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Unread 02-05-2011, 11:40 PM   #1
erikanh80
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Default Tramadol & Sub (pls read all b4 answering!!)

Hi everyone.......I know there was a thread months ago regarding this subject, however I searched & searched all over & cannot find it.

I'm very aware that people don't recommend Tramadol in general for addicts, as it can be addictive to some who take it.

I saw a Rheumatologist D.O. yesterday..........[I have had chronic pain issues for 2 years in my lower extremeties.....I have 4 diagnosis just for my knees which is severly painful, but had the other issues still not diagnosed as of yet. ] So I went to him for that. He believes I have Rheumatoid Arthritis & prescribed me Mobic....which is an NSAID for arthritis...its suppose to help with pain, inflammation & stiffness. He wanted to give me additonal pain help. He asked me if Ive taken anything else that worked. I said yes Percocet, (my DOC), but that I would like to know more about pain medications that are NOT opiates but also NOT over the counter. So I asked for something in the middle of that scale & he said "yes of course there's Tramadol."
(I took Tramadol 1 time about 1 year ago.....it was definately not something I enjoyed in any way, and I only tried it to try it, not to see if it helped my pain and I don't remember if it did or not.)
He said its fine that I didn't want to take it every day.....but that I should definately take it when I have a bad day that my pain is sever & flares up. He did make it clear that it was not the same as traditional Opiates....perc, vics, etc, which is why he was giving it to me.

Between me making it clear I didn't want an opiate & him seeing my rx's....I'm assuming that it is okay to take it while on Suboxone???? I'm not looking for advice regarding its addictable-qualities....I just want to know if it SAFELY can be taken together without a major interaction. I ask because I went on drugs.com to use the "interactions checker" and I checked Sub & Tram, and it said Moderate-Severe for interactions..........HOWEVER...it also says that when you check Percocet with just about anything imagineable.
So is this Okay? Has ANYONE actually taken them together & it was ok???????????

I don't plan on taking it at all...unless absolutely necessary. My knee has given out on me 3 times in my house, and its excrucuatingly painful......I'm worried if it happens again that Ill have to go back to the ER, and they'll give me Percocet like they normally would, and I DON'T WANT THAT TO HAPPEN! So if this IS ok, I just want peace of mind knowing so!!!! Thanks a bunch
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Unread 02-06-2011, 01:47 AM   #2
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Erica,
Sorry am not good at finding old post, but think I remember a few post over the years of people going on suboxone to get off tramadol. I can't remember if they had to do the traditional withdrawl first, but I thinks so. If so that would make me wonder if taking tramadol and then taking suboxone would cause percipitated withdrawl. We can deal with side effects, although not always pleasant, but I don't think percipitated withdrawl is a side effect that anyone would want to deal with. So I guess I am not answering your question, but am asking another myself. I am sure someone here will have an answer for you.

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Unread 02-06-2011, 07:37 AM   #3
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Hi Erika, here's a fairly recent thread on tramadol.

http://www.addictionsurvivors.org/vb...ad.php?t=25593

We've seen some people get pain relief from it and others not. In that thread, mlk_2900 had a disturbing experience with it, but she was down to 2mg or less which may have a lot to do with it. If your doctor offered you percocet, he most likely didn't read that you were taking Suboxone or doesn't know what it is. I wonder if he knew about the Suboxone either way (that you're taking it or what it is) if he would have prescribed the tramadol. But then again, there are many doctors who don't know about the addictive qualities because of the marketing of it as a non-narcotic pain reliever...

The one thing that is worrisome - as vhappy spoke about - is feeling any type of withdrawal symptoms after taking the tramadol and then taking Suboxone - as the buprenorphine would knock any of the tramadol off of the mu receptors. People who become addicted to tramadol do have to wait for mild to moderate withdrawals when starting transitioning from tramadol to Suboxone.

Have you tried breaking up your Suboxone into smaller doses every 4 to 6 hours to see if that helps with pain?

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Unread 02-06-2011, 08:19 AM   #4
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I said yes Percocet, (my DOC), but that I would like to know more about pain medications that are NOT opiates but also NOT over the counter.

Hi Erika, I copied this from your message. I am just curious and possibly playing the devil's advocate.... Why didn't you remind your doctor that you are on Suboxone for addiction to the Percocet?

