Opioids Methadone and hydroxyzine

[SummerTaylour]

Is it safe to take hydroxyzine with methadone? My doctor prescribed it but ever since I got off the hard shit, I have an irrational fear of dying from pills.

 

[LargeAppetite]

You said it best, your fear is irrational. Street drugs are more risky and cut. With a quick search I was able to find this.

"Opioids, sedatives, and alcohol can make hydroxyzine side effects more intense. These include drowsiness and confusion. Hydroxyzine also interacts with amiodarone, antipsychotics, and some antibiotics. These medications may raise the risk of serious heart rhythm changes."

Looks like you should be fine as it is a allergy medication and has no recreational value. I can't imagine you would be taking more of the Hydroxyzine than prescribed.

 

[Cult315]

You said it best, your fear is irrational. Street drugs are more risky and cut. With a quick search I was able to find this.

"Opioids, sedatives, and alcohol can make hydroxyzine side effects more intense. These include drowsiness and confusion. Hydroxyzine also interacts with amiodarone, antipsychotics, and some antibiotics. These medications may raise the risk of serious heart rhythm changes."

Looks like you should be fine as it is an allergy medication and has no recreational value. I can't imagine you would be taking more of the Hydroxyzine than prescribed.

Hydroxyzine definitely potentiates opioids but most notably rectally(plugging). Realistically all anti-histamines do but I believe without actually looking it up hyrdoxyzine is on the weaker side?

I’m not going to say doctors are always right, as they’re definitely not, but in most cases if you’re prescribed two meds together there’s a reason for it.

I couldn’t imagine somebody dying from the combo though unless you’re on some high dose of methadone. My guess is it’s on the lower end, though.

Do your own(thorough) research. Google hydroxyzine methadone interactions. One of the first results should be drugs.com or a similar site with very reliable info on the reaction of the two meds. But LargAppetite likely took their quote from the mentioned site and it doesn’t appear to be a serious risk combo. Just don’t mix with alcohol or other opiates.

 

[AlsoTapered]

Both hydroxyzine and methadone can cause long-QT but as others have said, it's dose dependent. Assuming your doctor knows you are also prescribed methadone, I'm sue the combination will have been considered.

I've often wondered why the UK stopped switching people from methadone to dihydrocodeine at the end of the taper as many say the last 10mg can be tough.

I appreciate that some nations don't use dihydrocodeine but hydrocodone would also appear suitable, adjusted for the latter's higher potency.

Well done on getting out of that scene. It may take a while but the freedom of not NEEDING a drug just to feel OK is a great feeling.

 

[negrogesic]

Yeah it's completely safe

 

[SummerTaylour]

I’m on 45mg in the morning and 65mg at night. Idk I just don’t wanna fall asleep and not wake up.

 

[AlsoTapered]

That, in UK terms, would be considered a reasonably large dose. At such levels we would likely consider having someone ECG tested to ensure long-QT wasn't an issue. But splitting the dose is absolutely the best way to minimize that risk. It's not methadone itself that is cardiotoxic but one of it's metabolites (specifically dinormethadone). People do metabolize methadone at different rates and in different ways. It's far from perfect but it's been in use for decades so specialists have a lot of experience.

I know two people who suffered heart attacks from lower doses (but both are still fine) given to treat pain. But I'm not trying to frighten you, I just know a lot of people who have chronic pain problems so over 35 years, 2 isn't that significant.

As long as the doctor is aware of all of your medication, I'm sure they will be aware of the possible cumulative effect. I don't know, maybe they gave you an ECG? But I would suggest that whatever you were taking before posed a significantly higher risk to your health and well-being than your prescribed medication.

I'm not a doctor, I'm a medicinal chemist so although I might have a lot of technical data, I'm not an expert on methadone and it's interactions. But your doctor will be and before ANY medication is given, a lot of careful thought based on education and experience will have been brought to bear.

If you have any concerns, I'm sure your doctor will be able to explain their thinking. I am unaware of any specific warning concerning the interaction of methadone and hydroxyzine so it must rarely, if ever cause an issue.

I'm not dodging the issue, just explaining why a simple yes/no answer is impossible to give. The fact someone else was fine has no bearing on your case. But from what I understand, IF there is an issue, it tends to turn up right away (within just a few days).

 

[Gaz_hmmmm]

That, in UK terms, would be considered a reasonably large dose. At such levels we would likely consider having someone ECG tested to ensure long-QT wasn't an issue. But splitting the dose is absolutely the best way to minimize that risk. It's not methadone itself that is cardiotoxic but one of it's metabolites (specifically dinormethadone). People do metabolize methadone at different rates and in different ways. It's far from perfect but it's been in use for decades so specialists have a lot of experience.

By dinormethadone I assume you mean mixed stereoisomers (Dextro and Levo) normethadone?
It’s not that that is the problem.

Dextro-methadone aka the mainly NMDA receptor antagonist isomer of methadone, is the problem when it comes to methadone’s potential cardio toxicity and QT prolonging action.

Regarding the original post, I’m in the UK and have been prescribed hydroxyzine before whilst on methadone, I had a hydroxyzine script for years.
You should be.

 

[AlsoTapered]

By dinormethadone I assume you mean mixed stereoisomers (Dextro and Levo) normethadone?

NO. Normethadone is when one of the N-methyl groups is removed, dinormethadone is when BOTH N-methyls are removed.

Now that species is cardiotoxic. But since the methadone molecule also contains a ketone (C(O)) moiety, the primary amine can react with it forming an imine. The reaction is reversible but essentially that cyclic metabolite is excreted.

That's who ORLAAM (levacetylmethadol) briefly appeared on the market and rapidly disappeared. It's duration of action is 3-4 days so it was considered superior for the purposes of supervised consumption. But it has no ketone. Instead it has an acetyl ester function (which may be hydrolized to the secondary alcohol) but either way, that cyclic metabolite cannot form.

ORLAAM rapidly disappeared due to reports of life-threatening ventricular rhythm disorders assumed to be triggered by long-QT. Notice that it is chiral. The name even begins with LEV. The levo isomer was actually less toxic but also less potent which the dextro is more potent but more toxic and has a shorter duration of action.

It's not entirely clear why normethadone still prevents opiate withdrawal but it makes sense that for pain, duration isn't a huge issue with [BID] or [TID[ being acceptable, but raecemic methadone prevents withdrawal for longer.

But if you can take it home, splitting those doses is obviously going to vastly reduce the plasma levels of dinormethadone. Methadone's onset, peak plasma level, duration of action and metabolic rate varies quite markedly between individuals. That's why it's generally only prescribed by a specialist (for pain at least).

All of the above might sound rather shocking but on the plus side, men are more at risk of developing Long-QT than women and it's still a small minority and of that small minority, only an even smaller minority ever suffer severe adverse events.

It would be VERY obvious after decades of use and millions of patients if the slight risk wasn't vastly outweighed by the benefits.

 

[JuncoPartner]

@AlsoTapered hats off to you mate, spittin' pure knowledge as always.