Tramadol ER question for Rustsmith

[Gerret]

I am addressing this question to Rustsmith because we have a similar Rx regimen but I'd also love to read anyone else's response.

For the past 8 months I have been taking 5 mg methadone @ 5pm and then 50 mg of Tramadol (short acting) plus kratom and Med MJ at bedtime. While this regimen didn't work great it was better than nothing. After 8 months I got tired of the apathy that methadone causes so I managed to talk my neurologist into letting me try Tramadol ER.

I showed him your previous post that suggested a 5 mg daily dose of methadone is equal to 400 mg of Tramadol ER and he thought that 400 was way too high. He agreed to an Rx of 60 Tramadol ER 100 mg to experiment with for a month.

I started 9 days ago by taking a single 100 mg ER at 5 pm along with my regular 5 mg methadone. I did this for 4 days, cut the methadone to 2.5 mg for 3 days and then for the last 2 nights took no methadone. Three days ago I came to the conclusion that 100 mg of ER doesn't do anything so I took 200 mg for 1 night which also did nothing and so for the last 2 nights I've taken 300 mg which also did absolutely nothing as I was up every 2 hours taking more kratom (which lasts 2 hours).

It's pointless for me to try 400 mg of ER because even if it worked (which I doubt at this point) my neurologist would never prescribe it.

At this point I'm thinking of giving up this experiment and just switching back to methadone until my next appointment. Do you have any words of wisdom about my dilemma such as giving it more time?

Thanks,

Gerret

[Rustsmith]

Tramadol is sort of a strange medication in that the med, as taken, isn't an effective opioid. It has to be metabolized by the liver, which sort of splits the molecule so that half becomes an opioid and half becomes an anti-depressant. There was probably a misunderstanding in that I was only taking 200mg or ER, not 400. 400 is the maximum tramadol dose for any situation and since we are all different, it appears that you simply don't get much benefit from tramadol.

So, I would agree that your best bet is probably to switch back to methadone. I haven't been on tramadol since last fall. I discovered that (for men and not women) methadone can cause a lowering of testosterone levels. When I asked my GP to check, we found that my free (not total) testosterone was about half of the low end of the recommended range. Low free testosterone can cause symptoms such as mood issues (in my case it was depression) and loss of libido. As a result, I started on testosterone supplementation injections and felt better in just a day or two. I have been back on 5mg methadone plus testosterone injections every 4 days (self injected) ever since early December and felt great until I came down with Covid four weeks ago.