Metabolizing & Bioavailability of Tramadol {Urgent}

[johanneschimpo]

\I have asked 4 different pharmacists to find out what other painrelif is avaliable...

Well the pharmacist can't write you a prescription so whatever they say is irrelevant unless your doctor gives it to you.

...my Dr was unable prescribe anything else as he is also unsure on what to do about this.

Based on this (don't take offense), your doctor is a fucking retard. I'm certainly no doctor, but I can think of many, many other viable options to control your pain (some of which I have mentioned to you in your many other threads on this topic). I guess what it comes down to is your doctor either has some sort of hard-on for tramadol, or he's just plain fucking retarded.


The question is not: what can I do to fix this problem? (the side effects of tramadol)
The question is: what do I have to do to get my stupid ass doctor to stop being a retard and give me another pain medication that will not cause such horrible side effects?

Any GOOD doctor would have discontinued this medication IMMEDIATELY after you told him your reaction to it.

Honestly, your doctor is a quack.

 

[Unlucky]

Fine, im going back to My Dr tommorow and im going to be a lot more stern with him and i wont be leaving till I get different medication.

No my pain is not neuropathic, my joints have been rapidly detereorating, it has a neurological basis as the cause but the results are torn ligaments all over my body particualrly worst in both ankles and knees. Find it difficult and painful walking and moving around.

I havent been able to use NSAID's as I have severe digestion and acid reflux issues (also a neurological symptom) and all the NSaid's I tried made this worse.
Fastandbulbous thanks for the tip, I had no idea benzonorphans caused confusion well they are no longer an option then.

I can't have cannibis either, i havent been able to since i developed the neurological condition, i went from being a pot head prior to the condition to having irregular and rapid heart palpitations from pot after, even from second hand smoke. It also gets me overheating more, anything that stimulates my body beyond its sensitive threshold gets me hot. and i cant imagine taking anything as intense as ketamine in my current fucked up state and survivng it.

Ham-milton u make a great point, the seretonergic part of tramadol definetly couldn't be doing my temperature problems any favours. Im throwing out the box of tram today and i think im going to give Dihydrocodeine or codene a try even thou it gets transfered into morphine and morphine is one of the substances that I adverse reactions to I will still give it a chance or maybe fentanyl only if it comes in an oral rather than patch. johanneschimpo dont worry i wont be posting on this topic agin i think ive annoyed everyone enough with the tramadol topics.

 

[Ham-milton]

fentanyl isn't orally active (unless you take a massive dose) but there are sublingual tablets and suckers available, but not many docs will consider those w/o a longer acting med.

 

[Smyth]

I used to see my doctor for pain relief and in the UK, you should consider yourself lucky to even get tramadol or dihydrocodeine from a regular GP. They'll only use opiates as a short-term measure from the regular doctor, you have to get referred to the pain clinic for more chronic treatment options.

My advice about increasing the dosage was based on my personal experience and is a bit of friendly 1:1 advice, I wasnt writing it in the same form that I would be if I was answering an exam script for becoming a doctor. LOL!!

His doctor isnt "retarded" as you put it. Doctors are there to diagnose people with serious medical disorders, not just to hand-out opiates to junky thrill seekers. If you are looking to get high, then get it through your skull that the doctor is the last person you should be consulting.

 

[Unlucky]

Im going into my Dr tommorow and after doing some researching online ive decided im going to go with the fentanyl oral lozenges, however I was unable to find some of the information I need like...

-does the effect of the lozenges dissapear quickly? cause i want something thats not going to last in my system too long incase I have an adverse reaction or a bad day where my body is acting up I want it to wear off quickly orwithin a few hours.

- am I able to break alozenge in half or only suck half to determine wether i will have any adverse reactions to it, i want to approach this with great caution ive had enough of adverse reactions and they really shake me up and have me questioning if i will live through it.

Also can someone please explain this to me....
============================================
WARNING: This medication should be used only to treat breakthrough pain caused by cancer in people already using narcotic pain medication. Severe, even life-threatening, breathing problems can occur in patients using fentanyl if they are not already using other narcotics. Do not use this medication for pain that is short-term nor for pain that occurs after surgery. This medication can be fatal if used by a child.

USES: This medication is a narcotic pain reliever that also relieves anxiety. It is used for breakthrough cancer pain only. This drug is not to be used for pain due to surgical procedures nor for acute pain.

http://www.medicinenet.com/fentanyl-oral_lozenge_cancer_pain_only/article.htm
=============================================

Why is this so????

 

[Mr Blonde]

Ask him about the methadone...if Ham recommends it, it can't be too bad an idea. Unless you've already tried that, of course.

Good luck getting the help you need!

 

[Unlucky]

Ok cheers man, methadone it is! and no i havent tried that yet, The fentanyl has me scared, lol after reading this in the rx list.....

life-threatening hypoventilation could occur at any dose in patients not taking chronic opiates

I dont understand why this can happen, if anyone knows an explanation would be much apreciated.

 

[Unlucky]

Ahh CRAP!! the rx list says about methodone...

"methadone's plasma elimination half-life is substantially longer than that of morphine (typically 8 to 59 hours vs. 1 to 5 hours). Methadone's peak respiratory depressant effects typically occur later, and persist longer than its peak analgesic effects."

The last thing I want is a long lasting medication that will have me at the edge of my seat wondering if and when anything wil go wrong, and if it does its going to be a long bumpy ride. I suddenly feel back at square 1

 

[Smyth]

Quite simply, users without a tolerance to drugs are the ones who are at greater risk of suffering an adverse reaction. It's just statistics, like highest proportion of car crashes involve people who are driving a stolen vehicle or have only recently passed their test, etc.

