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Opioids Help me find the right potentiation dose

Altered Perception

Altered Perception

Bluelighter
Joined
Dec 13, 2010
Messages
414
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On a big Island surrounded by sharks.
I have a medical condition diagnosed as a damaged Autonomic Nervous System and as a result I am exteremly hypersensitive to my opiate pain medication...

I have to always be careful that I take exactly the right amount because anything a little over and I begin to experience adverse reactions.

I usually dont potentiate because I dont find it necessary as I have enough of my medication to last me but this time round my doctor has gone on holiday and I am runing out of my pain meds so I tried to make my medication last me until he gets back by drinking a glass of my grapefruit juice two hours before taking my oxycodone and I found the effects to be way too intense and unpleasant.

Today I decided I would take even less than the usual 20 mg dose (which is the amount Im on after using for 3 years) as I was having a glass of grapefruit juice, so I took only 15 mg oxycodone but I made the mistake of having it at the same time as the grapefruit juice and that seems to have made a much more difference then taking it 2 hours after and right now I feel so ill I am about to go to the ER. I thought a glass of grapefruit juice would make 15mg feel like 20mg but instead its made it feel a lot more and I cant seem to get the amount right for potentiating, should i have taken only 10 mg to + glass of grapefruit juice to make it feel like 20mg? need some help getting the dose right. thanks.
 
ok

Ok I'm no doctor and I dont know much about your condition. Im not exactly sure what you want to know exactly. I do know there are ways to reverse such affects of O.D. which you are sometimes getting. When a person overdoses on opioids such as Percocet, OxyContin, Oxycodone or heroin etc. the antidote which is given by medical personnel is called Narcan. This is a medication which blocks all opioids from working, and reverses an overdose. If you can find out the ingredients to Narcan You might be able to find natural remedies to help your situation a little at least. Hope all goes well man. Good luck!
 
There is only one ingredient in Narcan and that is naloxone, no "natural" version or "remedy" of Narcan exists.

OP, you need to take lower doses and then potentiate from there, if needed. It is not a good idea to take more then needed and try to find ways to "reduce overdose" or something like that.
 
OMFG!!! Grapefruit is crazy shit!!! Ijust got back from the ER and I had the worst adverse reaction I have ever had in my life and believe me Ive had plenty.

1 freakin glass of grapefruit did things I would have never imagined, im still in shock, I still cant fucking believe it messed me up that badly, wow tottaly mind blowing.

Usually when I have an adverse reaction the fevers, muscle spasms and distruption in my vitals are fairly short acting but with the grape juice it was fucking amazing, it just went on and on and on, my muscle spasms and tremors lasted over an hours and usually it only lasts 5 minutes. The adverse reaction kept subsiding and then worsening and then settling and then suddenly worse again it was like waves just up and down for over an hour. I tottaly felt like I was going to die from the increased blood pressure and headaches.

I cant belive I had this type of a reaction to a much lower dose of my medication then what I usualy take, if I had taken 15mg oxy without the garefruit wouldnt have even felt it work but here I am back from hopsital from one of the worse reactions Ive ever had. I will never look at a glass of grapefruit juice the same way ever again.
 
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I tottaly fuked up the dosage and over did it, so ive had a think about it and it seem I have 3 options to do it right next time, please tell me which is best ...

1) Take a lot lower dose of opiates but consume higher dose of grapefruit to make up the difference

2) reduce you opiate dose only slightly but only have a very small amount of grapefruit to even out the difference

3) take grapefruit a lot earlier like several hours before taking any opiates to get a more subtle effect.

So in conclusion how soon I take the grapefruit makes adifference so should I use time as a factor to adjust dose or should I chnage the opiate dose vs grapefruit dose to find a right balance for me? there seems to be alot of variations I could use to get this right.
 
I would go with number 1, you obviously have a very powerful reaction to grapefruit juice + opiate.

However, because there isn't really any way to tell how much potentiation you're going to get with any given glass of GFJ, my suggestion is to nix the GFJ altogether and just take what opiate dose you need.

The last thing I wanna do is make a recommendation that sends you back to the Emergency Room....
 
Thanks for your suggestion but dont feel uneasy with your recomendations because i am going to be much more careful next time, todays event was a total eye opener for me and it thought me where my threshold is, so im glad it happened and now i know not to take that dose again.
 
Hi Altered Perception,

With your condition you shouldn't play around with enzyme inhibitors. If your primary doctor is unavailable you should take your script and medical records to another doctor or even the hospital and explain your situation until your doc gets back.

If you are 100% going to use grapefruit juice anyways then personally I would consistently take large amounts to attempt to maximize, and more importantly hopefully plateau, the enzyme inhibition so that I can isolate one variable in the level of drug to be taken and titrate it up until it is effective.

Please try and find alternate arrangements for your oxycodone instead.

Best of Luck!
 
^agreed with amapola. given your unique circumstances it would be best to see the ER if your doc is out of town. alternatively try see another doctor in the same practice as they'll have everything on record.

be careful, man.
 
Thanks guys for looking out for me but I am keen to give grapefruit a chance, I am certain that it has so much potential to be done right without causing me any symptoms but I just need to find that level.

amapola, could you please explain a little more on what you described, due to my inexperience I couldnt understand, did you mean I should get myself desensitized to the effects of grapefruit juice first by consuming it in the absence of any interacting drug ?
 