I had to write as this just struck such a cord..... In years gone by, I was horribly addicted to Tramadol. I used it when I couldn't get my DOC as it staved off withdrawal and was easy to buy without a prescription.... It is a crazy, addictive drug and in my opionion not that great of a pain killer..... But I know that everyone is different. I found that Tramadol was more painful of a drug to come off of than Fentanyl, Percocet, and Vicodan combined as far as withdrawal symptoms go. The horrible restless legs was just AWFUL.and the sleepless nights, and it also went on FOREVER, I am talking weeks! The only way to solve the problem would be to get my DOC. LOL....... I would think long and hard before taking Tramadol....

But then there is the question.... What does one take for pain? I sit here right now with horrible back pain from shoveling the never ending snow and wonder why the scientists can't come up with something to help with pain that isn't addictive!!!!!! Really, it is nuts! I feel for you and hope you find something that works for you. Best, FAD

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Unread 02-06-2011, 09:07 AM   #5
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Erika,
Tramadol has more of an antidepressant quality to it (rather than pain control) when one is on Sub. SO I was wondering if you've ever tried Toridol? It's non-narcotic as well and kicks butt! Just thought I'd throw that in there. Sorry I couldn't answer your question but in case you cannot take the tramadol maybe look into that. Deanna (in Deanna's taper thread) talked about using Toridol after her very serious surgery and how well it worked. I also opt for Toridol because it works so good. I've taken Tramadol for pain and it doesn't do much more than an Ibuprofen would do JMHO.
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Unread 02-06-2011, 09:47 AM   #6
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Hi Erika,
Sorry, I just realized that I didn't put the most important fact in my post and why I really wanted to respond! AGH...... The day that I started Suboxone I had taken a Tramadol that morning..... It didn't have any effect on my induction...... However, I realize that each person is different and you should definitely consult your physician.

Cheers, FAD
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Unread 02-06-2011, 04:57 PM   #7
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Quote:
Originally Posted by FAD View Post
Hi Erika, I copied this from your message. I am just curious and possibly playing the devil's advocate.... Why didn't you remind your doctor that you are on Suboxone for addiction to the Percocet?

He had on the screen, my list of medications, which he did look at, and Suboxone was on there........I know its on there, because all the systems are linked for all Doctors affiliated with that hospital...meaning he can access all the same records from my regualr doctor b/c its the same company/affiliation. I also made it very clear that I didn't want percocet, nor did I want anything that was an opitae. So thats why I am confused if its good or bad to take WITH sub......because he said that it was NOT an opiate. Yet on drugs.com it said not recommended to take together...so I'm just confused. I would've asked him this, but didn't think of it til I got home & remembered I saw a earlier thread about this issue before. Thanks Fad.....its good to know it did NOT cause a problem to take together for you! I understand some have had addiction proeblems with Tramadol alone......I'm not looking to take it alone as a drug or pain reliever......I am on Suboxone and plan to stay on it......I'm more wondering if it could be taken WITH suboxone, without a serious side effect!!!! Like trouble breathing.....withdrawal symptoms....etc And even with that...it would be a once in a while thing, and he didn't say he was putting me on it for good.....just for 1 month until we get my RA blood tests back. If I have RA, then he will be giving me other meds & hopefully I won't need to worry about it!!! Im not planning on taking it anyway...unless something happens or I have a really painful day.....luckily Ive learned to deal with it but some days are just so bad for me......very hard when I stay home w/ my 2 year old all day & have to run after him!!

Nancy: Yes Ive done the splitting up of my sub doses, and I get no pain relief at all. I see some people do, but I never have. With the 4 problems of my knees and now maybe the RA, I have days that its very very painful, to the point of not being able to walk. I have dealt with it while on sub......not taking anything for the pain except otc stuff.......however its getting to the point where I really do need something. The Dr didn't "offer" percocet, but I believe he was eluding to the fact that he would give it to me if it helped......you're right it doesnt make sense he would think of it......unless he really didn't read my info & saw I was on the sub.

