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Opioids How to get optimum analgesia with IR meds? Chronic dosing question.

tricomb said:
Chronic dosing is pretty much the way to go for pain patients, and any abusers who have the patience necessary. (Which excludes just about everyone using ROA's other than oral)

I first noticed that chronic dosing was working very well with (duh) methadone, then oxymorphone, then all the other opiates.

It works with hydromorphone too, but you need to dose even more frequently.

Right now, I'm taking 30-60mg DXM/day before I take my oxycodone and/or methadone, with hydromorphone for BT. I've completely weened myself off my LONG addiction to opana. (yay me!) I can still get the 5 and 10mg IR but I don't want to have to pay for that, they're more expensive than other cheap opioids, like methadone/HM/OC.

What I do, (the OP I made was using 20mg oxycodone as an example to keep the numbers simple) is pop a larger dose to begin with, like say, 30mg oxycodone, then resume chronic dosing in smaller amounts, and honestly, it works just fine and dandy!
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I have a question about DXM. Would that dosage of DXM work for me? I dose 150mg of OxyC every night along with 5mg of OxyM. I never heard of this DXM helping with tolerance. Does this work only when taking pills orally, or with snorting also? Care to elaborate? Or direct me some place to read.
 
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As a chronic pain patient, I too have been experimenting with DXM for about a month, I usually take 60mg in morning, 60 at night. The NMDA antagonism comes from the substance, not the route of administration (snorting vs eating vs plugging)

Last week I was put on a dilaudid/ketamine IV from a PCA after my spine surgery. Even though I knew about the NMDA info before I went in for surgery, so it seemed like an excellent combination both because of ketamines physical effects, but also the NMDA antagonism. When I asked the PM docs in the hospital, they seemed to imply that this was becoming their default response when IV pain meds dont work as well or as efficiently alone.
 
I have been using mucinex D ER which contains 60mg of DXM per pill. I know they are also in the nyquil pills but beyond that I am not too sure.
 
Fire&Water said:
What is the best OTC type of medicine that contains DXM with the least other ingredients ?
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Delsym is the best hands down, it's PURE DXM HBr, on a 12 hour time release which is what you want for NMDA antagonism.

I take 30-60mg (5-10mL) orally in the morning before I dose my opiates, and from what I understand 30-60mg definitely helps enough, and there are no psychoactive effects of DXM at these doses, at least for me. I've been taking DXM regardless of whether I take opiates, so on days without opiates I don't feel ANY effects from DXM, most likely due to the time release.

@fire&water, what should I ask my doctor about? What reason would I ask for it? I don't know how I feel about telling him I'm using DXM for NMDA antagonism. I would really appreciate some help with this.
 
After I told him, no more ER pain formulas, (because they suck & I found undissolved tabs' in my stool!) he suggested trying 2 mg. or less w/ 30 mg. oxycodone 2 x a day. I am using 1 mg subutex 2 x a day w/ 30 mg oxycodone, Even though I noticed it does help alot I have been using 7.5, 4-5 times a day (works as well)
All I can say is maybe you know somebody on this regimen & they are stable ? (which is true)
 
I just don't really understand what I'm supposed to tell my doctor about that, like, what did you mean by the rebound effect?

BTW, I'm not asking how to get prescribed it, just what it's supposed to do, cuz it's not an NMDA antagonist so what is its purpose?

Also, how do you dose it? like a certain amount of time before/after the last/first full-agonist dose of the day? Like how is it used in relation to my IR meds?
 
From what I understand...it's best to just play dumb about medications when you speak with your doctors as knowing a lot about them is a red flag...in the ER at least it is...it's one of the red flags my sister just learned about in nursing school...just sayin lol...
 
Rebound effect is usually why yer' Doc' takes you off of IR meds' because at first they might work for up to 4 hours (I am sure you know this) then before you know it you have trouble getting relief for 2 hrs. or less (rebound effect) That is where the Bupe' comes in, as in you dont really notice the pain meds' wearing off. As it is possible to prolong redosing up to double the time because the bupe' makes the severity of rebound less noticable
I use 1 mg. every 4-5 times 7.5 oxycodone
 
Fire&Water said:
Rebound effect is usually why yer' Doc' takes you off of IR meds' because at first they might work for up to 4 hours (I am sure you know this) then before you know it you have trouble getting relief for 2 hrs. or less (rebound effect) That is where the Bupe' comes in, as in you dont really notice the pain meds' wearing off. As it is possible to prolong redosing up to double the time because the bupe' makes the severity of rebound less noticable
I use 1 mg. every 4-5 times 7.5 oxycodone
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Very interesting, thankyou.
 
Thanks, I have been interested in getting RX'd buprenorphine because my tolerance is at an alltime low, lower than its been in years.

Fire&Water said:
What is the best OTC type of medicine that contains DXM with the least other ingredients ?
Click to expand...

I prefer Delsym because it's time released and doesn't have other active ingredients.
 
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Rx'd bupe + tramadol was a decent combo for me. I like the bupe cuz it last so long and is so much less addictive. I have alwayss liked tramadol.

One word for you: levorphanol.
 
muvolution said:
Rx'd bupe + tramadol was a decent combo for me. I like the bupe cuz it last so long and is so much less addictive. I have alwayss liked tramadol.
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Hmm, I'm on bupe as well, yet I often still get some pretty harsh back pain from a back injury from years ago, so I'm thinking of asking my GP if tramadol is a good idea to take as a prn med. Mind you, I'm on bupe for addiction management, so he may be completely against it.

I've heard that people on bupe and tramadol actually get decent pain management. I recently had surgery and was prescribed Nucynta for the postoperative pain. The first dose I took knocked me out, but after that, Nucynta did shit all for pain control.

Mu, in your opinion, how well does tramadol work with bupe? Does the bupe completely block out tramadol's analgesic effects?
 
RorerQuaalude714 said:
Hmm, I'm on bupe as well, yet I often still get some pretty harsh back pain from a back injury from years ago, so I'm thinking of asking my GP if tramadol is a good idea to take as a prn med. Mind you, I'm on bupe for addiction management, so he may be completely against it.

I've heard that people on bupe and tramadol actually get decent pain management. I recently had surgery and was prescribed Nucynta for the postoperative pain. The first dose I took knocked me out, but after that, Nucynta did shit all for pain control.

Mu, in your opinion, how well does tramadol work with bupe? Does the bupe completely block out tramadol's analgesic effects?
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Not Mu,
But I was prescribed Tramadol IR for a month & there is def' a synergistic effect with the two meds' WD's would be pure hell -
just from what I could imagine. - Now back to LEVORPHANOL ???
 
My levorphanol experiment was unsuccessful. I actually got a script for it today, had it in my possession, only to find out when I asked my pharmacist if they had it, she meant theyhad the vials for injection, not tablets.

There are no tablets at any pharmacy here, even hospital pharmacies. Fucking sucks. So my doc had to write me a script for fent... 12mcg. Patches. Bummed.

Anyways, I went from 120mgs of oxymorphone a day to 4mg bupe and 300mg tramadol, and was getting better pain relief from bupe and trams.
 
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