Opioids Methadone zythromicin long Qt interaction

[LucidSDreamr]

I have to take zithromycin antibiotic. It has an interaction with methadone of increasing risk of long QT and other heart EKG abnormalities that methadone already has risk for.

My methadone dose is 15 mg per day. I am staring to lower it now for the time of being on the antibiotic.

How dangerous is this interaction and any stories or advice?

Doctor and pharmacist both know and warned me about the interaction but said to proceed and take the drugs

 

[ShulginsReincarnation]

I have to take zithromycin antibiotic. It has an interaction with methadone of increasing risk of long QT and other heart EKG abnormalities that methadone already has risk for.

My methadone dose is 15 mg per day. I am staring to lower it now for the time of being on the antibiotic.

How dangerous is this interaction and any stories or advice?

Doctor and pharmacist both know and warned me about the interaction but said to proceed and take the drugs

Its a rather dangerous interaction to be totally honest, and depending on your age and individual medical history and family medical history it could kill you. That is why its advised not to combine the two, and the fact that both your doctor and pharmacist are so lax about it is kind of concerning (not overly surprised by this though.) You could potentially develop torsade de pointes, and if you experience dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope, then you should seek immediate medical attention. EKG monitoring is advisable if the combination is not avoidable, and lowering the dose will limit your risk some but not entirely remove it of course.

I mean, you know your body and health better than I, or any doctor or pharmacist does, so you decide what to do that all being said.
Risk versus benefit analysis should be done on a case by case basis when it comes to these type of things.

 

[LucidSDreamr]

Its a rather dangerous interaction to be totally honest, and depending on your age and individual medical history and family medical history it could kill you. That is why its advised not to combine the two, and the fact that both your doctor and pharmacist are so lax about it is kind of concerning (not overly surprised by this though.) You could potentially develop torsade de pointes, and if you experience dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope, then you should seek immediate medical attention. EKG monitoring is advisable if the combination is not avoidable, and lowering the dose will limit your risk some but not entirely remove it of course.

I mean, you know your body and health better than I, or any doctor or pharmacist does, so you decide what to do that all being said.
Risk versus benefit analysis should be done on a case by case basis when it comes to these type of things.

So the interaction is classified as “major” and seems to be a really big deal not just a “new cautious” sort of thing.

I think I’m going to wait till the 2nd and ask my doctor if he can switch me to regular clean mu agonist that doesn’t have (I didn’t see him I had to see his colleague I don’t know) cardiotoxicity (of course he won’t because he will go to prison if he prescribed me a real opioid).

I could also taper the methadone quickly down to 5 mg per day then take the Zith

Maybe I just get worse with my infection, try to find an alternative antibiotic, switch myself to something an opioid that doesn’t have this danger illicitly ( will have to research that) and there’s always a danger of getting designer RC opioids that will kill me somehow or fentanyl or something.

I hate this country and its war on drugs and all the extra damage created because of it.

The only reason I’m on methadone is because the DEA visited him and views hydrocodone as. Ore narcotic and abuse prone than methadone and with methadone he could lower my MME dosage because it lasts so long vs hydrocodone::::so now I’m stuck on this way
Ore addictive cardio toxic opioid when before I had hydrocodone that was schedule iii or IV a mere 9 years agoz

I hate this country so much

 

[ShulginsReincarnation]

So the interaction is classified as “major” and seems to be a really big deal not just a “new cautious” sort of thing.

I think I’m going to wait till the 2nd and ask my doctor if he can switch me to regular clean mu agonist that doesn’t have (I didn’t see him I had to see his colleague I don’t know) cardiotoxicity (of course he won’t because he will go to prison if he prescribed me a real opioid).

Maybe I just get worse with my infection, try to find an alternative antibiotic, switch myself to something an opioid that doesn’t have this danger illicitly ( will have to research that) and there’s always a danger of getting designer RC opioids that will kill me somehow or fentanyl or something.

I hate this country and its war on drugs and all the extra damage created because of it.