My biggest concern besides if they CAN be taken TOGETHER....was the issue of the precipitated withdrawal symptoms. I absolutely don't want that to happen!!! So I'm glad a few people did address that on here as a possibility......I just wish I knew for a fact....if it would do that, rather than speculation. I will definately NOT take any before I know more about what will/could happen. I am hopeful that the Mobic will be enough to manage my pain, in the 2 weeks it says it takes to work 100%. I hope it is. I refuse, and am totally committed to never touching an opiate again........I just want to make sure that this would be an okay option FOR pain for someone ON suboxone. I know he knew I was on it.....but I think he didn't want to bring it up, maybe he knew it might be a sensitive subject. He did say...."Tramadol is not an opiate....its similar...its great at relieveing pain, and 97% of users find it to be NON-Addicting". So he did point that out, so it seems he thought it'd be okay to take.

I just know some doc have given other people meds that HAVE contraindicated with sub.....and I don't want to take that chance. Anyone else who has actually taken it together....Id love to hear the experience. I will not touch it before I know more facts! I promise!!!!

james: thanks for the suggestion, I will look into that, I appreciate it. Ive never heard of Toradol......what is it exactly? What do you take it for?

VHAPPY: Thanks! No I don't the withdrawal if that IS a side effect.....I'd like to know if it is or isn;t....can't get that fact...however fad just replied he took them together and had no problem......idk....I will avoid till I see more experiences.....don't want to suffer when Im looking for RELIEF!!
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Unread 02-06-2011, 05:02 PM   #8
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Found this on another forum..........what do you think?? I wish it was a clear cut thing....yes you can, no you can't. Just want to know if it will cause interactions!!! I don't want to stop breathing or pass out or have withdrawal!! sigh.....lol

"I have been addicted to opiates for 7 years now. Because of my addictions I decided to try Suboxone (buprenorphine and naloxone) to help me with my addiction. It has been a lifesaver! I no longer have the overwhelming desire to use opiates on daily basis.

However, I have tried to take painkillers like oxycodone and kratom with very little results while on suboxone. I have found a substance that does seem to work while taking suboxone and that is tramadol. For some reason the suboxone does not block the tramadol from working. The high I get from the combination of the two drugs is quite euphoric! I take 8mgs of suboxone in the morning at about 9:00 followed by 200mgs of tramadol 30 minutes later. One hour later I am in heaven! The two drugs seem to work so well together. "

PS: Im not looking for "heaven, lol.....just pain relief! That would be great.

Last edited by erikanh80; 02-06-2011 at 05:08 PM..
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Unread 02-06-2011, 05:24 PM   #9
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I wish I hadn't abused Tramadol so I could take it with the Sub. But I was one of those who took a bunch of Norco's, Soma's, and Tramadol's daily to satisfy my addiction.

If you can take it the way it's prescribed, more power to ya!

Unfortunately it's not for me.

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Unread 02-06-2011, 05:46 PM   #10
erikanh80
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Abby, thanks. Did you find tramadol helpful for moderate-sever pain thought? And did you ever take them at the same time? Good you got off of them....I have read people who tram was actually their doc. Percs were mine, and I tried Tram once and for me it was nothing compared to percs....so that mixed with my total dedication and effort to being siber.....Im not worried so much about being addicted. I will never let myself take them every day.....I just want to know if I need it I can take it....and not be sick from it. Thx for sharing your experience...
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Unread 02-06-2011, 06:12 PM   #11
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I have taken them together and had no effects...no pain relief either.:
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Unread 02-07-2011, 12:12 AM   #12
erikanh80
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Default need translation, lol

So Ive been searching all night online & found an explanation of just WHY Tramadol does not cause precipitated withdrawal while on sub....as other opiates would do. So here is the explanation I copied.
Its all jibberish to me, but I know some people on here might understand this medical jargin....so if you can make sense of it & translate for me.....I'd appreciate it!!!! Just want comfort in knowing I can take it in an emergency pain situation....without getting sick. Thanks.

