shouldn't stop the opiate first. First of all, under 200mg of codeine per day is a low dose. It's nothing to scoff at, surely, but compared to moth people withdrawing, it will be pretty mild.

For that reason, if you're going to stop opiates and diazepam, stop the diazepam first.

The opiates will provide what little comfort they are capable off. They will take the edge off the withdrawal as best you can without taking a substitute (as in another benzo, a barb or ethanol) and help you sleep at night. The withdrawal from codeine will suck for about a week and then you'll just be a little off for a while afterwards.

One thing you didn't say was how long you've been on the drug. If it's not been 6 months of daily use, you may not have any withdrawal. Before I had a real habit, I was on methadone for a long time, and I decided to just stop taking it after about 6 months. Aside from a couple nights of extreme RLS (which I get a bit of no matter what), I didn't really have any withdrawals. I did learn that quetiapine makes RLS a billion times worse, leaving me half-conscious, but feeling like shit all the same.

 

[snubi]

Definitely don't do both at once.

Flippinhippies is wrong though. You shouldn't stop the opiate first. First of all, under 200mg of codeine per day is a low dose. It's nothing to scoff at, surely, but compared to moth people withdrawing, it will be pretty mild.

For that reason, if you're going to stop opiates and diazepam, stop the diazepam first.

The opiates will provide what little comfort they are capable off. They will take the edge off the withdrawal as best you can without taking a substitute (as in another benzo, a barb or ethanol) and help you sleep at night. The withdrawal from codeine will suck for about a week and then you'll just be a little off for a while afterwards.

One thing you didn't say was how long you've been on the drug. If it's not been 6 months of daily use, you may not have any withdrawal. Before I had a real habit, I was on methadone for a long time, and I decided to just stop taking it after about 6 months. Aside from a couple nights of extreme RLS (which I get a bit of no matter what), I didn't really have any withdrawals. I did learn that quetiapine makes RLS a billion times worse, leaving me half-conscious, but feeling like shit all the same.

In denmark heroin addicts take Flunitrazepam 2mg and Seroquel 300mg to sleep through/reduce the withdrawals when they cant get enough opiates/or they want to boost the opiates effect.
I have no experience using seroquel for opiate withdrawal i might add.

 

[Mr.Scagnattie]

I wouldn't combine the two drugs... If you are in a detox facility, they usually just put you on one or the other. Trazedone is usually the go-to drug to give addicts for sleep but it doesn't work for some people (me included) so they sometimes switch you to seroquel, which did wonders for me as it finally allowed me to get some sleep after over a week of pure insomnia hell.

 

[blight12]

You took Seroquel while on Opiates? Is this safe? Does it potentiate or increase the risk of OD from opiates? I really need to confirm this. Thanks.

 

[RobotRipping]

i don't think seroquel would cause any issues while being on opiates, it's not a CNS deperessant like benzos would be.

Codeine withdrawal isn't bad at all, i doubt after 7 days you'll have any issues other than slight cravings and diarrhea. Codeine's half life is like 3 hours iirc, so it's all out of your system by now. I've been through codeine withdrawals tons of times and never really had any problems coming of it. No RLS at all, no nausea, just bowel issues.

also 3mg of diazepam/day? you sure that's diazepam? Lowest dose i can get here is 5mg and that doesn't do a whole lot.

 

[Ektor]

There is something inside my head that tells me that if someone is using antipsychotics along with opiates, if he decides to stop opiates he will not suffer withdrawals as much as others would. And i have a friend on seroquel for whom this seem to apply, so thats just anecdotal evidence, but evidence nonetheless.
i think the reason for this is because antipsychotics block dopamine receptors, the dopamine depletion during opioid withdrawal will not be felt that much. maybe using antipsys along with opis will prevent some downregulation of dopamine receptors that would be caused by opiates alone, so reducing or eliminating total withdrawal symptoms, but this is just speculation.

blessings

 

[Jabberwocky]

frankly the withdrawal from codeine will be minimal-to none from experience. it was the first opiate that i dabbled with for about two years as you did and managed to get to a tolerance of about 300-400mg. i suffered no withdrawals at all, and was taking it pretty much everyday with some breaks in-between. if its the first opiate that you've dabbled with and haven't been through withdrawals in the past you're probably quite lucky in the fact your tolerance is only at 180mg, and the w/d from the stuff usually would come on about 4-10 hours since your last dance with the devil.

however, don't take this experience lightly and forget it. you will suffer minimal withdrawls the first time you quit opiates. the second time your tolerance will increase to higher levels and you'll start to suffer real withdrawals. each time will get worse and worse. i don't know why this happens - but a few others have experienced this phenomenon with opiates too.

