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 Post subject: Suboxone for Tramadol
PostPosted: Tue Nov 15, 2011 2:49 pm 
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Hello. I am brand new on Suboxone and am in desperate need of HELP.
I was taking Tramadol, thirty to thirty-five, 50mg tablets daily for the past 7 months.
The physical withdrawals were so bad when trying to quit that I tried everything I could think of to get through it....with no luck.
I began taking Suboxone film this past Sunday and have been living inside a real life nightmare ever since. I am PRAYING someone on here can help by letting me know what the heck is happening??
My doctor started me off with two, 8mg strips daily. Since I am having difficulty even thinking right now, I am going to try my best to explain what is going on.
I had not had a Tramadol for 18 hours when I took my first Suboxone dose so I was in moderate withdrawals. After dosing, all I can say is it feels like my body is plugged in to an electric outlet. I am experiencing these body/brain zaps...it's the only way I can describe them! They are almost impossible to handle. My skin feels like it's burning on the inside, having sweats, major headaches, and MAJOR anxiety! I had to call in sick yesterday and again today.
My doctor did adjust my dose for this morning down to half a strip this morning and other half tonight so 8mg, rather than 16mg. Although my body is FREAKING out, the Suboxone must be working because yesterday at 16mg, my brain felt heavily sedated and I had difficulty staying awake. Plus, I am not experiencing muscle cramps, runny nose, diarrhea....the normal opiate w/d's. That is where I am so confused.....what am I experiencing?!?!
Since Tramadol is an SSRI as well as an opioid, could these horrible things I'm going through be serotonin w/d's?
I asked my doctor and he said he feels "helpless" as he does not know much about Tramadol and I am his first Tramadol addict to be prescribed Sub.
From everything I've been able to read on line, it sounds like I am in full serotonin w/d. Has ANYONE out there been placed on Sub due to Tramadol addiction? If so, has anyone gone through what I've described? Doctor basically said he wanted me to go to ER, but if this will pass then I'd much rather stay home.
I am sorry if this is difficult to understand...it's tough to focus. But, please, if anyone can shine some light for me, I would be forever grateful. I feel so terrible and am really getting scared. Any suggestions, please? Thank you so much


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PostPosted: Tue Nov 15, 2011 3:14 pm 
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That surely sounds like the kind of symptoms you can get when you quit taking an antidepressant, so I think you're on the right track with your theory.

Maybe you need an SSRI for a while?

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 Post subject: SSRI
PostPosted: Tue Nov 15, 2011 3:26 pm 
I'm in kind of the same place as your doctor as I've never been in that spot or seen anyone in this spot specifically. What I do know is, as you said, tramadol works in some ways that are similar to SSRI’s, which we all know, have a withdrawal syndrome of their own and can also in high doses cause serotinin toxicity. What you are describing really sounds to me like Suboxone is helping with the opioid withdrawals but is not touching the SSRI-like withdrawals/other stuff. I would say if you are in ANY position to do so, find a Dr. who had a better understanding of this. Are you on a SSRI right now? It's so hard for anyone but a doctor to decide if this is SSRI withdrawal that could benefit from a SSRI titration or serotonin syndrome that needs to be treated with a serotonin antagonist. The wrong answer could be fatal. I wouldn't do anything without a Dr. because of serotonin syndrome's potential to be deadly. But, my non-med school thinking is that an staying on Suboxone is going to be fine, but the other unknowns are going to have to be dealt with by a doctor who understands what is going on. Whatever you decide to do, keep posting, because like you're finding not many people in this situation have been able to find a comfortable way out.

