Opioids Trouble with Opioids and Bupropion

[WellTram]

Hello.
I would like to know if anybody can explain the difference in effects between tramadol ir and dihydrocodeine sustained release. I have been taking tramadol for ocular pain and also anxiety but 29 days ago i was prescribed Wellbutrin 150mg SR and it absolutelly diminished tramadol effects, only effect left was that my pupils were LARGE like on huge dose of meth after taking bupropion and tramadol together. So my doctor chaged me to dihydrocodeine but didnt give me any advice on dosing. I hope that my Wellbutrin wont ruin DHC effects too..Was taking 150-300mg tram daily. Thanks for information and advice.

 

[Lifee]

Tramadol is a mixed ssri/snri iirc so taking tramadol with bupropion would most likely yield some strange affects nevertheless. I’m pretty sure you are putting yourself at risk of Serotonin syndrome with that combo. DHC is different than tramadol so there is that! Gl mate

 

[ColoradoBoy90]

Hello.
I would like to know if anybody can explain the difference in effects between tramadol ir and dihydrocodeine sustained release. I have been taking tramadol for ocular pain and also anxiety but 29 days ago i was prescribed Wellbutrin 150mg SR and it absolutelly diminished tramadol effects, only effect left was that my pupils were LARGE like on huge dose of meth after taking bupropion and tramadol together. So my doctor chaged me to dihydrocodeine but didnt give me any advice on dosing. I hope that my Wellbutrin wont ruin DHC effects too..Was taking 150-300mg tram daily. Thanks for information and advice.

Wellbutrin will weaken Tramadol quite a bit. There is no way around it. As Bupropion is a strong inhibitor of CYP2D6. This means it will heavily weaken Tramadol, as Tramadol is a considered by some a pro-drug. Basically Tramadol itself is a very weak pain reliever. It needs to be converted into its stronger form through CYP2D6.
As Tramadol has some pain relieving effects / weak opioid action. Its main effects though come once Tramadol is metabolized in the liver through the CYP2D6 enzyme. Then it converts into Desmetramadol, which is a more potent pain reliever (more potent opioid effects thus more potent pain reliever)
which is where Tramadol gets most of its pain relief effects from. Although I cannot seem to find a source that states how much stronger it is. They just say ?it is more potent?
I remember once reading it was roughly 6 times stronger. So whether its metabolites are 6X stronger or 2X stronger, either way it isn?t good for Tramadol. Anything that inhibits CYP2D6 will weaken Tramadol significantly, and Wellbutrin is an inhibitor of said enzyme.

As for dihydrocodeine, when looking on Google it shows that it also is metabolized by CYP2D6. Although it is not as dependent on it as Tramadol is, at least it seems. One study said that any CYP2D6 inhibitor (such as Wellbutrin) did make levels of dihydrocodeines stronger metabolites (as it also converts into stronger metabolites) about 3-4 fold less. Which is a lot and would weaken its effects. So it also will be weakened by the Wellbutrin, probably not as badly as Tramadol though. But the same study stated that pain relief from patients where mixed and some experienced the same pain relief even if on a CYP2D6 inhibitor, but not all.

 

[Hodor]

Basically, what Coloradoboy90 said...

Tramadol itself is a weak opioid, and a strong inhibitor of serotonin and noradrenaline.
O-Desmethyltramadol is a moderately potent opioid, as well as a noradrenaline reuptake inhibitor, with little effect on serotonin.
Bupropion and tramadol compete for the same liver enzyme, CYP2D6.

So while your liver enzymes are busy trying to chew up the bupropion, you get significantly increased levels of unmetabolized tramadol and decreased levels of the O-desmethyl metabolite, and thus higher serotonin levels and less opioid receptor activation.

 

[WellTram]

Sorry for opening one year old thread but I find important to say that DHC worked as good on Wellbutrin as without Wellbutrin so it is probably not affected ( or very very slightly ) by cyp2d6 inhibition. Right now I am back on tramadol because I no longer take Wellbutrin and my gp refuse to prescribe dhc anymore cause she thinks it's some kind of superstrong opiate. It was actually safer than tramadol, which induced 2 seizures with almost fatal consequences in doses about 700mg ( but I was also wding from alprazolam ).

 

[tarman]

I'm glad you dug it up. Thanks for the update.

Tramadol is so weird.