The only reason I’m on methadone is because the DEA visited him and views hydrocodone as. Ore narcotic and abuse prone than methadone and with methadone he could lower my MME dosage because it lasts so long vs hydrocodone::::so now I’m stuck on this way
Ore addictive cardio toxic opioid when before I had hydrocodone that was schedule iii or IV a mere 9 years agoz

I hate this country so much

Yes, the measures the US government has taken regarding the opioid epidemic is honestly some of the dumbest shit I have ever seen. Its almost as if the DEA isn't qualified to do the jobs that the public has entrusted them to do with the way they handle most things. I absolutely feel for you there as I am actually a big supporter of governments issuing heroin or morphine replacement for those who need it. I also don't see how forcing people to buy their drugs on the streets and get increasingly addicted to harder and more dangerous drugs is fixing the problem which is what they did by rescheduling and "cracking down" on "over-prescribing."

I recently ran the data and the DEA's actions resulted in an inverse effect when it comes to opioid prescriptions going down and overdose deaths going the opposite. All other drug classes kept trending upward in habitual use despite increasing hospitalizations from users of those drugs even though prescriptions had been limited, so that didn't do a damn thing either but at least it didn't inversely effect the number of deaths for those user populations. US drug "addiction"/habitual drug use has consistently trended upward regardless. I say its the side effects of a sick society, and I am not sure if you've heard of him yet but Dr. Gabor Maté agrees. Definitely suggest you check his talks out if you ever get bored and need something to listen to on this subject. Either one of two things, the US government wants people to get sick and die or they truly are one of the stupidest governments on Earth (could be both too I guess lol.)

Getting back to the problem at hand, there are several alternative antibiotics that can be used but being that I do not know exactly what type of infection you are handling I cannot make any suggestions there. Definitely talk to your doctor and see what else can be worked out. Hopefully the doctor you are familiar with is decent enough to work something safer out for you. Or, if you really need the infection gone now and don't have access to other antibiotics quick enough, then you can try substitution therapies but that is your risk yet again as you said. If you have a good supply that doesn't have you risking death that may be the best option depending on the type of infection you have, but its really your call. At least you are smart enough not to just mix those drugs like that; gives me hope that you'll make the right decision whatever it may be here.

 

[LucidSDreamr]

I recently ran the data and the DEA's actions resulted in an inverse effect when it comes to opioid prescriptions going down and overdose deaths going the opposite.

Getting back to the problem at hand, there are several alternative antibiotics that can be used but being that I do not know exactly what type of infection you are handling I cannot make any suggestions there. Definitely talk to your doctor and see what else can be worked out. Hopefully the doctor you are familiar with is decent enough to work something safer out for you. Or, if you really need the infection gone now and don't have access to other antibiotics quick enough, then you can try substitution therapies but that is your risk yet again as you said. If you have a good supply that doesn't have you risking death that may be the best option depending on the type of infection you have, but its really your call. At least you are smart enough not to just mix those drugs like that; gives me hope that you'll make the right decision whatever it may be here.

It’s pharyngitis.

As to the first point yes. You can see from this CDC OD data above that there was. No opioid epidemic when the DEA weaponized the cdc and caused this mess in 2016. You can see for two decades prior, opioid overdose rates were not increasing relative to population and there was literally zero opioid epidemic. It was all
A lie.

So in 2016 they start arresting everyone and opioids get banned and look at the death spike that happened in 2016 when fentanyl replaced pharma (They needed a new target since weed was becoming a legal in many states).

Every single instance of drug prohibition has resulted in a way more dangerous drug replacing it. We saw the same with oxy and fent. We are so stupid we can’t learn.

The DEA needs to be sued and ppl need to go prison for this. Not only the addict deaths skyrocketed, but suicides went off the charts from innocent patients now being denied medication they had been on for decades.

 

[ShulginsReincarnation]

It’s pharyngitis.

As to the first point yes. You can see from this CDC OD data above that there was. No opioid epidemic when the DEA weaponized the cdc and caused this mess in 2016. You can see for two decades prior, opioid overdose rates were not increasing relative to population and there was literally zero opioid epidemic. It was all
A lie.