-Travis


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PostPosted: Tue Nov 15, 2011 5:02 pm 
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Being a former Tramadol addict I know exactly what you are talking about. Because I was aware there would be an antidepressant withdrawal as well as an opiate withdrawal I was on a stable dose of Celexa before I went off the Tramadol. If you are not on an AD I would strongly suggest starting one. Some say that Effexor works in a way very similar to tram because it is an SNRI, but I have heard that Effexor also has a WD syndrome - although you could probably avoid the worst of it by slowly tapering off.
As far as the opiate WD, Tramadol is a weak opiate, especially compared to Suboxone, although 1500mg/day is a large dose. You might well be able to go down to a dose of as little as 4mg of Sub. However, if you are having cravings you will need to stay at the higher dose. Please work with your doctor on this. Because you have been on 16mg there is a lot in your system and it will take several days to really know how how the lower dose feels.
Please go to Dr. J's Suboxone talk zone (link at the top of this page) and search for Tramadol withdrawal. I remember there was a really informative post on it a while back. I think Dr. J actually doesn't recommend Suboxone for Tramadol, but there are many people on Sub because of that god awful drug.
Good luck and keep us posted on how you're doing,
Lilly


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PostPosted: Tue Nov 15, 2011 5:33 pm 
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Wow, first of all I have to say I'm rather confused about several things I just read in this thread. Thankfully, however, I used a shit-load of Tramadol myself so hopefully I can help a little bit with the origional question.

First of all, however, I'm confused by Lilly's post that says follow the link to Dr. J's Suboxone Talk Zone. --- Huh? Aren't we already there? At least I think we are - this is the Suboxone Talk Zone - no link needed. Am I wrong about that?

Then there is the comment about "serotonin syndrome's potential to be deadly" - again --- Huh? Is this true? Stopping a SSRI can be deadly? Really? I've just never heard of that - is it true?

So on those two I'm very confused. However, on your question of Tramadol withdrawal I can tell you that I was taking close to the amount you have been - although while not 30 to 35 a day, I was taking about 25 a day at one point. While I had a very significant withdrawal when inducting to Sub, I did not have anything like you are describing. I felt GREAT within a few hours of getting on Sub. In fact, in hindsight I very likely didn't need the full 8 mg Sub dose they gave me. It made me really tired and sort of "high". I say sort of as I felt SOMETHING but in no way the euphoria that I got early on from true opiates. This only happened with my first and second dose and never since that time - not once. Also, Tramadol IS NOT AN OPIATE. It is not scheduled like one is not classified as one - although it does act like one in some ways. I was actually sort of using Tramadol like Suboxone. That is to say, I didn't get high from it nor did I try - I just was able to stay off of "real" opiates by using Tramadol for nearly two years. I just had a friend who is trying to get off of Sub tell me that they were just prescribed Tramadol by their doc to help with the Sub withdrawals. I don't know what I think of that - although I'm skeptical.

So what's my bottom line here? I guess all I can tell you for sure is that speaking personally and from everything I've read, Sub should most certainly be able to treat your withdrawals. You may have some other issues going on but I would hope that you do have light at the end of this tunnel in that I am positive Sub will overcome withdrawal from Tramadol. I wish I could help you more, but at least you know that there is someone else out here that was able to go from Tramadol to Sub without really any trouble.


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PostPosted: Tue Nov 15, 2011 5:39 pm 
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I'm going to go against the flow here, and say it sounds like Tramadol precipitated withdrawal.

I've been through this, and every single symptom you described was exactly like moderate precipitated withdrawal. I'll just quickly describe to you what it felt like the times I a) Took Suboxone the same day as heroin. b) Took naltrexone while on methadone. I know the feeling of precipitated withdrawal all too well, unfortunately.

One way to describe it as an incredibly "jagged echo chamber lined with broken glass". It was like someone evil force had taken my body and put it into a torture chamber lined with nails, and thew a bucket of ice over my brain. My head started racing like I was on a bad batch of amphetamines, like I'd just guzzled 20 coffees, and my body was covered in pins & needles and electric zaps, and I felt nauseous, diarrhea, and really really cold. I punched the guy who convinced me it would be a good idea, which is out of character for me. Sounds extravagant, but it's true. Yuck.

