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Opioids Methadone to OXY EQUIVALENT

Be careful presuming that the same enzymes are equally responsible for the metabolism of both methadone enantiomers. In many drugs the isomers are metabolized by different liver enzymes or at least the relevance of a specific enzyme can be enormous.

I cannot find any fatalities that specifically refer to levomethadone and fluvoxamine and it would make more sense if fatalities were due to dextromethadone accumulating since the user wouldn't know - but that last point is purely a guess. German language texts on CYP3A4 inhibition of methadone metabolism may help.
 
schizopath said:
In Finland we have all our methadone in brand bottles. We have also levomethadone that one can inject and which hexen said works very well injected.
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Yes, the L-Polamidon is the brand name here in Germany for the liquid oral solution of Levomethadone. Since it doesn't contain any harmful additives it can be injected without worry. Sometimes I wake up and remember just how lucky I am. I mean L-Polamidon in its pure form with no syrup added is a privilege here in Germany. Almost nobody outside of our clinic gets this stuff as a pure solution because of the IV "abuse" potential.
 
Hey @Hexenstahl

I'm gonna throw some reading material at you. This first article is not extremely thorough. It is my previously referenced story of the person inducted on Fluvoxamine (Luvox) ending up in the hospital several days after starting the medication. She wasn't on the verge of death or anything, though she required supplemental oxygen if that tells you anything.

pubmed.ncbi.nlm.nih.gov

Fluvoxamine-methadone interaction - PubMed

Clinicians should be aware of the potential for a significant drug interaction between fluvoxamine and methadone.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

This next article is a little more interesting. It discusses this interaction as potentially positive. The point is made that the combination of the two could be used to make one's Methadone work better. I'm not just talking about potency either. I've experienced and used this combination myself extensively over the years. It's not just an increase in potency, it also just makes the Methadone "better". I crave less, feel more of an antidepressant effect from my daily dose and it also allowed me to sleep through the night completely, when previously, I'd always be up at 4:00-5:00 kicking my legs. Here is that article:

pubmed.ncbi.nlm.nih.gov

A therapeutic use of the methadone fluvoxamine drug interaction - PubMed

In patients unable to maintain an effective methadone blood level throughout the dosing interval, fluvoxamine can help increase the methadone blood level and alleviate opiate withdrawal symptoms.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

You would have to take the medication for several days before you started seeing serious changes, though by day 5 you should start feeling the difference.
 
@Keif' Richards
I'm currently on a dose of 25mg Levomethadone which is equivalent to 50mg of Methadone. How much Fluvoxamine is SAFE to take (and how often? Once a day?)? I'm asking because you said that you have been or are still using this combo, and therefore I'd like to receive harm reduction advice from you because you seem to be the only one around here who has made practical experience with these two drugs. I'm a VERY careful person who doesn't immediately jump at doing things just because it sounds great. I do my due diligence first before trying out anything new, so if you could help me I'd be very thankful. Initially I wanted to talk about this with you via PM, but perhaps future readers who are on (Levo)methadone might be interested in this subject too and having HR info at hand might prevent a possible death.
 
@Hexenstahl I hear you loud and clear. I appreciate your commitment to safety. I'd be happy to help. You can always send me a PM if you need something, but I'm happy to discuss this in-thread.

First, Selective Serotonin Reuptake Inhibitors (SSRI's) are pretty safe drugs. Provided you are healthy and not taking anything that interacts with the SSRI negatively, like an MAOI, you've got nothing to worry about.

25mg-50mg per day is a common starting point and the average adult dosage is usually ~100mg. Given how you've described your usage and goals, I think 25mg-50mg would be sufficient to produce positive results. It's going to take a few days for the effects of present. You would be taking the SSRI daily for this scheme to work.

As SSRI's are long-acting medications, the notion of an overdose sneaking up on you without warning of any kind is not likely.
 
Keif' Richards said:
@Hexenstahl I hear you loud and clear. I appreciate your commitment to safety. I'd be happy to help. You can always send me a PM if you need something, but I'm happy to discuss this in-thread.

First, Selective Serotonin Reuptake Inhibitors (SSRI's) are pretty safe drugs. Provided you are healthy and not taking anything that interacts with the SSRI negatively, like an MAOI, you've got nothing to worry about.

25mg-50mg per day is a common starting point and the average adult dosage is usually ~100mg. Given how you've described your usage and goals, I think 25mg-50mg would be sufficient to produce positive results. It's going to take a few days for the effects of present. You would be taking the SSRI daily for this scheme to work.