So in 2016 they start arresting everyone and opioids get banned and look at the death spike that happened in 2016 when fentanyl replaced pharma (They needed a new target since weed was becoming a legal in many states).

Every single instance of drug prohibition has resulted in a way more dangerous drug replacing it. We saw the same with oxy and fent. We are so stupid we can’t learn.

The DEA needs to be sued and ppl need to go prison for this. Not only the addict deaths skyrocketed, but suicides went off the charts from innocent patients now being denied medication they had been on for decades.

Oh, well, hell just get some amoxicillin then if you aren't allergic to penicillin; 500 mg every 8 hours for 10 days. I literally have some sitting right next to me just in case I get an infection. Antibiotics like that should be too hard to come by I shouldn't think. I mean they sell them at farm supply stores in the US I am pretty sure. I know Grainger sells them for veterinary purposes with no prescription in the US, but its a bit overpriced. Might be worth it if you have no other options available for a while though. Can probably get it rather quick through them depending on how the mail system runs there.

If you have a mild-moderate penicillin allergy, (or if the infection appears resistant to amoxicillin) then use cephalexin; 500 mg every 6 hours for 10 days. If you have severe allergy to penicillin, then use clindamycin; 300 mg every 6-8 hours for 10 days.

But, yea, a Z-Pack is a bit overkill unless your infection is rather severe. Not sure why the doc would even prescribe that considering the fact you are on methadone anyway like I said. Seems like a moron to me tbh lol

P.S. Don't fret too much, I am doing my best to get information out there regarding what the US government is complicit in. Not saying anything will come of it retribution-wise, but at least a significant number of those treating patients will come to understand the situation better. I have come to find many in the addiction medicine field in USA are being told that over prescribing caused the epidemic despite the insurmountable evidence to the contrary which you, yourself, just pulled off the CDC's website. The other data I compiled is from equally credible resources for the other drug classes, but I always tell people to focus on what happened with the opioid situation because its the most alarming thing I have ever seen.

Even if "over prescribing" happened, wasn't that safer than what the US is dealing with now? Heh.. Just my thoughts on it

 

[LucidSDreamr]

,

Even if "over prescribing" happened, wasn't that safer than what the US is dealing with now? Heh.. Just my thoughts on it

over course not and FIG. 4 i posted by the CDC proves that. In america 54% per people can't read above a 6th grade literacy level and I'm sure a significant percentage of those people are in policy making, congress, and law enforcement.

This county glorifies being uneducated, illiteratue, and anti science. America is shit. I don't care about "freedomes" I don't care that we are rich and have produced technology. We are filled with shit people and they draft this country down and make it the shit that it is and everyone, even the smart people, have to suffer because of their illiteracy.

 

[ShulginsReincarnation]

over course not and FIG. 4 i posted by the CDC proves that. In america 54% per people can't read above a 6th grade literacy level and I'm sure a significant percentage of those people are in policy making, congress, and law enforcement.

This county glorifies being uneducated, illiteratue, and anti science. America is shit. I don't care about "freedomes" I don't care that we are rich and have produced technology. We are filled with shit people and they draft this country down and make it the shit that it is and everyone, even the smart people, have to suffer because of their illiteracy.

You forgot the part where if you question those in power you get put to prison for it. I mean, considering the USA has 25% of the world's prison population yet only 5% of the total percentage of the Earth's total population is American says a lot about the country. I think maybe this is what you meant by "freedoms?" Definitely not a very free country compared to many others. Its the "great American lie" and its something that the people of USA are known for; believing they live in the "greatest country on Earth." Also, barely any protections under human rights laws either.

I feel bad for the people living in USA honestly, and more so for those intelligent enough to see through it all who live there such as yourself. Waking up every day in a living hell that they can't escape. No wonder the USA has major drug problems now that I think about it. Its literally like the people are choosing to numb themselves because it hurts too much to exist there. That's just awful now that I think about it... And, honestly, maybe the reason the rates of addiction are growing in the USA is because more and more people are coming to realize how bad things really are there and what is actually going on in the world because of the more widespread access to the internet these days. Hm, I'll ponder that one...

