Stimulants Methadone and D-Amphetamine: Interactions?

[splenda]

I am currently on methadone 160mg every morning that I take from the clinic. I've been on this dose for a while now and it holds me for about 20 hours, and although I wake up in slight withdrawal each morning it's bearable and I'm able to wait to get to the clinic to dose without any problems. I decided to re-start my dextro-amphetamine script because my ADHD symptoms have been quite bad as of recent and I'm just wondering if there are any problems between methadone and amphetamine. Does anyone here take methadone and d-amphetamine together?

My main worry is that the d-amphetamine will make my dose of methadone last shorter and that I might need to increase my dose of methadone by 10-20mg. I'll be taking the 10mg spansules 3x a day of d-amphetamine for the most part. If anyone can provide me some information about using d-amphetamine and methadone as a combined pharmacotherapy and can provide me with some insight, I'd be greatly appreciative. Thanks!

edit: On a side note, I really wish I could get on Vyvanse (l-lysine-d-amphetamine) because it lasts all day (12hours+) which means I wouldn't have to take the spansules, which only last roughly 5-6 hours, 3x a day. I wish my insurance covered it but unfortunately it doesn't. Does anyone know if Vyvanse will become more widely used anytime soon (so that my HMO will start covering it in their formulary)?

 

[Mr Blonde]

I couldn't find any information on interactions after a quick search. It's possible there may be some liver enzyme interaction.

You could always ask your doctor or methadone providers seeing as you are taking both the methadone and the amphetamine legitimately.

 

[Znegative]

you don't have to worry about it man. I was prescribed both a few years ago, its quite a nice combo in my oppinion. Kind of evens things out

 

[pallidamors]

I don't think amphetamine induces any enzymes that metabolize methadone, or any opiate for that matter. I've combined d-amph with plenty of opiates and never noticed a difference in potency, nor have I ever read that it changes methadone/opioid metabolism in any literature, and haven't seen it listed on any charts.

I suppose you could look it up on a cyp450 chart, but I don't think you're going to have any issues.

 

[Znegative]

are there any chemicals that do increase opiod metabolism?

 

[splenda]

My main issue and worry is that the d-amphetamine will speed up my metabolism/produce mild hyperthermia which will make me 'sweat'/'burn' out my methadone dose faster than normal. I do know that there aren't any pharmacokinetic interactions between methadone and d-amphetamine, as d-amphetamine is mainly metabolised by CYP2D6, while methadone is a substrate of CYP3A4 and CYP2B6 mainly while mildly inhibiting CYP3A4. So no interaction there, although I am a bit worried that the increased stimulation from the d-amphetamine will 'burn' my dose of methadone faster than usual.

Also, I've read on some sites that the only interaction between methadone and d-amphetamine is that the d-amphetamine will potentiate the analgesic effects of methadone; I guess this is normal since psychostimulants are known to potentiate the analgesic effects of opioids.

 

[splenda]

Hello Splenda! I used to take the 15mg dexedrine malinkrot spanules(they were so strong). With 16mg's of suboxone. I noticed that if I ever took to many spanules, I would be dosing extra suboxone. However the combination worked great, I was able to focus.

But I would also like to point out I was taking klonopin. So that probably helped. However my point is I think you'll end up needing more methadone, or less dexedrine. It would speed me up and make me have to use the bathroom more often. Good luck.

Not bad. How often would you dose the 15mg Dexedrine spansule? Yeah, I don't have any benzos so I wouldn't be able to use that as an adjunct to the Dexedrine. Why did you stop taking Dex/Sub/Kpin?

 

[pallidamors]

are there any chemicals that do increase opiod metabolism?

Plenty. Pretty much any CYP2D6 or CYP3A4 inducer. Those are the enzymes which metabolize most opiates, so inducing the enzyme would speed up the metabolic rate.

My main issue and worry is that the d-amphetamine will speed up my metabolism/produce mild hyperthermia which will make me 'sweat'/'burn' out my methadone dose faster than normal. I do know that there aren't any pharmacokinetic interactions between methadone and d-amphetamine, as d-amphetamine is mainly metabolised by CYP2D6, while methadone is a substrate of CYP3A4 and CYP2B6 mainly while mildly inhibiting CYP3A4. So no interaction there, although I am a bit worried that the increased stimulation from the d-amphetamine will 'burn' my dose of methadone faster than usual.

You're equating cardiac and respiratory stimulation with enzyme induction, which is a fallacy. A faster heart rate is not going to make your liver work any harder.

 

[splenda]

You're equating cardiac and respiratory stimulation with enzyme induction, which is a fallacy. A faster heart rate is not going to make your liver work any harder.

