Starting Naltrexone After Tramadol And Adderall
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History - My brother has been on Tramadol for the past year or so, he has tapered the dose down slowly over the past 2 weeks to reduce withdrawal symptoms. He’s been tramadol free 2 nights now with some residual insomnia. The restless leg has finally resolved thankfully. He is also struggling with chronic daily drinking and wants to start the sinclair method / low dose naltrexone. He has been on Adderall for the past 13 years for ADD. For the past month, his current dose has been low at 7.5 to 15 mg per day, and some days he doesn't even take any. He plans on discontinuing that as well. How long after being Tramadol free can he start Naltrexone? And can he start it while on Adderall? Please, any advice or experience is appreciated. THANK YOU :)

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Re: David (# 2)

You’re wrong. I take adderall and pain medication. A speed ball is when both are administered intravenously at once. Many, many people get pain relief while they are treating ADD.

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Ten pounds is barely beyond the amount of water weight I lose at 240 lbs. I don%u2019t know what you are doing? Just get on the treadmill for an hour and watch what you eat. Even slightly adjusting exercise and diet will shed that weight. Sometimes we need pharma, otherwise a small change in daily activity will solve your issue. The later is much safer, better, and you get that pride that you did it!

10lbs hardly represents a health threat. I suggest you do not treat it as one.

-Casper

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Re: Mason (# 4)

Tramadol has a very weak affinity for Norep receptors. So weak it is not a true concern. While the facts may be truthful, it’s deceptive to say Tramadol is a speedball in itself. It’s like taking loratidine compared to oxy. That’s the best analogy I can make. On top of that, if Tramadol has been used as a doctor would prescribe, it offers very little withdrawal that would constitute 1 day and over. If it has been abused or taken regularly for a long time it becomes a bit more of a problem. Salts of Dextroamphet will be felt physically for a short period of time. The mental cognitive functions will be a bear. I agree with Mason. One step at a time.

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Re: David (# 2)

Do some research on Tramadol. It's a synthetic opiate (opioid) that has SNRI properties.... meaning it inhibits the reuptake of Norepinephrine which is the human being neurotransmitter for "speed" in it's most crucial form. It's a speedball within itself.

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Discontinuing Adderall is no big deal. It may have symptoms such as dysphoria, depression, irregular bowels/digestion or stomach issues, and increased hunger for a few days at relatively low doses. Just be aware that it does reduce the seizure threshold by supplying excitatory neurons (i.e. NE or Norepinephrine and DA Dopamine). However, stopping Tramadol will increase the seizure threshold and likely improve the efficacy of Adderall if he truly is ADHD. The depletion of serotonin will leave more room for dopamine. Based upon the cross addiction here you might recommend some neuroprotective supplementation. A good strong multivitamin, B vitamin complex, plenty of magnesium, SAM-e, Inositol, healthy diet (means eating even if you're not hungry) and vigilant hydration.

Tramadol (which has SNRI properties) on the other hand is a two fold withdrawal. One from the Opioid perspective and the other from the 5-HT/NE perspective. This can be one of the most harsh withdrawals known regarding agitation, instability, cravings, and severe depression, fatigue and malaise.

Opioid withdrawal, while uncomfortable, is not really a deleterious concern as it is not life threatening. Naltrexone will surely exacerbate the withdrawal from tramadol but if he's been on it that long it's not really going to matter. Might as well just expedite it. It's not going to be fun either way. It's not usually protracted so just rip the band-aid off IMO. This will probably be the hardest addiction to kick from a psychological standpoint.

I am a recovering alcoholic. The Sinclair method gives the alcoholic an excuse to keep drinking. I tried it while I was actively drinking and it just made me drink even more. It's worth a shot I guess but realistically alcohol detox should be done under the supervision of medical professionals in an inpatient setting. Not very many alcoholics successfully ween themselves off, even with naltrexone. If you're a full blown alcoholic you'll find a reason to skip your dose or even still drink to further excess. At least, that's what I did while trying the Sinclair Method. It got REAL ugly REAL quick. (As a matter of fact I think that's when my alcohol induced rage, apathy, and anger peaked). Probably not the best time to try to eliminate two birds with one stone.

These cross addictions are very intricate and I would suggest that, if you have the resources, the initial detoxification be done on an inpatient basis. Of course, there is no inpatient regimen that allows for the Sinclair method.

Tramadol withdrawal is horrific but alcohol withdrawal can be life threatening. It's a tough situation for sure. Without the benefit of medical supervision I think it may be best to focus on isolating each dependency one at a time. Trying to do all of this at once is going to be extremely overwhelming.

I know that in theory it may all seem simplistic but trust me, it's not and it probably never will be. However, I'm not a doctor or a clinician or a social worker. So take what I say strictly as anecdotal, subjective and non-professional opinion.

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No one should ever take a stimulant in combination with even a mediocre opioid. This is a speedball. There exists no doctor that would prescribe you both simultaneously. As for Naltrexone, you go into full withdrawal if you take this. You should allow 3-4 days before beginning and stop doctor shopping.

-Casper

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The Tramadol needs to be fully out of his system, before he can start Naltrexone, generally a doctor will usually tell someone to wait until they are in full withdrawal, to avoid dangerous precipitated withdrawals, so if he has tapered down, it might be hard to tell. However, his doctor should be able to provide him with an idea of when he can start it.

Naltrexone can cause side effects such as nausea, dizziness, headache, stomach pain, and loss of appetite, according to FDA reports, but it is not known to cause problems with Adderall, but all such information should be double checked and discussed with his healthcare provider.

How is he doing, now? Has there been any change?

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