 

[LucidSDreamr]

You forgot the part where if you question those in power you get put to prison for it. I mean, considering the USA has 25% of the world's prison population yet only 5% of the total percentage of the Earth's total population is American says a lot about the country. I think maybe this is what you meant by "freedoms?" Definitely not a very free country compared to many others. Its the "great American lie" and its something that the people of USA are known for; believing they live in the "greatest country on Earth." Also, barely any protections under human rights laws either.

I feel bad for the people living in USA honestly, and more so for those intelligent enough to see through it all who live there such as yourself. Waking up every day in a living hell that they can't escape. No wonder the USA has major drug problems now that I think about it. It’s literally like the people are choosing to numb themselves because it hurts too much to exist there. That's just awful now that I think about it... And, honestly, maybe the reason the rates of addiction are growing in the USA is because more and more people are coming to realize how bad things really are there and what is actually going on in the world because of the more widespread access to the internet these days. Hm, I'll ponder that one...

I disagree about questioning ppl in power.

We have more free speech that most western and eastern nations except for South America.

Most places you can’t talk shit about and even mildly threaten the government without jail. In England you can’t even talk bad about others.

We have decent free speech; no real personal liberties except guns, and we don’t use the guns to get liberty which is what they were legalized originally for ; we use them to settle beef and road rage

 

[ShulginsReincarnation]

I disagree about questioning ppl in power.

We have more free speech that most western and eastern nations except for South America.

Most places you can’t talk shit about and even mildly threaten the government without jail. In England you can’t even talk bad about others.

We have decent free speech; no real personal liberties except guns, and we don’t use the guns to get liberty which is what they were legalized originally for ; we use them to settle beef and road rage

Interesting. It has been noted that press freedom in the USA has been rapidly declining in recent years, and that (especially under Trump in 2016-2020) journalists have been increasingly attacked for exerting their rights to free speech/press. I suppose that is a little different than jail for speech, but it really isn't much better in any case. The USA may not have hate speech laws for example, but I don't know that freedom of speech is as protected as it once was in the USA. I could be wrong though; I have no clue. I just know the USA ranks toward the bottom of the list for Western nations in freedom of speech via press now which it used to be in the top 15 not too long ago. Its like "Yeah, sure you can speak freely, but don't be surprised if someone tries to shoot you for it." That is just from what I have read though; I have no clue. Thanks for the insight from your perspective though; hopefully it is the way you describe rather than the way we hear about it being.

 

[LucidSDreamr]

Interesting. It has been noted that press freedom in the USA has been rapidly declining in recent years, and that (especially under Trump in 2016-2020) journalists have been increasingly attacked for exerting their rights to free speech/press. I suppose that is a little different than jail for speech, but it really isn't much better in any case. The USA may not have hate speech laws for example, but I don't know that freedom of speech is as protected as it once was in the USA. I could be wrong though; I have no clue. I just know the USA ranks toward the bottom of the list for Western nations in freedom of speech via press now which it used to be in the top 15 not too long ago. Its like "Yeah, sure you can speak freely, but don't be surprised if someone tries to shoot you for it." That is just from what I have read though; I have no clue. Thanks for the insight from your perspective though; hopefully it is the way you describe rather than the way we hear about it being.

Mainstream press is censored but you can still say anything on the internet or in person and be fine

 

[negrogesic]

The dose of 15mg/day of methadone is rather low, and methadone is only a weak-modest hERG inhibitor, so I wouldn't worry about it unless you have a congenital heart problem or other heart problem (like a conduction disorder, sick sinus etc.).

Make sure you're not deficient as far as electrolytes go. Otherwise, no cause for alarm.

 

[ShulginsReincarnation]

The dose of 15mg/day of methadone is rather low, and methadone is only a weak-modest hERG inhibitor, so I wouldn't worry about it unless you have a congenital heart problem or other heart problem (like a conduction disorder, sick sinus etc.).

Make sure you're not deficient as far as electrolytes go. Otherwise, no cause for alarm.