Tramadol is a very unique opioid in that in addition to its traditional u-opioid agonism (where it is a very weak agonist), it is an SNRI. Its pharmacological significance is manifested by its main metabolite, which is the CYP2D6 O-demethylated product called M1. M1 has about 200 times the u-opioid agonism of tramadol and so is still a rather weak opioid, with u-agonism of about 1/30 of morphine. Tramadol's analgesic (or more correctly, pain-killing) ability reside in a synergism between weak opioid receptor agonism, and weak serotonin and norepinephrine reuptake inhibition. Norepinephrine signalling has been implicated in relieving neuropathic pain and severe pain that is often unaffected by traditional u-opioid agonists. Tramadol's recreational use resides also in a synergism between these three systems. The SNRI activity of tramadol takes place very rapidly and can produce a mild euphoria, though more commonly a pleasantness or mildness of manner, a mood-brightening effect.
The reason that tramadol can be used concommittantly with buprenorphine is that buprenorphine WILL antagonize tramadol's opioid activity, but will have no effect on its SNRI activity, except possibly to slow the degradation of M1 via enzymatic inhibition. Since little or at least only some of tramadol's pharmacological activity is in its opioid agonism, buprenorphine will only antagonize some or little of its effects and will unlikely cause precipitated withdrawal, especially because buprenorphine itself has far stronger u-agonism than tramadol or M1.
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Unread 02-07-2011, 07:07 AM   #13
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Hi Erika, if you do decide to take the tramadol, time it so that you're not taking your Suboxone until at least 7 hours later as the halflife seems to be 5 to 7 hours. The statement above I think is saying that it seems to act less on the mu receptors but more on the serotonin and norepinephrine. So if you're taking any antidepressants or St. John's Wort, you want to be careful.

You may want to read this, especially the side effects:
http://www.nlm.nih.gov/medlineplus/d...s/a695011.html

Willard had a difficult time with tramadol recently:
http://www.addictionsurvivors.org/vb...ad.php?t=25676

Toradol can be a good pain reliever but can't be used for more than 5 days in a row. Here's a good link on it:
http://www.nlm.nih.gov/medlineplus/d...s/a693001.html

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Unread 02-07-2011, 06:19 PM   #14
erikanh80
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Thank you so much Nancy. This is all very helpful for me!!!

In the event that I ever NEED it,,.....I will definately be sure to follow that advice, so I appreciate you taking the time to let me know, it sure does make a lot of sense. And I don't take antidepressants, but thanks so much for telling me....and anyone who else that does & has thought of Tramadol, so they know it could be harmful.

I also read the same about the Toradol.....which seems that since it is only suppose to be used for less than a week consecutively....that it would also be a good option as "emergency" pain relief, for people like me who may experience a couple days a month, where the pain has a sever flare-up, since it wouldn't be consecutive.

Thanks everyone who took the time to reply. I appreciate it. For now I will steer clear of it completely, unless I have a day that is truly unbearable. Your replies have helped.
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Unread 02-09-2011, 04:02 PM   #15
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Hi everyone...just wanted to update this topic....

I went to my sub doctor last night for my monthly appointment.

I told him I saw a rheumatologist, who put me on Mobic & Tramadol.
My sub Doctor said those were both fine to take with suboxone......he said that he would not take more than 3-4 Tramadol per day though. So that would be a 200mg maximum per day of Tramadol for someone on suboxone.

I couldn't imagine even taking 3 or 4, but he said that would be okay on a bad day, if I took it every 6 hours for pain....hence 4 in a 24hr period.

So just wanted to share that. He didn't see it as a problem......he was very glad that I'm being active in treating my chronic pain seriously....as he said its crucial to resolve pain issues before getting off of sub completely. He said I'm doing very good several times which made me feel on top of the world.....and since all my tapers have gone well....I decided to try tapering down by 4mg this month instead of the usual 2mg taper. He was very pleased that I feel so great, and have tapered with no problems or issues. He said at this rate...if all goes well this month....then next month I can taper by 4mg again...and I'll be off in a few months! He said I'm such a different person than my induction visit just 4 short months ago.....and I can tell I am as well. I feel great and Im happy to finally resolve my pain conditions....and with the help of all my Doctors being aware of what I'm taking, so that I know I am doing something that is okay. Thx everyone for your responses!
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Unread 02-09-2011, 08:08 PM   #16
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It doesn't seem like your doctor knows much about Suboxone. I'm talking about the Tramadol prescribing doctor, not your Sub one. He should of looked into any interactions and made you aware. Bupenorphine is much stronger than what is in Tramadol. Depending on your dosage of Suboxone, even if you were on only 2mg, I really doubt you will receive any pain releif from the Tramadol. Mainly due to your tolerance to bupenorphine but also due to the fact the bup occupies the opiate receptors in the brain and usually won't allow other opiates in. So unless you stop the Suboxone, or decrease to a very minimal dose, I doubt you will find pain relief.