No, what he's suggesting is that you should consume enough grapefruit juice before you dose opiates to ensure you keep the enzymes in your liver completely blocked when you do dose, rather than drinking a small portion and hoping for the best.

I agree with both of the moderators above, playing with enzyme inhibitors when you are so incredibly sensitive to blood levels of drugs affected by them is a risky game to play.
 
amapola, could you please explain a little more on what you described, due to my inexperience I couldnt understand, did you mean I should get myself desensitized to the effects of grapefruit juice first by consuming it in the absence of any interacting drug ?
Click to expand...
No not desensitized.

At the moment you have 2 variables, the amount of drug you are consuming and the amount of grapefruit juice you are consuming. If you keep on changing these two things up you have no real baseline to judge what caused certain effects. Furthermore since the action of the grapefruit juice is extremely hard to accurately quantify, no one can really say what will happen if you drink more juice or less juice.

The amount of drugs you consume is going to be much easier to control, and regardless of how much grapefruit juice you've taken you can probably still assume twice as much drug is going to have twice as much of an effect...insofar as the grapefruit juice level doesn't change

Therefore we should try and make the grapefruit juice inhibitory effects constant, and vary the amount of meds you consume by slowly titrating up to the dose you need. Although something like taking a sip of grapefruit juice every hour may result in a plateaued level of inhibition of your enzymes, I really don't know if it will build up the effects or what. The best way that I can see of trying to ensure a steady state is to try and reach the maximum grapefruit level where taking more grapefruit juice won't effect anything.

Then you are merely taken medication in a grapefruit saturated environment and can find the proper dose for you. Furthermore by starting with the maximum level of grapefruit juice you minimize the risk of the grapefruit juice unexpectedly having more of an effect and overdosing. It's more likely it would suddenly not be as effective.

I'd like to point out now that approaching this from a scientific experimental point of view does in no way add any sort of actual safety into doing this.
 
Thank for explaining it, I have a better understanding now and I agree controlling my medication dose is much easier, especially that I have been given an oral liquid oxycodone hydrochloride which allows me to measure the exact amount with a syringe as to avoid the adverse reactions.

I didnt realise there was a threshold to grapefruit juice hence my misunderstanding initially, so the liver can support only so much of the effects of grapefruit juice before and rendering any additional amount inneffective?

If thats the case yes I agree I should load myself up on grapefruit juice and then start testing perhaps with 1mg oxycodone to begin with and titrate upwards just as I did when i was first desensitising to oxycodone, you guys are a genius, excellent suggestion. So what is the loading dose for grapefruit juice ?
 
I didnt realise there was a threshold to grapefruit juice hence my misunderstanding initially, so the liver can support only so much of the effects of grapefruit juice before and rendering any additional amount inneffective?
Click to expand...
I'm fairly certain that grapefruit juice's enzyme inhibition is predominantly in the intestine and not in the liver. Whether or not you reach a physical threshold, by having relatively large amounts of grapefruit juice filling the intestine at all times during dosing small fluctuations should be minimized.
 
Thanks again, I thought it was the liver that inhibits the CYP450 enzyme but further research showed your right and Grapefruit juice is a potent inhibitor of the intestinal cytochrome CYP3A4.

Today I decided to take my regular dose of 20mg Oxycodone without the Grapefruit Juice but I still ended up in the ER with another severe reaction, it was most unexpected, so I just got home and tried to figure out if by searching online if by any chance the effects of the Grapefruit Juice from yesterday could actually still be at work, and surely I found thses statements...

The idea of having your juice in the morning and medication at night will not work because the effect on your body remains, even after 24 hours

http://www.brighthub.com/health/diet-nutrition/articles/28939.aspx

The increases in blood levels of the medication may continue 24 hours after consuming grapefruit juice

http://www.walgreens.com/marketing/...ctions/drugsinteractions_grapefruitjuice.html

These risks continue for up to 72 hours after consumption

http://www.drug3k.com/forum1/First-...-interfere-with-certain-medications-13595.htm
 
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Geez, They didnt warn you about this in the ER? Inhibiting enzymes can last up to a week sometimes. Hope you keep this in mind before you take your next dosage. This is espeacially true with enzyme's like monoamine oxidase inhibitors MAOI's. Notice that people who take MAOI's cannot eat things like cheese even after being off the meds for several days etc. I might reccomend keeping some kind of medication or something around so you can reverse the affects if you intend on experimenting with your medications. whether it be Narcan or charcoal pills for ingestion's etc. Beings how you are experimenting make sure you research it as much as you can before putting your life at risk. BE CAREFULL. I dont like it when people end up in the ER. I dont know you personally, But I hope you are ok, and I hope you will do more research before you take your meds again.
 
Sorry about the delay in my response.

Thank you for your advice and concern, I was never warned about this in the Er because I didnt tell them about the Grapefruit Juice. I've already had problems with some of the Er staff as they have come to know me over the years with all my attendance due to adverse reactions and some have speculated and accused me off being a junkie as they have never come across anyone with my medical condition or sensitivity before so they jump to conclusions, telling them about the GFJ would have made me look bad.

What you said makes a lot of sense, ever since I started this Grapefruit juice thing I've ended up in the ER a lot more often, even when I've taken 4 days off from Grapefruit juice Ive still been effected badly but I never made the connection atthe time because i just didnt think the effects of Grapefruit Juice could last so long but now it all makes sense.
 
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