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  • BDD Moderators: Keif’ Richards | negrogesic

If You're Fat Can You Still Metabolize Opiates Fast?

T

TayVicJoh

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Sep 12, 2015
Messages
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Hi, I'm fat, 5' 200 lbs (yes, I know I need to lose weight) and take 30 MG of methadone once a day. Yet, I feel like withdrawal starts at about the 18th hour. If you're fat, can you still metabolize medications fast? BTW, I've gained 30lbs since methadone. My sweet tooth is crazy! Anyone else have that problem?

Thanks in advance for any help. And an extra thanks for anyone that can help me without pointing out the obvious, that I need to lose weight.
 
In people with extra body weight, drugs may not get to those optimal levels, as there is more body mass for the drug to saturate. So if you've had an increase of weight, the same drug at the same dosage might not do what it used to. Which is why a lot of drugs are based on weight. For example, when I'm intubating someone.. we use the dosage 1-2mg/kg for succinylcholine. If I were only to give someone 75mg if they weighed 100kg, the medicine might not work (or work very ineffectively). So maybe you need to be on 35mg or even 40mg (if they make it in that dose, I have no idea), because of your weight. In no way, shape, or form and I making fun of you, or telling you to lose weight. Simply put, a lot of medicines are based on weight. More weight ='s higher dosage needed.

I had to "up" my seizure medication dosage (which I have been on successfully for 5 years) because I gained weight as well. From 100mg to 200mg. (started taking performance enhancers and gained like 40 pounds). Im NOT saying this is the problem, but it could be.

**As I said, the medicine I used was just an example (succinylcholine). I simply picked it because it was a weight based medicine (like thousands of others). I had NO thought of the "half-life" in mind. It was just an example of a weight based medicine, which I randomly picked.**
 
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Yes, even with a BMI-(body mass index) much higher than yours, rapid metabolism is possible. Though you might want to discuss it with your doctor/ MMT counselor as many people do better with 2x daily or split dosing. When I was in MMT I did better with split dosing, as well as many other people I knew as a patient advocate. Often taking half your dose in the morning and half in the afternoon or evening leads to more stable levels and less fluctuation that can cause the "pre-dosing jitters" as we called them.

Although the need for more drug based on body weight/ size has to do with several variables like Volume of Distribution. Some 350lb patients needed 1/3 of what other 120lb patients did. Anesthetics and paralytics like succinylcholine or etomidate have half lives of 10 mins and operate differently than long acting meds that accumulate like methadone and depend on subjective effects more so than something that's used in emergency medicine and requires suppression of reflexes so you don't gag on an endotracheal tube.

Preference for sweets and weight gain is also fairly common while on methadone or pain meds. Often the weight comes off after opioid cessation though so I wouldn't worry about it.

Obesity and glycemic dysregulation associated with chronic opiate administration manifest clinically in the methadone-maintained population.

Evidence from both preclinical and clinical studies demonstrates that chronic opioid exposure is associated with increased sugar intake. Preclinical research has attempted to refine the potential pathways and mechanisms of action through which opiates may regulate sugar intake, and how sugar consumption may affect the endogenous opiate system. Preclinical animal studies suggest that direct action of mu agonists at the nucleus accumbens shell, hypothalamus, and paraventricular nucleus is associated with development of sweet preference

The preference for sugary foods resulting from opiate administration may lead to increased consumption of such foods, and possibly accumulation of excess body fat and weight gain.

Activation of the mu-opiate receptor is associated with several effects on glucose intake and glycemic control. These include inducing sweet, or palatable, taste preference; hyperglycemia induced by direct action on pancreatic islet cells, likely insulin resistance caused by dietary preference for sugary foods; weight gain and tooth decay likely also associated with preference for sweet foods. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109725/
Click to expand...
 
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You two have been incredibly informative and really kind. I appreciate your replies so much. I am not MMT I'm a pain patient. With the opioid crisis I won't ask. He's made it pretty clear increasing my dosage again will never happen. If I can get 18 hours of relief, I'll be thankful for that. Again, I really appreciate the time you both took to type out such informative posts. My question has been well answered.
 
You might be an aberrant metabolizer. I am. When I was on 120mg of methadone, I'd be sick by 4pm everyday. Through a blood test I found that out. My level was so low in the morning, they questioned if I was really swallowing it. Very frustrating.

When I was put on methadone 10mg tablets, by my Dr. at that time, I split dosed. 60mg in am, 60mg in pm and I was fine. Just a thought. Good luck!
 
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