As SSRI's are long-acting medications, the notion of an overdose sneaking up on you without warning of any kind is not likely.
Click to expand...
Thank you very much Keif.

1. DXM should not be taken with SSRIs as far as I know, right?

2. Does one build tolerance to Fluvoxamine?

3. Should I take it before my opioid or simultaneously?

4. How is it that some people have died while taking methadone and Fluvoxamine? Have they taken massive doses of Fluvo or dosed too frequently?

5. What is the reason you have stopped taking Fluvoxamine?

6. Any long term side effects I should know of? I'm worried that it will mess with my serotonin levels.

7. Can this medication cause dependency?

8. One last thing: I'm taking daily doses of ultra low dose naltrexone. Any dangerous interactions with that?

Thank you again.
 
I have also read that Fluvoxamine stays in your system for 3 to 5 days. If I took it daily my blood serum level would keep on increasing until it reaches a dangerously high level, correct?
 
Hey!

1. Serotonin Syndrome is a very serious, potentially deadly medical condition. It is always mentioned as a matter of due diligence, though in real life, Serotonin Syndrome is a rarer condition than you would expect considering all of the discussion about it.

With that in mind, I'm gonna tell you the same thing. Dextromethorphan (DXM) taken with SSRI's could cause Serotonin Syndrome. If you're using reasonably responsible dosages of DXM, it is not likely that this combination would produce Serotonin Syndrome. I will say, there will be no doubt whatsoever that something is very wrong with you if Serotonin Syndrome comes on. You're got gonna be sitting on the couch eating potato chips wondering if you have Serotonin Syndrome.

It's just good HR to talk about Serotonin Syndrome, but it's not something I would lose sleep over worrying. If you ever have concerns, go to the hospital.

2. I take 100mg Fluvoxamine per day with 70mg Methadone. I've never had to increase the SSRI or seen any reason to. So I believe the short answer here is no.

3. You would be taking it every day to get your levels stable, so the timing is not super-relevant. I suppose taking the Fluvoxamine ~5 hours before taking the Methadone would provide the most efficient results, though I believe the timing is pretty negligible.

4. I am not familiar with any cases of fatality caused solely by the combination of Methadone/Fluvoxamine. The case I posted earlier about the female being admitted to the hospital illustrates how this person was still able to seek help for themselves. If you're injecting Fentanyl, it's pretty hard to Naloxone (Narcan) yourself. You should have ample warning regarding your health due to the long-acting nature of the SSRI.

5. I still take Fluvoxamine and Methadone. I take 100mg Fluvoxamine and 70mg Methadone. I've been on doses as high as 150 in the past. To illustrate, I feel noticeably better taking the smaller dose with Fluvoxamine than I did simply being at the higher dose. It did not just make the Methadone stronger, it made it "better". Now I would never take Methadone without Fluvoxamine, as the Fluvoxamine is ultimately what allowed me to be satisfied with Methadone.

6. SSRI's are pretty safe and well-tolerated. The most common complaints concern reduced libido/sex drive. I'm not familiar with any serious chronic complications. You can potentially get the benefit you're after from a low(er) dose like 25mg. At lower dosages, the libido issues are less prominent.

7. Yes, but not in the same way Opioids would. SSRI withdrawal generally consists of mild anxiety and confusion for about a week. I've been through SSRI withdrawal, it's nothing if you've done something like Opioids; a minor inconvenience. Even still, you can avoid the withdrawal syndrome by doing a short taper. So the answer to your question is that dependence/tolerance to the SSRI is not anything to worry too much about.

Hexenstahl said:
I have also read that Fluvoxamine stays in your system for 3 to 5 days. If I took it daily my blood serum level would keep on increasing until it reaches a dangerously high level, correct?
Click to expand...

Nope. You will reach a steady state following about a week of administration. It doesn't work like how you've described so don't worry about that.
 
Keif' Richards said:
Hey!

1. Serotonin Syndrome is a very serious, potentially deadly medical condition. It is always mentioned as a matter of due diligence, though in real life, Serotonin Syndrome is a rarer condition than you would expect considering all of the discussion about it.

With that in mind, I'm gonna tell you the same thing. Dextromethorphan (DXM) taken with SSRI's could cause Serotonin Syndrome. If you're using reasonably responsible dosages of DXM, it is not likely that this combination would produce Serotonin Syndrome. I will say, there will be no doubt whatsoever that something is very wrong with you if Serotonin Syndrome comes on. You're got gonna be sitting on the couch eating potato chips wondering if you have Serotonin Syndrome.

It's just good HR to talk about Serotonin Syndrome, but it's not something I would lose sleep over worrying. If you ever have concerns, go to the hospital.