Everything you're describing could just be precipitated withdrawal, and I have been through bad SNRI withdrawal as well. IMO, 18 hours is too soon to be put on Suboxone, especially after taking oral opioids. Also, 2 x 8mg strips is an incredibly large induction dose.

I'm no doctor, and I'm not suggesting I know more than your doctor. But regardless of whether it was precipitated withdrawal or SSRI withdrawal from tramadol, or a combination of both, your doctor hasn't done you any favours with your induction. IMO (and I'm no doctor, just someone with too much experience with painful stuff), the Suboxone managed to kick the remaining tramadol off your receptors, which precipitated Tramadol's unique SSRI/opiate withdrawal profile.


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 Post subject:
PostPosted: Tue Nov 15, 2011 6:20 pm 
donh wrote:
Then there is the comment about "serotonin syndrome's potential to be deadly" - again --- Huh? Is this true? Stopping a SSRI can be deadly? Really? I've just never heard of that - is it true?


It is true. Serotonin syndrome has nothing to do with stopping SSRI medications. Serotonin syndrome is caused by overdosing on serotonergenic compounds and, yes, can be a deadly condition. SSRI withdrawal which is, again, something different, isn't fatal so far as I know.

http://en.wikipedia.org/wiki/Serotonin_syndrome

Above is kind of a laymans reference for serotonin syndrome. It's a serious deal and hopefully not the case, but it's good be be aware of as the medication that was your DOC has been linked to this condition.

-Travis


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PostPosted: Tue Nov 15, 2011 6:26 pm 
donh wrote:
First of all, however, I'm confused by Lilly's post that says follow the link to Dr. J's Suboxone Talk Zone. --- Huh? Aren't we already there? At least I think we are - this is the Suboxone Talk Zone - no link needed. Am I wrong about that?


Oh, and this is Suboxforum.com which is part of Suboxonetalkzone.com, but not the same thing.

Travis


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 Post subject: Suboxone for Tramadol
PostPosted: Tue Nov 15, 2011 7:45 pm 
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Thank you to every single person that responded. I cannot even tell you how much it helps just to know you are out there right now.
When hearing that the Sub has been great for those of you that were using Tram, I feel a lot of hope, however it is so difficult to feel hopeful right now. Maybe I'm allergic? I feel so awful right now that it literally takes all my energy typing. I feel like I'm going to die.
Tearjerker, I wonder if you are right about the precipitated w/d? However, I definitely feel the Sub because my head feels really heavy, like I'm sedated and I'm super sleepy, yet my mind and body are FREAKING OUT. When w/d'ing from opiates, I've never felt sleepy, just the exact opposite. Plus, I do do not have diarrhea or aching muscles like I have with opiate w/d's before? This thing, I think, is worse. I've NEVER experienced anything like it. A lot of the things Tear described are things I can relate to. When I speak, it echos back in my head. (sounds crazy, but I do not know how else to describe?) I also now can't keep anything down if I try to eat. SO shaky too.
If it is precipitated w/d, what do I do? Do I keep taking the Sub again tomorrow? And when will it all stop?
My doc called today and said to just use half of one strip tomorrow. He tried to talk me in to going to the hospital to be checked for 24 hour observation, but I told him if it got worse I'd go. He said he just really does not know why I'm responding the way I am? I'm praying with all my heart it turns around and no matter what, I will not put anything else in my system. I want this to work so badly. Again, ty ty ty to all who took their time to respond. It is like having a life line out there. My family is very supportive, but never have been addicted to anything and as much as they try to understand....they don't, ya know? I'm going to go lay back down and pray for calming. (sorry if I'm all over the place....my thoughts are so scattered)


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 Post subject: curious
PostPosted: Wed Nov 16, 2011 1:01 am 
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I've always been curious about this drug. I ve heard of peeps that love this drug or hate this drug. the ones that love it take 30? pills a day....i always wondered how the hell someone would get so many tramadol...if i asked any of my old dealers for tramadol, they would die laughing at me. seriously, i hope everything works for you man, this is a drug i'm just learning about


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PostPosted: Wed Nov 16, 2011 2:41 am 
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When I had p/w on Suboxone, I did feel it slowly improve. The precipitated withdrawal with suboxone was weird, because while it was really painful at first, slowly the agonist effect of buprenorphine started to kick in and the withdrawal effects faded into a bit of a buprenorphine stone/sedation. It's weird, because for a while it almost felt like I had both at the same time.

