Potentiating morphine

[bob78]

Swim has read on these forums about potentiating opiates through using grapefruit juice and antacids.
Swim would to know is it possible to potentiate Sevredol and MST the same way or any other way??

[Forthesevenlakes]

sevredol, swim is recalling from swiy's last post, is a morphine preparation. grapefruit juice can potentiate morphine by inhibiting its breakdown in the liver (thus increasing the time that its in the system) and antacids do so by basifying the stomach environment (so more gets absorbed there). the antacid cimetadine (marketed as tagamet) is particularly effective since it both inhibits one of the cytochrome p450 enzymes that break down morphine, and functions as an antacid.

a low dose of dxm can be used to potentiate opiates/opioids. 30-60 mg is generally used, since it gives a potentiation effect without becoming a dxm trip.

quinidine found in tonic water should have a similar effect as the grapefruit juice.

this thread may also have other ideas. happy potentiating!


also, swim is thinking of making this thread into one big potentiation megathread and trying to merge it with the thread he linked to. so if anyone else has ideas for potentiation of opiates please post them here.

[bob78]

Again swiy has helped out swim, cheers.
I notice that Tagamet is mentioned, swim takes Losec (omeprazole) and wonders whether it could be used as well?

It would be great if we had all the potentiation posts in one thread.

Cheers again.

[Forthesevenlakes]

omeprazole could be tried, but swim does not think it would work. omeprazole is a proton pump inhibitor, and somehow can help with ulcers that way. it does not seem to be a true antacid.

tagamet works because it an antacid, but it is also unique (to swim's knowledge anyway) in that it inhibits a cytochrome p450 enzyme that would normally metabolize morphine as well. most antacids and other ulcer medications do not do that. thats why swim mentioned tagamet specifically.

however, swim has never tried omeprazole, and maybe it would work, although swim does not see theoretically how it could do so.

[jbnugget]

SWIM recently read that the ONLY H2 blocker that works is cimetidine. It's also mentioned in the patient info given out by pharmacies in the US.

[enhancion01]

Metoclopramide is a dopamine antagonist. So swim thinks this would possibly potentiate morphine.

It is also used as a anti nausia med for chemotherapy patients.
So swim thinks it would probably help with any nausia that comes along with taking opiates.

Not absolutly sure though any other info would be appretiated

[blackie]

Bob is due to start taking metoclopramide next week, so will let you know if there is any fun to be had

[hobbes1651]

Swim ran cimetidine (tagament) through the drug interactions checker using

Interactions between your selected drugs cimetidine and MS Contin (morphine) (Moderate Drug-Drug)

MONITOR: Cimetidine may increase the action of narcotic analgesics. Cases of respiratory depression and apnea have been reported. The mechanism is unknown.
MANAGEMENT: Patients' vital signs should be closely monitored while receiving this combination. If clinically significant respiratory depression occurs, the drugs should be withdrawn. The use of a narcotic antagonist, such as naloxone, may be needed.

Drugs interaction checker is a great source of info on drug interactions and possible potentiators. The most obvious once being CNS depressants however when you go down that road you begin to play with fire. Swim wouldn't advise anyone to do it, but people can make their own decisions.

However when Swim ran dextromorphan through Drugs it did not pop up as having a drug interaction. Swim thinks if anything its simply due to Dextro's own ability to cause a CNS reaction not a direct interaction with morphine. Swim has been about every pain medicine out there. Swim has a tethered spinal cord as the result of a spinal tumor. Swim's combo if he chooses to mix is a benzo and ms contin or dilaudid. However swim if he is going to look for euphoria tends to use the opioid only as the benzo opioid interaction tends to lead to more drowsiness than is desired.

Disclaimer: Swim has been prescribed 150 mcg of Duragesic an hour plus break through meds usually MSIR 30mg as needed (Yes two different patches). Swim's tolerance is extremely high due to 4 separate major surgeries. He has been on and off pain medicine for 8 years for nerve pain due to his tethered cord. Swim wouldn't recommend starting on a high dose of anything or using potentiation until Swiy knows their basic tolerance. It's best to play it safe!

hobbes1651 added 4 Minutes and 33 Seconds later...

Originally Posted by blackie

Bob is due to start taking metoclopramide next week, so will let you know if there is any fun to be had

metoclopramide and morphine (Minor Drug-Drug)
Concomitant administration of metoclopramide and sustained-release morphine may decrease the time required to achieve peak morphine serum concentrations. In the acute clinical setting, this effect may be accompanied by an increased level of sedation and earlier onset. In patients being treated chronically, the interaction does not appear to have clinical significance.

It looks like it simply decreases the time it takes for morphine to reach its peak effects. It does not look like it will increase the "strength" of morphine.