Opioids Tapentadol (Nucynta) - De-addiction Guide

[kbsreeganesh]

I was prescribed Nucynta for C-spine spondylosis and chronic pain. I increased the dose gradually for the high it produced and am on 12 - 14 immediate release tablets per day. Nucynta ER is not available in India. Even though I don't get any High no more i cannot decrease the count. I am taking 2 divided doses in a gap of 4 hours in the morning. I also take Xanax 1.5mg and Zolpidem (20-30mg) at night. Now by evenings I get episodes of severe Rage and anger, unexplainable Hollowness in head, severe headaches, confusions, memory loss and confabulations. Tachycardia, Palpitations, Dry Mouth & sore throat, abdomen pain and Hyperalgesia are also present. De addiction center is not an option since I have to take care of my Granny. Please guide me how to tapper and come off of it. Suboxone , Methadone are not available in India. I can get Buprenorphine Sub lingual tablets though. Plz Plz guide me to detox as well as get through withdrawal and get rid of these drugs from my system. I have a nurse who can administer IV fluids and Vitamin supplements if required to support (though Naloxone cannot be administered). Hope you will help me at the earliest...

 

[Rybee]

I was prescribed Nucynta for C-spine spondylosis and chronic pain. I increased the dose gradually for the high it produced and am on 12 - 14 immediate release tablets per day. Nucynta ER is not available in India. Even though I don't get any High no more i cannot decrease the count. I am taking 2 divided doses in a gap of 4 hours in the morning. I also take Xanax 1.5mg and Zolpidem (20-30mg) at night. Now by evenings I get episodes of severe Rage and anger, unexplainable Hollowness in head, severe headaches, confusions, memory loss and confabulations. Tachycardia, Palpitations, Dry Mouth & sore throat, abdomen pain and Hyperalgesia are also present. De addiction center is not an option since I have to take care of my Granny. Please guide me how to tapper and come off of it. Suboxone , Methadone are not available in India. I can get Buprenorphine Sub lingual tablets though. Plz Plz guide me to detox as well as get through withdrawal and get rid of these drugs from my system. I have a nurse who can administer IV fluids and Vitamin supplements if required to support (though Naloxone cannot be administered). Hope you will help me at the earliest...

mmm okay... think we need a little clarification:

I was prescribed Nucynta for C-spine spondylosis and chronic pain.

What dose were you prescribed to follow? IR/ER - mg/day - doses/day?

I am on 12 - 14 immediate release tablets per day.
Again, what dose?

Even though I don't get any High no more i cannot decrease the count.

What do you mean by 'decrease the count'?

I am taking 2 divided doses in a gap of 4 hours in the morning

Again, what dose?

I also take Xanax 1.5mg and Zolpidem (20-30mg) at night.

Every night, most nights, or PRN - and always 1.5mg Alprazolam and always 20-30m of Zolpidem?

Now by evenings I get episodes of severe Rage and anger, unexplainable Hollowness in head, severe headaches, confusions, memory loss and confabulations. Tachycardia, Palpitations, Dry Mouth & sore throat, abdomen pain and Hyperalgesia are also present.

From personal experience, that's not entirely surprising. Tapentadol/Nucynta/Palexia is often referred to as Tramadol's 'Big Brother'. Essentially, it is a centrally acting opioid analgesic of the Benzenoid class with a dual mode of action as an agonist of the μ-opioid receptor and as a norepinephrine reuptake inhibitor. It is for this reason, that users often find it much more 'stimulating' than 'typical Opiates' such as Morphine/Hydrocodone/Oxycodone/Hydromorphone/Oxymorphone/Fentanyl that don't posses such novel action and often leave patients feeling more on the drowsy/sedated side. When I suffered from depression I found Tramadol to be very helpful as it helped 'perk' me up and energise me a little bit more. When I later graduated from Fentanyl and Oxycodone to Tapentadol for my Spondylothesis it soon came back to me how just how stimulating I found it. So it's absolutely no surprise that you're feeling hyped up and suffering from a little emotional stability in the form of anger/rage/anxiety/nervousness with tachycardia and palpatations. It's most likely to be as a direct result of the Norepinephrine reuptake inhibition properties. Though compared to Tramadol, it does have less affect on levels of Serotonin.

De addiction center is not an option since I have to take care of my Granny. Please guide me how to tapper and come off of it. Suboxone , Methadone are not available in India. I can get Buprenorphine Sub lingual tablets though. Plz Plz guide me to detox as well as get through withdrawal and get rid of these drugs from my system. I have a nurse who can administer IV fluids and Vitamin supplements if required to support (though Naloxone cannot be administered). Hope you will help me at the earliest...

Again, when you can tell us what kind of doses you've been taking, how much (if any) more you are able to source then we can help you with a bit more of a taper plan.

Suboxone , Methadone are not available in India. I can get Buprenorphine Sub lingual tablets though. Plz Plz guide me to detox as well as get through withdrawal and get rid of these drugs from my system. I have a nurse who can administer IV fluids and Vitamin supplements if required to support (though Naloxone cannot be administered). Hope you will help me at the earliest...