What everyone here said about SSRI withdrawal from Tramadol could be equally on the money. There's a heap of other stuff going on with that drug I know little about that doesn't happen with other opioids. It all seems quite messy. When I was in rehab, there was a guy in there for tramadol addiction, and his withdrawals were really intense. I didn't understand it, because I thought it was one of the weaker opioids.

It's good you got in touch with your doc. Definitely take less Subox tomorrow, especially if you feel sedated. Also, buprenorphine is a bit of a mind-racey opioid anyway, at least for me. I can find it harder to sleep if I have a larger dose in the evening.

Also, the active metabolite of tramadol has a half life of 9 hours, and tramadol itself has a half life of 7 hours. By 18 hours you'd still have a fair bit floating around your system IMO.


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PostPosted: Wed Nov 16, 2011 12:05 pm 
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donh - it's a little confusing because they share the same name, this is the Suboxone Talk Zone forum, but if you press the third link from the left at the top of this page it will take you to Dr. J's blog, also entitled Suboxone Talk Zone. The article I was referring to is in the archives of that blog.

In Re: Tramadol - it is not scheduled as an opiate, but the m1 metabolite is a mu opiate receptor agonist. In other words, it is converted to an opiod in your liver. It's the biggest loophole in the book, which is why it can be extremely easy to obtain (and many doctors know about as much about is as they do about Sub :? ). But some folks are catching on and it has been scheduled in some states.
Interestingly, some say Tramadol is a placebo or "does nothing", and that is because some people lack the enzyme that metabolizes Tramadol to the active metabolite. It is one of the CYP3A enzymes, I believe.

I basically got hooked on Tramadol because I was using it as a substitute for opiates that I was having a harder and harder time obtaining. Like donh, I felt sort of buzzed when I first started taking Sub, but my doc encouraged me to do at least a year of maintenance because of my long drug history. I hindsight, though, I really feel that Sub is overkill for Tramadol, because it is so much stronger of an opiate, and raises one's tolerance considerably. On the other hand, it can give someone with a pill popping habit some time and space to deal with their addiction and triggers, and get their lives back in order before being totally drug free.

Also, in regards to using Tramadol to get off of Sub, more than one person has posted about using that approach and the results have not been good. Tramadol has a uniquely miserable WD syndrome ( I think I stole that quote from Dr. J), builds tolerance and acts as an SNRI. It also has a 36 hour half life. Any doc who thinks getting off of that is easier than getting of of Sub is sadly misinformed.


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PostPosted: Wed Nov 16, 2011 1:20 pm 
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Hi Lilly,

Since you know a lot about Tramadol I thought I would throw this question at you. If you do not possess the enzyme that turns tram into an agonist would you still have opiate withdrawl when discontinued? O realize the SNRI withdrawl would still be present but am curious if it still affects the my receptors if your body doesn't turn it into an opiate. Also if you do not possess the enzyme would it even do anything for someone in opiate withdrawl?

I have no intention what so ever to get back on Tramadol but am just curious. I understand you may not be able to answer these questions but figured if anyone could here it would be you. I hope you are feeling well and if not I hope you do soon!