You could try making enquiries into duloxetine (Cymbalta) for pain relief.

Alot of the pain relief from morphine is from improved affect. It's often said that it doesnt *stop* the pain as such, but it does become less noticeable

 

[Unlucky]

Thanks for the tip but it seems Duloxetine has too much of an antidepressant effect and acts on the serotonin, last time I took anti depressants without being depressed it ended up distrupting my sleep and all my neurological symptoms flared up. I already have issues and adverse reactions to my bodies own natural brain chemicals and overheat so I'll pass on that one but i apreciate the help. Told ya's I was adifficult case to manage.

 

[Mr Blonde]

Ask your doc about the methadone still, and if he agrees ask if you can be in a controlled setting for the first day or so. If anything goes wrong, they can always administer an antagonist.

 

[Unlucky]

^^^ Yea that would be the smart thing to do but I somehow sense its going to be difficult to arrange a place to be monitored in a controlled environment as these methods are a bit unorthodox for Dr's but I will try. Thanks

 

[Mr Blonde]

A hospital, perhaps?

I mean, you do have a painful, unique condition that is very hard to treat. If a bit of effort is put into it, by putting you in a hospital room, dosing you up with methadone and watching you...they could just find the pain management solution you've been looking for.

Just out of curiosity...how much longer do you have to wait to get into the pain management clinic? I'm an Australian as well, but I've never heard much about them.

 

[Unlucky]

For a firts consultation at a private clinic its $300 and the wait is about 1- 3 months but at the puplic hospital where its free and bulk billed which is what im doing the wait is 8 months to 1 year. The public system is so messed up here I had to wait 3 years on the list to get a knee operation

 

[Ham-milton]

Ask him about the methadone...if Ham recommends it, it can't be too bad an idea.

you must be shrooomming! I'm wrong more than most people, I just don't admit it or am really good at explaining things away.

I think methadone is an okay idea, but it has significant detractors. It's not likely to cause the hypersensitivity, and maybe the NMDA antagonism would be good for the neurological disorder (what isn't it good for?), but the withdrawal is an absolute bitch, and for someone without a tolerance and a propensity towards recreational drug use (I'm guessing, since the OP referred to it as a 'right' that had been lost, but that's not much to go on), it's a really bad idea.

 

[Bondmaker]

I would guess...

That fentanyl might not be a bad option. And it most certainly is orally active. The red warning lights are due to it's potency. ALL narcotics can slow your breathing reflexes down to nil, that's what kills you when you overdose on narcs. It's just that fentanyl is so potent (25 micrograms, one quarter of a mg is the initial dose) that it is easier to "make mistakes" in dosing. But with the lozenges it is difficult to screw up unless done intentionally. Fentanyl is unfortunately , short acting, and not recomended for chronic pain, but the patches are good enough to augment or supplant longer acting opiods in, say, a cancer scenario. Opiods in general tend to lower body temperature, so if you ever were forced to come off them cold turkey, your body temperature would spike. You are between a rock and a hard place. Not having an effective pian management team is what your major problem is now. You have to sometimes SCREAM at your GP to get his/her attention that you have troubles that need immediate attention to. You must be proactive or things won't change. And others are correct. Few of us are "real doctors", however many of us are trained in the use of drugs. Good luck!

 

[Ham-milton]

fentanyl's oral bioavailability ranges from 0-49%, with most of the data towards the bottom of that (based on what I found by googling, which isn't 100%).

so it ranges from inactive orally to a little active orally.

It's no wonder they don't sell an oral fentanyl product- you'd have to 2-3x as much as you would SL.

 

[Mr Blonde]

you must be shrooomming! I'm wrong more than most people, I just don't admit it or am really good at explaining things away.

No! Now you have ruined the illusion!

Ok, I'll rephrase it as: Ham is a very knowlegeable and smart guy, so I would listen to what he has to say.

For a firts consultation at a private clinic its $300 and the wait is about 1- 3 months but at the puplic hospital where its free and bulk billed which is what im doing the wait is 8 months to 1 year. The public system is so messed up here I had to wait 3 years on the list to get a knee operation

Tell me about it, the public healthy system in Oz is definitely shit.

Short of hoping Kebin07 fixes it up in the next few months, maybe you should move to a Scandinavian country with free, excellent health care?

 

[Unlucky]

My Doctor refused to prescribe me fentanyl or methadone beacuse he said they were hi level narcotics that required permission from the government and that he could get into trouble and that fentanyl was only suitable for patients dying of cancer and methadone is for people trying to get of heroin and if he prescribed me either There was a chance I would turn into a junkie and his seen it all before.

When I got home I was so mad I put a hole in my wall and now my had and wrist hurts like hell, as If my joint problems werent bad enough my anger got the better of me. Im at a loss now and if i go around shopping for doctors I doubt they would be willing to give a new patient such medications as the stupid junkies who do that already make it difficult for genuine people like myself.

 

[Ham-milton]

Wow, you're screwed.

Methadone and Fentanyl shouldn't require permission from the government- wtf is that about? I don't think that's even the case in Australia- is it?

Christ, I had a relatively simple damaged nerve in my elbow (still do), and I was treated with fentanyl and methadone, sometimes together even.

You'll have to see a different doctor. Your doctor is obviously a moron. Very few patients with legitimate need for painkillers develop addiction.