Buprenorphine may be a possibility, but, as far as I'm aware, it doesn't have much Norepinephrine re-uptake inhibition so you may suffer acutely in the early stages of that. Not that I would recommend it, but why did you specifically mention that Naloxone cannot be administered?

Apart from the Tapentadol/Nucynta/Palexia, the Alprazolam/Xanax and the Zolpidem/Ambien - you need to be completely honest about whether you're taking anything else?

Please could you also give me a brief history as to your dosage, length of use, and reason(s) for using the Xanax/Ambien?

I hope this helps... just a little further information and I'm sure we can sort you out

 

[Sprayah14]

I'm quite sure that most of the symptoms you're experiencing, especially rage and anger is because you live in India....I wouldn't be happy living there either bud!

 

[Runtoparadise]

I feel for you. I just posted in another thread about how awful the effects of Tapentadol were for myself.

How long have you been on it, & do you still suffer from chronic pain? I see that you were prescribed them but don't ask about a substitute or seeing your doctor except to say you can get sub wafers.

What mg tablets are they? Obviously 12-14 50mgs is going to be much easier to come off of then the same number of 150mgs.

You cannot take suboxone until you've stopped taking the Tapentadol. So, you can taper by taking less each day until you're out, then jump off when you reach that point. (Whatever the mgs, it's not a monster sized addiction). It wouldn't be a huge jump.

Personally I don't think you need to use the subs unless you want to go the alternative way & flush the nucynta & wait 36 (iirc, someone cmiiw), hrs to start.

To my knowledge, spondylosis doesn't go away, so what do you intend to do about pain? Unless it's under control with prednisoline or another med. I don't think you'd know at this stage though as you're likely masking the pain.

Rtp

 

[i3069]

Are nucynta even worth using recreationally? I've never tried them but have access to some. Just curious if there's a buzz with them?

 

[Mad Dash]

I heard if you do a high enough dose yes, but 100 mg = 10 mg oxy.

 

[Runtoparadise]

Tapentadol is a weak opiate. If you're opi naive you possibly could, but the nasty SNRI effects cancel out any potential for abuse IMHO.

That's why OP has all the issues in the evenings,

Rtp

 

[kbsreeganesh]

I was prescribed Nucynta for C-spine spondylosis and chronic pain.

What dose were you prescribed to follow? IR/ER - mg/day - doses/day?

I was prescribed 50mg Immediate release tablets twice a day.

I am on 12 - 14 immediate release tablets per day.

Again, what dose?

I take 12 - 14 50 mg immediate release tablets 6 or 7 in the morning and then 6 or 7 tablets 4hrs later. In addition if I have the episodes of rage some times I take a whole strip(10 - 50mg tablets), break things and also hurt myself(hitting myself in the walls).

Even though I don't get any High no more i cannot decrease the count.

What do you mean by 'decrease the count'?

I am unable to decrease the number of tablets i take despite not getting high anymore. But I have real intention to decrease them.

I also take Xanax 1.5mg and Zolpidem (20-30mg) at night.

Every night, most nights, or PRN - and always 1.5mg Alprazolam and always 20-30m of Zolpidem?

Yes I take 3 0.5mg of Xanax and also 2 10 mg of Zolpidem along with it.

Suboxone , Methadone are not available in India. I can get Buprenorphine Sub lingual tablets though. Plz Plz guide me to detox as well as get through withdrawal and get rid of these drugs from my system. I have a nurse who can administer IV fluids and Vitamin supplements if required to support (though Naloxone cannot be administered). Hope you will help me at the earliest...

Buprenorphine may be a possibility, but, as far as I'm aware, it doesn't have much Norepinephrine re-uptake inhibition so you may suffer acutely in the early stages of that. Not that I would recommend it, but why did you specifically mention that Naloxone cannot be administered?

Buprenorphine can be bought OTC. Naloxone IV Injection cannot be bought easily. Since I read Naloxone is useful for Withdrawal I have specifically mentioned it.

Apart from the Tapentadol/Nucynta/Palexia, the Alprazolam/Xanax and the Zolpidem/Ambien - you need to be completely honest about whether you're taking anything else?

Some times I take Ketorolac(Ketanov) 10mg tablet for headache - May be once a week.

I dont take any other medicines. But I dont eat food properly ( Loss of appetite)

hope this is sufficient.

 

[kbsreeganesh]

How long have you been on it, & do you still suffer from chronic pain?

I was prescribed about 3 years back. I am overdosing from 1.5 yr only (increased gradually)

What mg tablets are they? Obviously 12-14 50mgs is going to be much easier to come off of then the same number of 150mgs.

I am taking 12-14 50mg immediate release tabs only

ou cannot take suboxone until you've stopped taking the Tapentadol

Suboxone is not available in India.