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PostPosted: Wed Nov 16, 2011 8:15 pm 
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joyful wrote:
Hello. I am brand new on Suboxone and am in desperate need of HELP.
I was taking Tramadol, thirty to thirty-five, 50mg tablets daily for the past 7 months.
The physical withdrawals were so bad when trying to quit that I tried everything I could think of to get through it....with no luck.
I began taking Suboxone film this past Sunday and have been living inside a real life nightmare ever since. I am PRAYING someone on here can help by letting me know what the heck is happening??
My doctor started me off with two, 8mg strips daily. Since I am having difficulty even thinking right now, I am going to try my best to explain what is going on.
I had not had a Tramadol for 18 hours when I took my first Suboxone dose so I was in moderate withdrawals. After dosing, all I can say is it feels like my body is plugged in to an electric outlet. I am experiencing these body/brain zaps...it's the only way I can describe them! They are almost impossible to handle. My skin feels like it's burning on the inside, having sweats, major headaches, and MAJOR anxiety! I had to call in sick yesterday and again today.
My doctor did adjust my dose for this morning down to half a strip this morning and other half tonight so 8mg, rather than 16mg. Although my body is FREAKING out, the Suboxone must be working because yesterday at 16mg, my brain felt heavily sedated and I had difficulty staying awake. Plus, I am not experiencing muscle cramps, runny nose, diarrhea....the normal opiate w/d's. That is where I am so confused.....what am I experiencing?!?!
Since Tramadol is an SSRI as well as an opioid, could these horrible things I'm going through be serotonin w/d's?
I asked my doctor and he said he feels "helpless" as he does not know much about Tramadol and I am his first Tramadol addict to be prescribed Sub.
From everything I've been able to read on line, it sounds like I am in full serotonin w/d. Has ANYONE out there been placed on Sub due to Tramadol addiction? If so, has anyone gone through what I've described? Doctor basically said he wanted me to go to ER, but if this will pass then I'd much rather stay home.
I am sorry if this is difficult to understand...it's tough to focus. But, please, if anyone can shine some light for me, I would be forever grateful. I feel so terrible and am really getting scared. Any suggestions, please? Thank you so much



I was never on Tramadol or ssri just Vics or Loratab or a perc every now and then but mostly Vicodine. when i jumped off subs back in April,I thought i would go thru a regular whitdrawal i had the nauesa i didnt direah or vomit i was just burnning and bad anxiety had head zaps body zaps burnning feet i thought it would be over in a couple of weeks 7 monts later i still have the burnning head zaps and tingling in my body. my Dr. said i cant be going thru whithdrawal and prscribed me vicodine for the pain of the burn at first he gave me Tramadol then i found out it causes all this brain zapping i need answers too good luck


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PostPosted: Wed Nov 16, 2011 9:54 pm 
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Lillyval wrote:
I hindsight, though, I really feel that Sub is overkill for Tramadol, because it is so much stronger of an opiate, and raises one's tolerance considerably.


I'm with ya on that one. After seeing a couple of people who took Nurofen + occasionally get put on Suboxone and methadone, and end up on high doses, it's made me question whether it's always appropriate to use pharmacotherapy. These people are now severely dependent on opioids. If a person ends up with a greater tolerance to opioids after treatment, they only have to deal with stronger cravings if they choose to go off IMO, which is counterproductive.

Joyful, talk to your doc about what people said about SNRI withdrawal (ah sorry, "discontinuation syndrome"). It sounds like you're going through both, and SNRI withdrawal can be really unpleasant as well, comparable with opioid withdrawal. You gotta be tactful with your doc if you've realised he/she's made an error. Instead of placing any blame, or presenting a solution to your doc, I've found it better in the long run to not hurt a doctor's ego by suggesting we/you know better than they. It's better to drop suggestions, say you were told something by someone, and let your doc come to the solution themselves.


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PostPosted: Thu Nov 17, 2011 10:39 am 
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Breezy, in answer to your questions my GUESS would be No and No. However, Tramadol itself, before being metabolized has pain killing properties (unknown mechanism), so whether or not someone would have a withdrawal from that I don't know.


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