Opioid Recommendations

[MJDK]

This is from the recent Mayo Clinic paper on Recommended Use of Opioids. Does this mean that hydrocodone negates the benefit of ropinirole if taken together?

Importantly, pretreatment of RLS with a dopamine antagonist will negate any benefit of opioids, also suggesting that opioids interact with or work via dopaminergic systems to treat RLS. If naloxone, an opioid antagonist, is given to untreated subjects with RLS, no overt effect is seen, but if given in a double- blind fashion to opioid-treated patients with RLS, the RLS signs and symptoms reappear, suggesting that naloxone blocks the beneficial effects of the opioid agonist. However, naloxone does not block the beneficial effects of a dopamine agonist, suggesting that the dopaminergic response is not mediated via an opioid mechanism.

[stjohnh]

This is from the recent Mayo Clinic paper on Recommended Use of Opioids. Does this mean that hydrocodone negates the benefit of ropinirole if taken together?

Importantly, pretreatment of RLS with a dopamine antagonist will negate any benefit of opioids, also suggesting that opioids interact with or work via dopaminergic systems to treat RLS. If naloxone, an opioid antagonist, is given to untreated subjects with RLS, no overt effect is seen, but if given in a double- blind fashion to opioid-treated patients with RLS, the RLS signs and symptoms reappear, suggesting that naloxone blocks the beneficial effects of the opioid agonist. However, naloxone does not block the beneficial effects of a dopamine agonist, suggesting that the dopaminergic response is not mediated via an opioid mechanism.

No, ropinirole is a dopamine agonist, NOT a dopamine antagonist. Ropinirole and opioids can be used together. Does that answer your question? If not, perhaps you can reframe the question.

Some recent research has suggested that opioids influence the BID (brain iron deficiency) problem that most RLS patients have. Indeed it is possible that the best treatment may be Iron + opioid. More research is needed.

[QyX]

Hydrocodone is something different Naloxone.

Hydrocodone is a classic opioid, chemically very similar to other classic opioids like Oxycodone, Hydromorphone or Morphine.

Drugs like Ropinirole or other dopamine agonists like Pramipexol don't have a negative on opioids or block their effects in any way.

Importantly, pretreatment of RLS with a dopamine antagonist will negate any benefit of opioids

Dopamine antagonists are for the most part antipsychotics, drugs like Haloperidol, Olanazapine (Zyprexa), Quetiapine (Seroquel), Chlorprothixene, etc...

Those drugs can cause severe RLS symptoms and in that situation, an opioid wouldn't help much.

naloxone does not block the beneficial effects of a dopamine agonist, suggesting that the dopaminergic response is not mediated via an opioid mechanism.

This simply means what it states. Let me try to rephrase it: ... naloxone does not have a negative impact on the positive effects dopamine agonists can have on RLS symptoms. Dopamine agonists will still work, even when you take Naloxone. Conclusion: the effects of dopamine agonists are mediated with a different system than the opioid mechanism.

Basically here you have two different pathways to influence RLS symptoms:

a) use dopamine-agonists to influence the dopaminergic system
b) use opioids who mediate their effects via the opioid-receptors (mu, kappa, delta ... )

Does this clear things up?

[MJDK]

Yes, thank you very much. I was misunderstanding the the terms. I appreciate your responses.