I have difficulty tapering, but main difficulty is because of the rages when i tend to put tablets with out rationality or thinking. I get these episodes almost daily nowadays.

Pain I can manage. i will be able to start exercises and alternative therapies. But the depression and other side effects are difficult to handle and I am afraid about my heart and now I have no stamina to walk as well.


So I need help

 

[Runtoparadise]

That's why you specifically mentioned naloxone,- as in that plus Buprenorphine equal suboxone?! That you can obtain the Bupe OTC, is that what you meant?

Surely your prescription is not indefinite? You'll run out early right, how do you handle that?

I have been & I am in a very similar situation, so I understand the urge to take more & more even though Im lucky to get two minutes of a buzz let alone any sort of high. I thankfully don't have the noradrenalin to accompany my opiate.

So, you are not alone kbs. Apart from myself, there's a number of BLs in your position & I'm sure plenty will be along to offer kind words, support & advice.

What I think is a wise plan, is to obtain an antidepressant, an SNRI not a SSRI. Absolutely do not touch it yet. Put it aside for later.

As you taper down, (we'll metaphorically hold your hand, BL is fantastic for support, & you'll make cyber friends too), keep in mind you're tapering off two drugs that your body is craving. Physically & psychologically.

I'm not sure exactly how to do this, (calling in antidepressant experts), but what I'm thinking is to taper off the Tapentadol in a way that you first wean off the opiod part while staying on a stable,- though lower than your current intake of noradrenalin.

That's where your safely tucked away box of an SNRI comes into play.

I've gotta run, but I'll post more shortly. Does any member dispute this idea? It randomly popped into my head, it's not like I've spent the day pondering over this. And/or know how to integrate as tapering?

Take care,

Rtp

 

[kbsreeganesh]

@Runtoparadise

I am sorry but I dont undersatnd you. what is your theory? can you eloborate..

What do u think would be the role of SNRIs???

Do u think it will help tapering the dose or is it for the withdrawal symptoms. Arent SNRIs difficult to stop?

 

[kbsreeganesh]

@ Rybee

Is the information I provided enough? If not please ask...

Once you have sorted out a plan. lemme know at the earliest

Thank you

 

[Runtoparadise]

Sorry, I was in a rush when I posted ystrdy. The role of the antidepressant containing noradrenalin, not a seratonin inhibitor, is to replace the drug in Tapentadol.

So that you don't have to withdraw from two substances at once. You're correct in saying antidepressants are difficult to come off of rapidly, so in tapering of Tapentadol you'll add in the SNRI as you lower your dose to make it a bit easier. Hopefully.

Off the top of my head I'm not sure of the ratio of opioid & noradrenalin, in Tapentadol. Or of at what stage of the taper you'd start the antidepressant, which is why I asked other members for ideas. Or even if it's feasible.

Does that make it a bit clearer? Coming off one drug at a time rather than two just seems like an obvious choice to me.

You didn't answer regarding that it sounds though you have an endless supply of your prescription. Do you get your script once a month? With the amount you're taking don't you run out early, how do you get this past your doctor (& pharmacist)?

Rtp

 

[kbsreeganesh]

I do get tapentadol, dont ask me how, But now I have a clear conscience to come out. I have tapered to two sets of 5*50 mg tablets and its the same for 3 weeks and I cannot bring it down any more. How to reduce further - Any Ideas?

 

[RDP89]

I'm quite sure that most of the symptoms you're experiencing, especially rage and anger is because you live in India....I wouldn't be happy living there either bud!

Least useful post ever......pretty ignorant though if that's what you were going for.

 

[kbsreeganesh]

any idea of the least dose of SNRI required?

 

[Runtoparadise]

You're still at this? I don't know what the ratio of SNRI is in 50mg Tapentadol tablets so can't advise you.

Perhaps use teh google and supplement from there.

Good luck.

Rtp

 

[kbsreeganesh]

what will be the best SNRI?

yeah I am on this still.. worse the dose has not decreased beyond 300mg twice daily sm times i take an additional 200 mg.

in between I had increased to 600mg twice daily from there drastic reduction of 50 mg per day in 2 weeks until 2 weeks ago after which ders no reduction

so I need a proper plan to taper tapentadol with the help of NRI and then taper the NRI

plz help

 

[tacodude]

I believe the herb St. John's Wort is a weak SNRI. It may be a useful herb to look into.

 

[Runtoparadise]

IMHO herbal supplements can vary so much in strength & quality depending on the price & vendor. OP seems to be able to obtain prescription meds just fine. I'd wait until you're down to 150mg Tapentadol minimum before starting a mid-range antidepressant dose of an SNRI.

The good news is that you're not taking massive doses. The bad news is tapentadol is a nasty drug & you've been using/abusing it for a long time.

Why can't you lower your dose further? Physical withdrawl or psychological cravings?

Another idea is to use codeine to do a rapid taper if that's available to you as it doesn't seem to be your drug of choice. Its a weaker again opioid & will ease physical wd symptoms while you taper.

Rtp