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Misc hydroxyzine vs. phenergan (promathezine)

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For me it's promethazine, which is OTC here. Hydroxyzine isn't OTC, it's less sedating but it's a better anxiolytic.
 
I find promethazine more sedating than hydroxyzine, but i find i can take higher doses of hydroxyzine without any side effects (up to 500mg) whereas if i were to take that amount of promethazine i would go delirious....
 
^ Yeah promethazine is much more potent than hydroxyzine. But I prefer hydroxyzine for its anxiolytic property (and it's the best potentiator for opiates of all the antihistamines).
 
i would *love* to try hydroxyzine - but i can confirm that promethazine is kick ass sedating - great if you dont have any benzos OTC in the UK too so for the win!
 
^ For me 25mg (one tablet) is enough, although I can go up to 50mg.
 
i will take up to 100mg promethazine... any more and i start feeling strange, sort of dissossiated... in an unpleasant way...
 
I second basically everything said so far... promethazine is more sedating, but I'd much rather have hydroxyzine (assuming we're talking about potentiating opioids or for anxiolysis).
 
^especially an antihistamine that duals as an antipsychotic. I've taken some of the atypicals for their sedative properties and I just don't think there is anything recreational about any anticholinergic drugs. I only use them in low doses for sleep or to potentiate opioids because the opioids will counter act what I find to be the most unpleasant effects (namely restlessness).
 
I would prefer hydroxyzine. I have had both but I don't remember what promethazine is like. I know hydroxyzine helps potentiate benzos and opiates well, and that's why I like it.
 
yeah cane although , promethazine is a very mild dopamine antagonist , it still is an antagonist none the less - apparently taking prometh with tramadol is not so cool either .....

i need to check the search tool to ask about this though - and not hijack this thread...

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im with you mon capitan , despite what i first thought i have noticed some pleasant potentiating with prometh and codeine - chlorphenamine is quite nice as-well....

opiates and 1st gen antihistamines are designed to be together in my opinion

not only do they potentiate the nod , but also stops the itching... win win scenario right guys

as long as your careful of course
 
Free_Man** said:
opiates and 1st gen antihistamines are designed to be together in my opinion

not only do they potentiate the nod , but also stops the itching... win win scenario right guys

as long as your careful of course
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Absolutely! And not just the itching but the nausea, the redness on the skin, the neck/shoulder stiffness some experience, etc.

It makes sense that they go together if one drug produces an unpleasant histamine release and the other blocks that. The sedation is a nice bonus though!
 
^ i would be tripping out on that dose !!!! im sure that dose isnt safe - geeze - pm me when your a blue lighter if you want barnstable .... lets chat :)
 
Free_Man** said:
^ i would be tripping out on that dose !!!! im sure that dose isnt safe - geeze - pm me when your a blue lighter if you want barnstable .... lets chat :)
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Yeah, i'm definately not proud of it, i'm really quite disgusted with myself in all honesty! Only one more post and I can PM people!
 
When I used to do heroin, I would regularly consume ~200-250mg promethazine over the course of the night and never feel any anticholinergic and/or bad side effects. I didn't do this from day one, so I guess I developed a "promethazine tolerance."
 
johanneschimpo said:
When I used to do heroin, I would regularly consume ~200-250mg promethazine over the course of the night and never feel any anticholinergic and/or bad side effects. I didn't do this from day one, so I guess I developed a "promethazine tolerance."
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I'm the same, I built it up over about 8 years, my dosage wasn't always as high as I mentioned before. I still wake up fine in the morning and don't really have any major side effects but it's really worrying me lately due to the apparent risk of parkinsons and just the damage i'm doing to my body!
 
free man said:
yeah cane although , promethazine is a very mild dopamine antagonist , it still is an antagonist none the less - apparently taking prometh with tramadol is not so cool either .....
Click to expand...

i've used prometh with tramadol in the mix quite a bit in the past and never had any ill effects. i think the prometh is too weak of an antoginist to have any effect, don't quote me though. it's probably quite dependent on dosages of each as well - which i've always kept minimal

^I wasn't sure so I checked the drugs.com interaction checker for the two and this is what I got:

MONITOR CLOSELY: The risk of seizures may be increased during coadministration of tramadol with any substance that can reduce the seizure threshold, such as selective serotonin reuptake inhibitors (SSRI antidepressants or anorectics), monoamine oxidase inhibitors, neuroleptic agents, central nervous system stimulants, opioids, tricyclic antidepressants, other tricyclic compounds (e.g., cyclobenzaprine, phenothiazines), carbapenems, cholinergic agents, fluoroquinolones, interferons, chloroquine, mefloquine, lindane, and theophylline. These agents are often individually epileptogenic and may have additive effects when combined. Many of these agents also exhibit CNS- and/or respiratory-depressant effects, which may be enhanced during their concomitant use with tramadol.SOURCE
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I was prescribed tramadol with the a TCA for months and always got warnings about the seizure issue. I imagine for MOST people therapeutic doses of promethazine and tramadol would not be extremely dangerous, but if you are seizure prone or taking larger doses I would be VERY careful.