 

[adder]

I have to disagree that the withdrawal from codeine is going to be a walk in the park. During withdrawal your mindset plays a huge role. And as you haven't taken anything stronger than codeine and dihydrocodeine, you may feel your W/D is hell on Earth despite the low dose. I can assure you that positive mindset may diminish withdrawal symptoms drastically, I experienced many ups and downs during a 2-month withdrawal from methadone (and that happened although I tapered it down and jumped off 4mg). You may start feeling discomfort even after 12 hours since your last dose because you don't take much. Anyway, I know CYP3A4 inhibitors may make codeine much more potent and longer lasting (I could feel strongly one dose of codeine for over 12 hours while being in a daily binge when I had to take fluconazole and then ketoconazole at the same time).

As some people posted, don't decrease diazepam when you go through opioid withdrawal. You may really want to consult your doctor how to manage your situation. The dose of codeine/DHC is not high so it's definitely going to be much much easier to jump off them than diazepam. Getting off diazepam may still take some time although your dose is already relatively low, so staying on codeine/DHC may not be really worth some benefits for your mind coming from opioid effects. But you must also keep in mind that the most difficult part begins after physical withdrawal is over and you start feeling depressed without an opioid. That may present problems with further decreasing diazepam so you may be stuck at 3mg for some time now.

I've been tapering down clonazepam for some time now and I know for sure that even increasing my dose from 4mg to 6mg didn't help me a bit during methadone withdrawal with sleep and anxiety. Now I'm on Suboxone and it's rather buprenorphine helping me taper down clonazepam. I don't have to get off both an opioid and a benzodiazepine now. I wouldn't have changed the order of drugs tapered down (i.e. I would still first get off methadone and then get off clonazepam slowly, because methadone felt "toxic" to me meaning I was sick and tired of it but I guess generally it could be of some help during clonazepam taper-down).

In my opinion and experience the order in which you taper down your drugs the least painful depend on how strong the opioid(s) you take is (are) and how long each of your addiction lasts. But generally long addiction to a strong full opioid agonist + long addiction to BZDs -> stay on your opioid (switch to something else, e.g. extended release DHC in your case) and taper off your BZD first, stabilize, then taper off your opioid.

 

[Ektor]

great part of the withdrawal syndrome is psychological. it happened to me too, even with heroin.. the first time i tried to quit it my biggest problem were cravings, not withdrawal, i was even astonished by their absence to the point i thought to be immune to withdrawal syndrome or i thought that "all those addicts seem crazy they invented that excuse to continue using!"

So remember, your first weapon against addiction is your mind, along with a healthy body, try to be busy in things you love and if you have never experienced serious withdrawal you likely experience none this time!
as other people said, do not try to quit benzos while in PAWS from codeine, better the other way around if you want to stop with both.

P.S. i really think that antipsychotics play a big part in making someone not feel opiate withdrawal and i think this matter deserves more discussion on the pharmacological and subjective aspects!

people feel free to comment on this issue!!!

 

[RobotRipping]

^that's interesting about AP and withdrawal. Definitely a topic for discussion, perhaps you should start a thread on it.

I've honestly gone through codeine withdrawal more times than i can count. I am a great metabolizer of codeine as well, 90mg with no tolerance can get me rocked. I've never had any issue quitting codeine, psychological or physical (except diarrhea). This is after years of use, with other opiates, i've endured some of the worst withdrawals i ever want to face but codeine, nothing. I guess it depends on the person and their state of mind more than anything else. Codeine does not give me PAWS either, the half life is far too short for this to happen IMO. I think it's a great taper drug for these reasons.

 

[3dmusic]

Hi

Sorry I am late in replying to this thread.
I am really grateful for the replies.
I am down to 2.4mg valium now.
This thread gave me lots to think about and I am thankful for that.