Uh, no. The only reason I listed the CYP450 pathways of metabolism for both drugs is to point out that they have no CYP450 interactions, that's all. I'm not linking the CYP450 enzymatic system to 'increased cardiovascular output.' You're reading things wrong/linking things together that I did not link together.

I'm simply wondering, CYP450 enzymatic system ASIDE, if d-amphetamine will 'burn' my methadone dose faster because of d-amphetamine's thermogenic and stimulant properties.

 

[pallidamors]

I don't see what thermogenesis would have to do with methadone, but maybe I'm misunderstanding you.

Are you asking if methadone would be metabolized faster since your elevated heart rate, etc. would be pumping the methadone to and from your brain faster, thus delivering it to the liver and kidneys more quickly? Or are you asking if not as much of it would be stored in fat because of the amph's thermogenic properties?

If that's what your asking, I still think the half-life limiting factor with methadone is largely due to hepatic metabolism, and less so because of storage in fatty tissue. That's not to say that the stimulants wouldnt have an effect on how long the methadone lasts, I just think that the difference would be so small as to be negligible.

 

[Cane2theLeft]

Uh, no. The only reason I listed the CYP450 pathways of metabolism for both drugs is to point out that they have no CYP450 interactions, that's all. I'm not linking the CYP450 enzymatic system to 'increased cardiovascular output.' You're reading things wrong/linking things together that I did not link together.

I'm simply wondering, CYP450 enzymatic system ASIDE, if d-amphetamine will 'burn' my methadone dose faster because of d-amphetamine's thermogenic and stimulant properties.

The metabolism of the drug is mediated by the enzymes you guys were discussing so you can't put them aside AND talk about the metabolism. If the enzymes that metabolize the two drugs don't affect each other, I don't see how d-amp will affect methadone clearance.

I'm not sure I fully understand what the last part means. Simply because d-amp is a stimulant won't have any affect on methadone clearance and I don't know what thermogenesis has to do with it.

 

[splenda]

The metabolism of the drug is mediated by the enzymes you guys were discussing so you can't put them aside AND talk about the metabolism. If the enzymes that metabolize the two drugs don't affect each other, I don't see how d-amp will affect methadone clearance.

I'm not sure I fully understand what the last part means. Simply because d-amp is a stimulant won't have any affect on methadone clearance and I don't know what thermogenesis has to do with it.

There's more to drug pharmacokinetics than just the enzymatic system. Since methadone is mainly stored and retained in fat, thermogenesis from the d-amphetamine can alter this, along with the other stimulant properties of d-amphetamine.

Pallidamor kind of hit on the point I was trying to make, .

Thanks for the responses guys; if anyone has any more ideas and tips for dual pharmacotherapy with opioids (specifically methadone) and psychostimulants (d-amphetamine, methylphenidate, etc.), your response would be greatly appreciated .

 

[Cane2theLeft]

^you're right there is more to pharmacokinetics than just CYP450 monooxygenase system but I don't think there is anything that affects opioid metabolism anywhere near as substantially as it does.

If d-amp did affect metabolism of methadone to any clinically significant level, it would be indicated in the drug interactions listed between the two.

 

[splenda]

^you're right there is more to pharmacokinetics than just CYP450 monooxygenase system but I don't think there is anything that affects opioid metabolism anywhere near as substantially as it does.

If d-amp did affect metabolism of methadone to any clinically significant level, it would be indicated in the drug interactions listed between the two.

You're right about any significant interactions between the two would be listed and known but sometimes there are differing responses to medications that could cause interactions of iatrogenic origin specific to each drug therapy.

Although I don't expect any problems between the two. An interesting point, cocaine is known to cause an increase in opioid receptor density in the nervous system, which thereby causes opioids (including methadone) to be less effective, sending some people who mix cocaine with MMT into withdrawal. I'm wondering if this effect of increased opioid receptor density is specific to cocaine only? Thanks!

 

[Znegative]

I hear you man, I'm glad that wasn't the case with me. when I was on MMT my favorite thing in the world was shooting coke. however, if I skipped out on the clinic for a few days, I did find that coke made me horrible feeling

 

[WhistlingZoso]

I have permanent back issues that have put me in life-long pain mgmt, and I have to take 40mg of methadone + ~ 30mg oxycodone a day. I take 30mg dextroamps when they are available, and I am more than happy on those occasions because I know that my pain meds will do their job without making me nod off. I personally prefer the upside of things, so I really don't like the sleepiness associated with methadone.
I find that there is little to no reduction in the potency or duration even though I may experience thermogenic effects from the amps. In fact, the opposite seems to be the norm for me. On the days I take the dextro-amps, I actually have the potential to decrease my methadone intake for the day. I do try to avoid cannabis on those occasions because if I smoke, it sets off sketchy, anxiety episodes.
Coke seemed to produce the same results as the dextro-amps when dosing done/coke simultaneously.