EDIT: promethazine is a phenothiazine neuroleptic

cheers, cane.

i've tried a few anti-d's while on tramadol as well and apart from feeling shitty from the AD itself, never had any ill effects either - once again doses were kept quite low. i was kind of suprised initially with my doctor because he never mentioned anything about the potential problems that could arise from mixing (therapeutic doses btw)tramadol and an ssri. i had to bring it to his attention but he reassured me i will be fine and i believed him. saying that, i'm a litle skeptical over the whole hype with the +400mg seizure risk, but that's not to say i don't ackowledge there being a risk. and i always aware people of it as well

^agreed all around. My doctor also never told me of a risk, I just started getting notices from the pharmacy ~3-4 months after I started the regimen. Within a few months I was taking 300-400mg/day of tramadol and 90mg/day of nortriptyline so I also question the hype of the 400mg tramadol seizure risk. I have heard tramadol seizure stories and I have no doubt it lowers the seizure threshold but I just wonder if the prevalence is a bit overblown and the risks overstated.

The 400 mg limit is probably a bit like the LD50. where half of the subjects in a study die from the given dose of a drug. At 400 mg of tramadol, there is a significantly increased number of people who will get seizures.

^Yeah, that is self-evident that not everyone will seize at 401mg, the issue I have is if the risk is overblown. The general consensus is that the danger is so high that NO ONE should surpass 400mg/day and if we are talking about 1% risking seizure going over 400, then I would say the risk is overblown. If the figures are closer to 50% then of course I will keep reiterating "don't pass 400mg"... I just don't know the severity of the risk and the sporadic anecdotal reports I've read don't really support a trend either way.

yeah , i mean i have taken more than 400mg of tramadol a day - which i know is not clever - i have taken it with codeine as well which is in that list of potential dangerous interactions that cane has pictured (opioids) - (im presuming this include an opiate as well....)

i have taken it with chlorphenamine which probably wasnt too wise (i think chlorphenamine is a serotonin releasing agent?) - but even though i exceeded the doses - i was careful and i didnt exceed the max doses too much

i would +1 what Leftwing and Cane have both said - it does seem a little bit overblown the whole tramadol seizure hype.... having said this though i have noticed some strange effects when i first started taking the tramadol.... i was pretty god damn stimulated and did feel tense - i was scared of having a seizure - but only because i have heard that it can cause one....

when tolernace developed - there was no problems at all -

i still would not like anyone to follow my lead........i have heard some horrible scarey stories about interactions with tramadol and other drugs (especially serotoniergics and tryptaminergics) its not really a safe drug to abuse in high ammounts in my opinion....... and of course if your seizure prone its got to be a big no no - i guess its the same as it is with all drugs - moderation moderation moderation - awareness and common sense :)

----

moving back on topic i have bought some promethazine OTC today 8 x 20mg tablets so i look forward to adding a little something extra to my codeine tonight - i need the sleep- and the combo works wonders :)

leftwing said:
i've used prometh with tramadol in the mix quite a bit in the past and never had any ill effects. i think the prometh is too weak of an antoginist to have any effect, don't quote me though. it's probably quite dependent on dosages of each as well - which i've always kept minimal
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thanks leftwing , i will be carefull with my dosing - i always am nowadays - ill stick to 40mgs max i think...

Free_Man** said:
i still would not like anyone to follow my lead........i have heard some horrible scarey stories about interactions with tramadol and other drugs (especially serotoniergics and tryptaminergics) its not really a safe drug to abuse in high ammounts in my opinion....... i guess its the same as it is with all drugs - moderation moderation moderation - awareness and common sense :)
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^agreed 100%, very important.

I'd say its about an SD-0.1 ('S' standing for seizure), varying a bit if you have a history of them.

The 400mg tramadol number and hype is even more overblown than APAP poisoning risk IMO.

johanneschimpo said:
I'd say its about an SD-0.1 ('S' standing for seizure), varying a bit if you have a history of them.