Wouldn't you agree that if he hasn't had a recent 10 lead done and reviewed by a qualified medical professional, that there's no way to know for certain he doesn't have risk factors? No different than them telling a bunch of people that the Moderna vaxx is "safe and effective" yet it had the capacity to cause myocarditis and heart failure in what they thought to be otherwise healthy young men (I suspect pre-existing conditions that were not screened for in the cases of death that occurred, but it could be independent of such as the myocarditis often was which is even worse in that case.) But, yeah, wouldn't you also suggest he speak with his doctor before proceeding considering there IS a potential risk and there are safer options?

Obviously, it is up to him, but do you disagree with any of what I brought up? And, I mean in an objective manner, not a subjective "well I would just do it if I were him" kind of way... We all have different risk tolerances when we are decision making of course, so that is why I ask you to answer in an objective fashion.

Thanks.

 

[LucidSDreamr]

The dose of 15mg/day of methadone is rather low, and methadone is only a weak-modest hERG inhibitor, so I wouldn't worry about it unless you have a congenital heart problem or other heart problem (like a conduction disorder, sick sinus etc.).

Make sure you're not deficient as far as electrolytes go. Otherwise, no cause for alarm.

Wouldn't you agree that if he hasn't had a recent 10 lead done and reviewed by a qualified medical professional, that there's no way to know for certain he doesn't have risk factors? No different than them telling a bunch of people that the Moderna vaxx is "safe and effective" yet it had the capacity to cause myocarditis and heart failure in what they thought to be otherwise healthy young men (I suspect pre-existing conditions that were not screened for in the cases of death that occurred, but it could be independent of such as the myocarditis often was which is even worse in that case.) But, yeah, wouldn't you also suggest he speak with his doctor before proceeding considering there IS a potential risk and there are safer options?

Obviously, it is up to him, but do you disagree with any of what I brought up? And, I mean in an objective manner, not a subjective "well I would just do it if I were him" kind of way... We all have different risk tolerances when we are decision making of course, so that is why I ask you to answer in an objective fashion.

Thanks.

Thanks for the feedback.

I’ve decided not to take it and see if the throat infection can be naturally handled by my immune system and I’m also gonna ask my doctor for an alternative antibiotic that doesn’t have this interaction, if there is one that’s appropriate for my infected throat.

Pain is kind of flaring too so I’m gonna be upping them methadone dose and don’t want to worry about this interaction

 

[negrogesic]

Obviously, it is up to him, but do you disagree with any of what I brought up? And, I mean in an objective manner, not a subjective "well I would just do it if I were him" kind of way... We all have different risk tolerances when we are decision making of course, so that is why I ask you to answer in an objective fashion.

Thanks.

I think the risk is objectively low considering that:

a) the methadone dose involved here is very low, and methadone has only micromolar affinity as a hERG inhibitor so only large doses produce clinically significant hERG inhibition in healthy adults.

b) azithromycin has even weaker affinity than methadone, and the extent to which this hERG inhibition is clinically relevant is up for debate: https://emcrit.org/pulmcrit/myth-bu...use-torsade-de-pointes-or-increase-mortality/

c) a physician and pharmacist also concurred that said interaction was not particularly alarming (I only just read that; when I first responded I was quickly responding to the thread title). Not that they are infallible, but their input has weight, and they arrived at a consensus

d) the patient is an adult male, not elderly, presumably without heart defects, and the patient is acutely aware of the risk for interaction, so if an interaction were to materialize they would seek prompt treatment.

So, objectively, I'd say the risk of interaction is low.

And, while I didn't have time to fully elaborate when I first responded, in my original answer I provided data to objectively support my view that the risk was fairly low, barring a heart condition. Specifically, I noted that the dose of methadone involved was very low, and that methadone isn't a high affinity hERG inbibitor. This is quite in contrast to your initial response, which lacked any kind of objective data or information to back up your response (other than, "to be totally honest") while you simultaneously dismissed the advice of the doctor and pharmacist, as follows:

Its a rather dangerous interaction to be totally honest, and depending on your age and individual medical history and family medical history it could kill you. That is why its advised not to combine the two, and the fact that both your doctor and pharmacist are so lax about it is kind of concerning (not overly surprised by this though.)

