Posted by Elizabeth on January 30, 2002, at 5:49:59
In reply to Re: opioids » Elizabeth, posted by christophrejmc on January 25, 2002, at 1:01:58
Re pluses of buprenorphine:
> Thanks, although the last point is probably the only one that matters to me at this point.That's not surprising, but the others may be more important to your doctor!
> Mostly because of the formulation (my PDR [a bit dated -- 1996] lists Stadol as the only one that comes in a non-injectable form) but also because they are not prescribed as much.
It's true; all doctors (I'd hope) are familiar with MS Contin, whereas I've gotten some "huh?"s when I mentioned buprenorphine! Some of the slow-release formulations of some of the full agonists are longer-acting than buprenorphine. Duragesic, the fentanyl patch, is my favorite; it lasts three days, supposedly (some people find it doesn't last quite that long and need to change it every two days or so, one of the reasons I detest "one size fits all" dosing regimens). But there are good reasons to try buprenorphine before moving on to these drugs.
Say, how is the Nardil working for you? I presume you need help with residual symptoms (you don't seem "actively" depressed). That's been a chronic problem for me too; regular ADs help, but I have some symptoms that seem impervious to the standard psych drugs.
> I was going to try to get Stadol NS (Nasal Spray), but it seems like there are too few reasons not to try the "harder" opiates (Ultram doesn't seem to be very efficacious and I'm afraid of adding it to an MAOI [currently, I am taking Nardil]).
I've encountered a couple people who found that very high doses of Ultram worked even though it didn't do anything for them at the recommended doses. You're right that it shouldn't be taken with MAOIs, BTW; most other opioids are fine. (A notable exception is Demerol, but that would make a lousy AD anyway.)
> The only opioids I've used were Vicodin and codeine. I remember the Vicodin making me feel somewhat better (both physically and psychically), but codeine did absolutely nothing at moderate doses (for my mood or my nasal pain).
Codeine doesn't work for me either. I've learned recently (by way of a tricyclic serum level) that I may have a metabolic deficiency which would account for the lack of effect of codeine. (Nearly all of the analgesic effect of codeine is due to its metabolism into morphine; a deficiency in the enzyme that catalyzes this process -- which is also involved in the metabolism of TCAs -- generally makes codeine ineffective, at least at normal doses. This might be your problem as well, although it's hard to say for sure.)
> Yeah, but it sounds like the alternative routes are a pain in the ass.
I think that self-administering buprenorphine by IM injection would be easier to do in your arm rather than your ass (although both are viable sites)! :-)
-elizabeth
poster:Elizabeth
thread:4588
URL: http://www.dr-bob.org/babble/20020124/msgs/92155.html