I know this doesn't include any enzyme or metabolic break down info but it is first hand real world experience, so I hope it helps.

Peace!

 

[omegapoint]

Without any question from personal and SWIM and other SWIM experience:

AMPHETAMINES *HELP* (WHEN USED APPROPRIATELY) IN ***LOWERING*** OPIATE DOSES.

not cold turkey but titrating down or time-off/delaying...

Even METHYLONE works for Methadone and Tramadol chronic abuse withdrawl.

Amphetamines will decrease half-life (increase elimination) of opiates such as Methadone...

But they will POTENTIATE u-receptor binding at post-synaptic terminal etc.

IMHO.

Stronger, but not as long...

Yep???

The metabolism of the drug is mediated by the enzymes you guys were discussing so you can't put them aside AND talk about the metabolism. If the enzymes that metabolize the two drugs don't affect each other, I don't see how d-amp will affect methadone clearance.

I'm not sure I fully understand what the last part means. Simply because d-amp is a stimulant won't have any affect on methadone clearance and I don't know what thermogenesis has to do with it.

Indeed you can NOT separate these two enzymatic pathways etc but I do believe it will increase opiate sensitivity etc...

Looking solely at electronics here: --> ie: hepatic metab considered, but.... for example, the fact things like Li+ (in CO3 etc) takes away "high" but all NE/other parasymp systems still run as per normal d-amp use.

Does d-amp not potentiate Na+ action potential further/harder overall???

 

[Cane2theLeft]

^First you bumped an old, dead thread and then you posted three times in a row. Please edit your last post to add information if no one has posted after you (I merged all 3).

Do you have sources that show how and why "Amphetamines will decrease half-life (increase elimination) of opiates such as Methadone..."? I'd like to read more if you have sources and if not, its just your word.

Also, please don't use SWIM. No one uses swim here, it annoys a lot of people and does not provide any legal protection.

 

[muie]

Nothing wrong with bumping an old thread is there? I too feel the topic is important enough that this thread should be bumped!

Cane2theLeft - regarding sources the best & most accurate is you yourself!

I know that all drugs that involve CYP2D6 will decrease the effects (St. John's Wort, Phenobarbital, Amobarbital, etc) of methadone!

I'm on MMT, I take 105mg/day & have zero tolerance to stimulants. I took 60mg Vyvanse about 6-7hrs after my dose & I was pissing like a racehorse, sweating and most incredible I took a big shit 4-5 times that night. I take a shit once/1 time a day and that's with a LOT of effort, a lot of fiber in my diet along with dry figs, prunes, and even then its not guaranteed that I shit. This time I felt like I had no opiates in my system that I could shit so easily like I said 4-5 times huge shits over the course of the night. Pissed a lot also leading me to believe the increased metabolism greatly reduced my methadone levels.

I barely slept that night, I may have slept 2-3hrs of disrupted sleep & was feeling really much like I needed to dose. It was morning already so at 9am I drank 105mg, at 10am I fell asleep until 1pm and when I woke up I felt as if I had maybe half my methadone dose. This being b/c if was 12hr formulated and dextroamphetamine has a 10-12hr half life so even now, 3 days after taking the 60mg Vyvanse I still feel a decrease in my methadone levels.

I now have HARD PROOF that methadone's half life SIGNIFICANTLY decreases in the presence of amphetamines just like in the presence of phenobarbital or St. John's Wort except on top of the precipitated w/d you are also jittery & agitated making for even worse w/d. Better worded methadone greatly potentates amphetamine NOT the other way around!

D-amphetamine raises body temperature and methadone increases sweating therefore I assume it too raises body temperature.

When I took my methadone dose next day still having amphetamines in my system I hardly felt the sedating/relaxing effects I feel.

p.s. The amount of times I took a shit in one evening after taking 60mg Vyvanse is more than enough evidence to suggest the quick elimination of methadone from my system PERIOD!!!!!!

 

[Snakevillon]

I always notice when I take adderal that whatever opiate I'm on that day (subs or dope) will wear off sooner like when I dose my 1 mg sub it keeps wd symptoms away for 14 hours and same with dope but when I take amps too I go into wd s a few hours earlier everytime so it's not a chance occurrence it happens everytime