So, comparing my objective initial answer and the entirely non-objective one that you originally provided (above) it's a little over-the-top for you to then come at me with this:

We all have different risk tolerances when we are decision making of course, so that is why I ask you to answer in an objective fashion

The above request -- "so that is why I ask you to answer in an objective fashion" -- is quite ironic (almost implying that my first answer wasn't objective), while your original response had zero supporting logic other than..."to be totally honest" -- aka, source: "Trust me bro".

 

[negrogesic]

I didn't even read the rest of this thread, but scrolling up I just saw that you went on to give unqualified medical advice:

But, yea, a Z-Pack is a bit overkill unless your infection is rather severe.

Again, source -- "Trust me bro". Maybe the physician is trying to prevent a severe infection? Maybe the physician knows what he is doing? Maybe he went to medical school? Maybe he's spent countless hours in clinical practice?

Not sure why the doc would even prescribe that considering the fact you are on methadone anyway like I said. Seems like a moron to me tbh lol

Maybe a physician would prescribe azithromycin because he knows the risk of interaction is low, particularly given the circumstances (patient on a very low dose of methadone, healthy adult male, rarity of clinically-induced azithromycin cardiotoxicity, etc.).

 

[ShulginsReincarnation]

I didn't even read the rest of this thread, but scrolling up I just saw that you went on to give unqualified medical advice:



Again, source -- "Trust me bro"

That's really not unqualified medical advice; its me stating what I know about the combination based upon available resources found on the web such as PubMed and Google Scholar. I stated, and I will repeat, that a Z-Pack is a little bit overkill in the case of pharyngitis. That is true; I don't see a reason to treat this with azythromycin when other alternatives exist that don't run any risk whatsoever and would be equally as effective.

Thanks for clarifying that the relative risk with azythromycin, but obviously I had to do my own research which turned up similar enough findings:

Azithromycin-induced torsade de pointes - PubMed

Although erythromycin frequently induces long QT interval and torsade de pointes, the newer drug, azithromycin, has rarely been reported to be associated with torsade de pointes. We report here the occurrence of a significant typical QT prolongation within a few hours after taking azithromycin...

pubmed.ncbi.nlm.nih.gov

Azithromycin-induced proarrhythmia and cardiovascular death - PubMed

An emerging body of evidence suggests that azithromycin therapy may prolong the QT interval and, in rare cases, precipitate the potentially fatal arrhythmia torsade de pointes. Patients with additional risk factors for QT prolongation appear to be at highest risk, including women, elderly...

pubmed.ncbi.nlm.nih.gov

methadone has only micromolar affinity as a hERG inhibitor so only large doses produce clinically significant hERG inhibition in healthy adults.

That is not at all what I have come to find via the web, so I would love to know where you found this information yourself as it seems sus...

https://www.ahajournals.org/doi/pdf/10.1161/JAHA.121.023482?download=true

https://jpet.aspetjournals.org/content/303/2/688

I did find this though, "The main cardiac effects of racemic Methadone, a synthetic opioid, include prolongation of QT interval and torsade de pointes. The FDA approved racemic Methadone as an analgesic in 1947. In humans, Methadone is strongly metabolized in the body, predominantly in the liver by CYP3A4 and CYP2B6. CYP2B6 metabolized in vitro (S)-Methadone with 1.8-fold preference versus (R)-Methadone. In a patch-clamp experiment, using HEK293 cells expressing hERG, (S)-Methadone blocks hERG 3.5-fold more potently than (R)-Methadone. Methadone is not a high-affinity blocker of hERG1, and the 3.5-fold difference between enantiomers might not be clinically relevant. The difference in hERG inhibition is accompanied by additional stereoselective PK and PD properties inducing the (S)-Methadone toxicity.
Early studies pointed out disadvantageous side-effects of racemic methadone when compared to the (R)-form, but they did not receive the deserved attention [83]. It is obvious that the use of pure (R)-Methadone in place of racemic should be considered for all patients treated, for instance for pain, in order to reduce the risk of cardiac toxic effects and sudden death."