I know this can be a very tricky line for addicts and pain sufferers to cross. I am an RN, so I have some knowledge in this. I believe that someone in pain deserves to get pain relief regardless if they are an addict of not. But it can come down to moral issues within the addict to decide if this is right for them or if it is just to risky.

But back to your main question, no bad interactions should occur. It is possible the Tramadol could potentially put you into withdrawels from being on Suboxone, but the chances are slim. Just be aware. And also, any side effects from opiates (bupe and tramadol included) will be increased. As in constipation, headaches, dry mouth, ect of what your side effects you already have will be increased.

And be aware, an opiate is an opiate, regardless of how strong, regardless of its full or partial antagonist or agonist effects, and all can become habit forming, physically and mentally. Even if you aren't using them to get high, you stay on Tramadol for pain, and your body will eventually develop a tolerance. I think you need to find a better doctor who is more educated in pain management and addiction. Good luck.

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Unread 02-09-2011, 11:44 PM   #17
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Thx Stephers310

I don't know if you saw my update, but i went to the sub dr yesterday and he wasn't concenred that i was given tramadol. He also did question if i would find relief in general...as he said some do and others find it the same as ibuprofen pain relief. But as for withdrawal or other interactions, he said the 2 together will not cause any harm. Luckily....the Mobic I was given is providing FANTASTIC pain relief and Im very pleased with it, so don't feel the need to bother trying to tramadol! Very happy about this!!

Either way....I won't be taking it on a daily basis. I was given it just for 1 month supply, in case I have a real bad day from now until my bloddwork comes in to confirm the RA. That dr did say that if it was RA, he would changing me to plaquinil which would take care of the pain, and he wouldn't keep me on the tram, so it was kind of an "interrim" kind of thing.

I was worried the most about precipitated withdrawal, however my sub doctor confirmed yesterday that it wouldn't happen with tramadol....because it has a slightly different affect on the same receptors sub works on....making it that it wouldn't cause exactly the same affect as in the case if i took a percocet.
(I copied an explanation of how its different up in the thread) So that made me at least not nervous anymore. I haven't taken it yet, but will keep it around just in case i do have an unexpected, unmanageable day.

Its great to hear you say that addict or not one should def be taken seriously with pain treatment & I agree. I think it should be decided on a case by case basis of course. I think the sub dr & pcp or any specialist should always be in synch with the patients information. That doesn't always happen or is possible due to patients being able to share what they want & what they don't want to! I think because my addiction was just under 1 year, and the fact that I've successfully tapered every month since induction, with no failed urine tests, etc...having no other diseases with meds...ex: depression, anxiety, etc....I think all of that made them both feel I would be capable of being responsible with the tram, as I have. I feel good that they trusted me, and that I can show they were right in doing that, as I havent taken any and don't plan on it....after having this Mobic work so well!!

Anyway thx for chatting Erika

oh ps: that was just a rheumatologist that i saw....my regular pcp doctor is great & ran a detox clinic for 20+years. so don't worry, this was just a one-time visit & interrum script until we have the diagnosis. after that ill be dealing with my pcp again.
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Unread 03-07-2011, 04:17 PM   #18
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Hey I just wanted to let you know that I take subs and tramadol. I have horrible lower back problems from a staph infection that infected my spine after a back surgery and left a huge mess. So I know all about pain! I have had no issues with taking them together, but I recommend being very careful. I am on a low dose because I didnt want this medication to effect my recovery. It doesnt keep me completely comfortable but it definatley takes the edge off. So if your having a bad day you are fine to take it. Just be careful! and Good Luck!
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Unread 03-19-2011, 09:59 PM   #19
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This seems to sum up that as recovering addicts medications and street drugs affect each of us in a different way. So what I get from this is that it's great to get input from several different people to educate ourselves but not to take any one persons advice as gospel. Your Dr.(s), your support group(therapist?),and finally your conscience are the decision makers. My advice/opinion is that if you feel convictions in your spirit that it's the right or the wrong thing to do...........then............you already have your answer. rt
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