2. I take 100mg Fluvoxamine per day with 70mg Methadone. I've never had to increase the SSRI or seen any reason to. So I believe the short answer here is no.

3. You would be taking it every day to get your levels stable, so the timing is not super-relevant. I suppose taking the Fluvoxamine ~5 hours before taking the Methadone would provide the most efficient results, though I believe the timing is pretty negligible.

4. I am not familiar with any cases of fatality caused solely by the combination of Methadone/Fluvoxamine. The case I posted earlier about the female being admitted to the hospital illustrates how this person was still able to seek help for themselves. If you're injecting Fentanyl, it's pretty hard to Naloxone (Narcan) yourself. You should have ample warning regarding your health due to the long-acting nature of the SSRI.

5. I still take Fluvoxamine and Methadone. I take 100mg Fluvoxamine and 70mg Methadone. I've been on doses as high as 150 in the past. To illustrate, I feel noticeably better taking the smaller dose with Fluvoxamine than I did simply being at the higher dose. It did not just make the Methadone stronger, it made it "better". Now I would never take Methadone without Fluvoxamine, as the Fluvoxamine is ultimately what allowed me to be satisfied with Methadone.

6. SSRI's are pretty safe and well-tolerated. The most common complaints concern reduced libido/sex drive. I'm not familiar with any serious chronic complications. You can potentially get the benefit you're after from a low(er) dose like 25mg. At lower dosages, the libido issues are less prominent.

7. Yes, but not in the same way Opioids would. SSRI withdrawal generally consists of mild anxiety and confusion for about a week. I've been through SSRI withdrawal, it's nothing if you've done something like Opioids; a minor inconvenience. Even still, you can avoid the withdrawal syndrome by doing a short taper. So the answer to your question is that dependence/tolerance to the SSRI is not anything to worry too much about.



Nope. You will reach a steady state following about a week of administration. It doesn't work like how you've described so don't worry about that.
Click to expand...
Ok thank you for taking your time to answer all those questions. I will do more research and then think a little bit more about it, maybe sleep a couple nights over it until I make a decision.
Also, what do you mean with "better"? More euphoria?
 
Hexenstahl said:
Ok thank you for taking your time to answer all those questions. I will do more research and then think a little bit more about it, maybe sleep a couple nights over it until I make a decision.
Also, what do you mean with "better"? More euphoria?
Click to expand...
Indeed, you're a lucky lady ;)

Essentially, yes. Euphoria is a term that could be used. I feel more content, think less about Heroin. That sort of stuff.

You and I both know that we would rather have Heroin/Morphine than Methadone, right. One could argue it's the duration of action that makes Methadone less "euphoric". I believe this plays a role, yet it's not the whole story.

When I first began maintenance I always thought about Heroin. I wasn't even sick. I was on a high(er) dose. Still, there was something missing from the drug that was causing me to continue fantasizing about using Heroin.

As I was researching a while back, I came across the papers regarding the interaction between Fluvoxamine (Luvox) and Methadone. I was just trying to get high originally. Several days in I was already nodding out ~45 minutes after taking Methadone, which is crazy. I was actually getting more fucked up than I wanted to be. The timing worked well, as shortly thereafter, I got a UA for Benzodiazepines so they cut my dose in half to 70, where it remains to this day.

After getting my dose cut in half, I felt fine. After a few weeks at this, I realized I'd stumbled on to something good. I was experiencing much of the mental/physical benefits of the drug (including minor euphoria as it kicked in) and I wasn't sleeping all day, groggy or any of the other negative side effects of Methadone. That was years ago and it still works for me.
 
Hexenstahl said:
Aw damn. Is there any opioid that some hick in Louisiana can synthesize? Maybe morphine extraction? But I guess you need a shit ton of Opium to do that in which case it's financially more sound to just buy morphine lol.
Click to expand...
I knew multiple hicks in Armenia that would make desamorphine(krokidil) from coeadine pills that could be bought from any pharmacy. An if you knew what you were doing an took the time to make it correctlly as in filter all things bad for you out. The rush was better than anything I have experienced in california.an unfortunately I'm an experienced user with everything I.v.
 
I did make and taste desomorphine and even orally the onset is fast. Duration isn't long so I can well imagine that anyone on a 'mission' to stay high could spend their entire day (and night) smurfing pharmacies and making product.

I might add yield is LOW. I mean if you B/A first with calcium carbonate to isolate the phenolic products and then dissolve in HCl and crash out the product, 1000mg of codeine only yields about 80mg of material and some of that will be nordesomorphine.
 
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