So, maybe you got confused when the article stated "Methadone is not a high-affinity blocker of hERG1, and the 3.5-fold difference between enantiomers might not be clinically relevant."???

https://www.sciencedirect.com/science/article/abs/pii/S0223523420302592

Fuck if I know man... All I know is your response was quite shit and I have no respect for a dipshit that runs their mouth and retaliates with bad information when trying to defend his position. I will give you some credit for your having been correct about azythromycin.

But, as @LucidSDreamr and I were discussing, opiates such as heroin (as in this example) are not nearly as cardiotoxic as methadone:
"Both methadone and heroin inhibit hERG currents in a concentration-dependent manner. The following values were calculated for IC50 (concentration causing half-maximal inhibition) and n (the Hill coefficient): 4.8 μM and 0.9 for methadone, 427 μM and 0.7 for heroin. In conclusion, the potency for block of hERG currents is about 100-fold lower for heroin when compared to methadone."

Comparison of the Effects of Methadone and Heroin on Human ether-à-go-go-Related Gene Channels - Cardiovascular Toxicology

Torsades de pointes (TdP) is a life-threatening form of ventricular arrhythmia that occurs under conditions of delayed cardiac repolarization indicated by prolonged QT intervals in ECG recordings. The main mechanism of QT prolongation and TdP is block of the rapid component of the cardiac...

link.springer.com

I'm honestly too tired for this dumb shit... You sit here and say how the fact that methadone is known to be dangerous cardiovascularly speaking in its own right doesn't raise immediate alarm when combining with azythromycin which the article you referenced even acknowledged is a misconception which I politely asked you to enlighten me on. Meanwhile, in another thread he says psychedelics can't help people get clean because junkies are known to shoot dope at the peak of acid trips. Like, fuck.... yes, of course, but you're a lot more likely to recover if you actually try... Fucking critics everywhere on this forum... I'm more and more rapidly coming to find this is not a harm reduction forum so much as a mingling ground for drug addicts that don't give a fuck about their own lives.

 

[LucidSDreamr]

I didn't even read the rest of this thread, but scrolling up I just saw that you went on to give unqualified medical advice:



Again, source -- "Trust me bro". Maybe the physician is trying to prevent a severe infection? Maybe the physician knows what he is doing?



Maybe a physician would prescribe azithromycin because he knows the risk of interaction is low, particularly given the circumstances (patient on a very low dose of methadone, healthy adult male, rarity of clinically azithromycin cardiotoxicity, etc.).

@ShulginsReincarnation

*Edit never mind; ban this little 24 yr old thesis writing fucker is my vote. He just called me a piece of shit junky because I use opioids. I guess that includes you too @negrogesic …you piece of shit junkie you . I guess just disregard everything below trying to give the kid a chance.

He’s crying that psychedelics are illegal
And blaming it on me because I use opioids and acid didn’t cure my opioid addiction. He is indeed retarded and just disregard me giving him the benefit of the doubt below


seems to keep getting into it with a number of different people on this site including myself in another thread. Buut I also think he means well and has been helpful and contributed good content in most discussions, albeit maybe a little rough around the edges.

This discussion I’m this thread is about pretty cut and dry medicine; so I’m surprised peoples opinions are riling everyone up.

He does mean well and does seem to know his shit for the most part though; just seems like someone that hasn’t been humbled yet by working with colleagues much smarter than him or is working in one of those academic or immediately post academic environments that is a constant dick measuring contest to see who is the smartest in the room. Horrible environments to work in long term imo; even if you are indeed the smartest one in the room. It all gets exhausting after a while.

I would blame it on being on drugs too because I tend to act holier and smarter than thou when on certain drugs; but he doesn’t seem to be much of a drug addict though so I don’t think that’s the issue.

I think he does have some base of useful knowledge to contribute to BL but I have seen him in a number of tiffs on the site including one with myself discussing psychedelics as cures for addiction where he is being the arbiter of truth and scientific fact in some really murky areas like the use of psychedelics in psychological treatment. This isn’t an exact science like physics or something.