The 400mg tramadol number and hype is even more overblown than APAP poisoning risk IMO.
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i haven't looked into the SD - what are some search clues for me to get a definition and equations involved?

i was just doing some reading on tramadol and seizure and found this abstract. sorry for going way off topic, maybe i should split this out into a new thread.

http://informahealthcare.com/doi/abs/10.3109http://informahealthcare.com/doi/abs/10.3109/15563659709043367
Abstract

Background: Tramadol is a novel analgesic possessing both opiate and noradrenergic effects. Its low potential for abuse suggests increasing use, but there are limited data on the toxicity in overdose. Methods: Multicenter prospective case series. All exposures from October 1995 through August 1996 reported to seven Poison Centers were evaluated. Results: There were 126 cases of which 87 were tramadol alone. Of the tramadol alone cases, 51 were female (59%). Age ranged from 1 to 86 y with a mean and median of 26.8 y (SD 17.2) and 25 y, respectively. There were 15 cases of children less than 6 years old. Symptoms reported with overdose were: lethargy 26 (30%), nausea 12 (14%), tachycardia 11 (13%), agitation 9 (10%), seizures 7 (8%), 4 each (5%) of coma and hypertension, and respiratory depression 2 (2%). All seizures were brief. Naloxone reversed sedation and apnea in 4 of 8 patients. One patient experienced a seizure immediately after administration of naloxone. Other treatments were: diazepam (3 patients), and phenytoin, lorazepam and nifedipine (1 patient each). Tramadol 500 mg was the lowest dose associated with seizure, tachycardia, hypertension or agitation while 800 mg was the lowest dose associated with coma and respiratory depression. Urine drug screens performed on 19 patients were negative for opiates. All symptomatic cases exhibited effects with 4 h of ingestion. Mean hospital stay was 15.2 h (range 2-96 h, SD 15.8). Nineteen patients were admitted to an intensive care unit with a mean stay of 25 h (SD 20). Discussion: Much of the toxicity in tramadol overdose appears to be attributable to the monoamine uptake inhibition rather than its opioid effects. Agitation, tachycardia, confusion and hypertension suggest a possible mild serotonin syndrome. No arrhythmias beyond tachycardia were seen. Conclusion: This study suggests significant neurologic toxicity from tramadol overdose. Serious cardiovascular toxicity was not seen
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i don't have full acess but it'd be interesting reading the full article

^ Sorry if I confused you, SD-50, and the like, is just a term a made up, playing on the term LD-50. :p


It would mean the dose for 50% of people who take it to have a seizure. Thats why I said its more like SD-0.1 ... that 1/1000 [0.01%] people who take it will actually have a seizure. I am throwing a random number out there, stating that I believe the tramadol seizure risk is exaggerated/overhyped [on BL] in a normal, healthy adults [assuming they aren't already prone to seizures, have a family history of seizures or are on other drugs that lower the seizure threshold].

right, i got you. i knew it was a play on the term LD-50 and assumed the SD 0.1 equalled 1 in every 100 having a seizure. thanks for clearing it up.

I am throwing a random number out there, to say that I believe the tramadol seizure risk is exaggerated in a normal, healthy adult [assuming they aren't already prone to seizures, have a family history of seizures or are on other drugs that lower the seizure threshold].
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100% agreed.

a few years back i remember there being quite a few people coming in OD warning about seizures they'd just had on reasonably low doses of tramadol. other than that, i've really not seen much other anecdotal evidence to support the claims made:\

I don't know how close to 400mg the dose needs to be, but there isn't too much room to play with past that before you start to get into the territory of what is definitely too much (700mg is the common number I see)...

FWIW, tramadol makes me shaky...

^ Sometimes I feel a little twitchy from it, but it is an SNRI (or I guess a 5-HT releaser and NRI, but whatever), so thats not all that uncommon to feel. Combining it with other drugs with similar action will certainly increase the shakiness/twitchiness/whatever, but its not a seizure.




Lefty: http://www.pharmacytimes.com/issue/pharmacy/2009/2009-05/RxFocusTop200Drugs-0509

Tramadol was the 82nd most prescribed drug in 2008. Your article is from about a decade before, but the point stands - for how commonly prescribed it is, you don't hear nearly as much about the seizures it produces as you'd expect to.

BollWeevil said:
I don't know how close to 400mg the dose needs to be, but there isn't too much room to play with past that before you start to get into the territory of what is definitely too much (700mg is the common number I see)...

FWIW, tramadol makes me shaky...
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i've read people claiming doses of around 75-100mg causing a seizure - one may have been fatal iirc. i could probably dig through the search engine and bring them up. but yeah, i think the 5-700mg range is the territory, if you're going to run into problems, where you will fall into them.

i get the shakiness from time to time as well, lower and higher doses. i don't think it's anything too uncommon as jc pointed out in his sneaky edit.

jc - yeah i knew that study was a decade old, like you and i said, the point still stands.

i think i'll definitely split this out, we've totally derailed this
 
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