Idk blue light isn’t really a contest to see who knows the most about drugs or who is right or who is wrong on minute details that don’t ultimately matter or in subjective areas of psychology or personal relationships ppl have with drugs that will differ from person to person.

This ain’t the graduate student break room or the break room at Merck R&D so maybe we all don’t need to act like it so much…because those fuckers are exhausting to be around if you ask me.

I’m usually high and pretty psychologically fucked in general so don’t take anything I ever say too personally….I don’t know about everyone else.

 

[ShulginsReincarnation]

@ShulginsReincarnation

*Edit never mind; ban this little 24 yr old thesis writing fucker is my vote. He just called me a piece of shit junky because I use opioids. I guess that includes you too @necrogesic …you piece of shit junkie you


seems to keep getting into it with a number of different people on this site including myself in another thread. Buut I also think he means well and has been helpful and contributed good content in most discussions, albeit maybe a little rough around the edges.

This discussion I’m this thread is about pretty cut and dry medicine; so I’m surprised peoples opinions are riling everyone up.

He does mean well and does seem to know his shit for the most part though; just seems like someone that hasn’t been humbled yet by working with colleagues much smarter than him or is working in one of those academic or immediately post academic environments that is a constant dick measuring contest to see who is the smartest in the room. Horrible environments to work in long term imo; even if you are indeed the smartest one in the room. It all gets exhausting after a while.

I would blame it on being on drugs too because I tend to act holier and smarter than thou when on certain drugs; but he doesn’t seem to be much of a drug addict though so I don’t think that’s the issue.

I think he does have some base of useful knowledge to contribute to BL but I have seen him in a number of tiffs on the site including one with myself discussing psychedelics as cures for addiction where he is being the arbiter of truth and scientific fact in some really murky areas like the use of psychedelics in psychological treatment. This isn’t an exact science like physics or something.

Idk blue light isn’t really a contest to see who knows the most about drugs or who is right or who is wrong on minute details that don’t ultimately matter or in subjective areas of psychology or personal relationships ppl have with drugs that will differ from person to person.

This ain’t the graduate student break room or the break room at Merck R&D so maybe we all don’t need to act like it so much…because those fuckers are exhausting to be around if you ask me.

I’m usually high and pretty psychologically fucked in general so don’t take anything I ever say too personally….I don’t know about everyone else.

I didn't call you that, go read what I wrote again.

I'm just going to ignore both of you as well; really wish it were possible to block staff on here though instead of having to actually just ignore them. Would make it easier since 75% of the people I am choosing to ignore are staff.

I literally just skimmed part of this response because I have no further patience with either of you for the reasons mentioned.
And, go ahead and ban away, I'll just come back with a different digital signature. It doesn't take a rocket scientist...

 

[LucidSDreamr]

I didn't call you that, go read what I wrote again.

I'm just going to ignore both of you as well; really wish it were possible to block staff on here though instead of having to actually just ignore them. Would make it easier since 75% of the people I am choosing to ignore are staff.

I literally just skimmed part of this response because I have no further patience with either of you for the reasons mentioned.
And, go ahead and ban away, I'll just come back with a different digital signature. It doesn't take a rocket scientist...

I didn't call you that, go read what I wrote again.

I'm just going to ignore both of you as well; really wish it were possible to block staff on here though instead of having to actually just ignore them. Would make it easier since 75% of the people I am choosing to ignore are staff.

I literally just skimmed part of this response because I have no further patience with either of you for the reasons mentioned.
And, go ahead and ban away, I'll just come back with a different digital signature. It doesn't take a rocket scientist...

If you’re going to ignore negrogesic you might as well delete the profile you made like a week ago and get the fuck off the site because he’s probably the most knowledgeable person in here on drugs and you’re going to miss out on good information

something tells me you aren’t here to learn anything though. You’re here to jack off your own ego

And trust me man; I don’t care if you went to Harvard and published 20 first author papers in Science while you were there…..with your attitude you are going to get your ass fired and have an extra hard time in the professional world no matter how smart you are with a personality as shitty as this