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Methadone and Amitriptyline- Bad Combination?

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Unread 11-11-2007, 07:40 PM   #1
Cake
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Default Methadone and Amitriptyline- Bad Combination?

Hi Everyone!

I'm due to start methadone tonight- 5mg daily for a week, then up to 10mg daily. But I'm also on endep and baclofen and I've been reading that endep and methadone can cause serious problems. Baclofen-Methadone has a moderate conflict, but endep and methadone is quite major.

This is what I've found out:

methadone and amitriptyline (Major Drug-Drug)

MONITOR CLOSELY: Methadone may cause dose-related prolongation of the QT interval. Coadministration with other agents that can prolong the QT interval may result in elevated risk of ventricular arrhythmias, including ventricular tachycardia and torsade de pointes, because of additive arrhythmogenic potential related to their effects on cardiac conduction. High dosages of methadone alone have been associated with QT interval prolongation and torsade de pointes. In a retrospective study of 17 methadone-treated patients who developed torsade de pointes, the mean daily dose was approximately 400 mg (range 65 to 1000 mg) and the mean corrected QT (QTc) interval on presentation was 615 msec. The daily methadone dose correlated positively with the QTc interval. Fourteen patients had at least one predisposing risk factor for arrhythmia (hypokalemia, hypomagnesemia, concomitant use of a medication known to prolong the QT interval or inhibit the metabolism of methadone, and structural heart disease), but these were not predictive of QTc interval. It is not known if any of the patients had congenital long-QT syndrome.



Now I don't know much about QT intervals etc, but I do know that I don't want to have heart problems and end up in hospital!

Has anyone here been on both at once? Did you have problems with it? Is this info more for those on higher dosages?

I'm waiting on hearing back from my pain clinic (could take a while! ) so I thought I'd just ask on here, to see if anyone's come across this.

Thanks,
Kate
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Unread 11-11-2007, 09:37 PM   #2
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Hi Kate,

I don't understand that stuff either but as I see it, if it sounds at all risky, wait until you have checked it with a physician or a pharmacist. I can't imagine a physician prescribing two meds that could present a significant risk of harmful interactions, but better safe than sorry.

By waiting until you have talked to the doc, the worst you risk is a lecture about independent reading of medical stuff, and maybe about not trusing the doc to think about these things (could happen). On the other hand, doctors sometimes make mistakes and patients have paid the consequences.

You have gotten by this long without combining these meds, so even a few days wait isn't gonna create any problems. I would wait until I talked to the doc...Vic
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Unread 11-13-2007, 09:11 PM   #3
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Quote:
Originally Posted by Cake View Post
Has anyone here been on both at once? Did you have problems with it? Is this info more for those on higher dosages?
Hi there Kate. I have taken both at the same time and never had a problem. In fact, I have never heard of this major reaction. I was taking 5mg of Methadone along with 125mg of Amitriptyline.

Hope this helps.

Pain free hugs xxx
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Unread 11-14-2007, 07:34 AM   #4
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Thanks for the replies.

I asked the pharmacist to double check it and she said they're ok together at this dose. Apparently that warning is more for when you're on a higher dose of methadone, like over 70mg a day, and as I'll only be taking 10mg a day there isn't a worry. Always better to double check these things though, hey?!

x Kate
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Unread 11-14-2007, 11:25 AM   #5
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Our Chronic Pain Forum sticky...I have a long post there on drugs and QT.
Including 4 lists of them from Univ. of Arizona.

Sometimes dose is important. But one thing you MUST understand is that if
you are taking two or more potential QT prolonging drugs, and are stable, if you develop dehydration, low potassium and/or low magnesium from any reason, you could tip into a QT event.

This would be poor diet, the flu, vomiting, or use of diuretics suddenly that deplete potassium and magnesium.

This is what happened with the drug cisapride (Proplusid) which when given with diuretics for people with high blood pressure, became then dangerous when magnesium levels dropped. That drug was taken off the market, because of doctors failure to heed to warning letters sent out.

Not all pain management doctors understand the risks of methadone.
So you should really have a baseline EKG done to see if you are a hidden risk to QT, before starting methadone treatment.

But the bottom line is normal people can suffer a QT event based on situations that come up with use of the various drugs and the combination of electrolyte changes.
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Unread 11-14-2007, 12:45 PM   #6
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Default Hi Kate,

I have been on Methadone for over 4 years. I'm thinking actually 5. I have so much trouble with dates and times.

There are a lot of people that can't take it. I did take it with the Amitriptyline for awhile. I just didn't like what the Amitriptyline did to me on it's own.

As far as dosage. I do 1/2 of 5 mgs. 3 times a day. If I am having bad days I will do 5 three times a day. Last night I did the 5mgs. with a heating pad and lidoderm patches in one area.

I think too it depends on how far along in a persons' remission what dosage they may take. I feel like I am close to remission but if I let the Methadone get out of my system, I have major pain so I honestly can see a difference even on a low dosage.

I would call the Drs. office and ask the Nurse if she will double check on taking them both together. I would say that someone mentioned to you that there might be a problem instead of saying you read it on the internet if you feel that might be a problem with your Dr. I tell my Dr. all the time I get on the internet and read. My Dr. is ok with it but I see others on here that have Drs. that don't want them on the internet.

Ask the Pharmacist also if you don't want to ask your Dr. I do that at times. I agree with you that it's better to be safe then sorry.

Ada
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Unread 11-15-2007, 05:23 PM   #7
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Originally Posted by InHisHands View Post
Hi there Kate. I have taken both at the same time and never had a problem. In fact, I have never heard of this major reaction. I was taking 5mg of Methadone along with 125mg of Amitriptyline.

Hope this helps.

Pain free hugs xxx
I certainly don't mean that you shouldn't be cautious with this- of course you should be very careful, as always. I now look up all my interactions just in case there is something the doctor missed. Better safe than sorry with medicines like this!

Glad that things are ok on a lower dose. I hope your day is as pain free as possible!
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Unread 03-23-2011, 06:20 PM   #8
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Default methadone and amitryptiline

hello, my pain doc just put me on 10 mg meth and 5 mg amitryp together 3x per day just yesterday, tues 03/22. waiting to see what happens. according to doc the two work well together, amitryp enhancing the affects of the meth. keep me posted, let me know what happens and i will do the same
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Unread 03-23-2011, 06:59 PM   #9
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Hello Broturtle...

Just wanted to let you know that you may not get many responses as this thread is very old (from 2007).

But you may, as several of the members are still here...


I wish you the best...

Abbie
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Unread 03-24-2011, 08:29 AM   #10
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I don't know about Amitriptyline, but on Tuesday by Pain Mgmt Doctor prescribed Methadone. I've been suffering for almost 4 years, had several blocks, spinal cord stim implanted twice (first one battery moved and wires migrated), 90 Mg Cymbalta, 200 Mg Lyrica, 100 Mg Celebrex, 25 Mg Hydroclorot (blood pressure & swelling), 10 Mg Ambien (@ bedtime), and currently coming off Clonidine. I had been taking between 5 and 6 Vicodin 7.5 Mg, but since the Methadone has been introduced, I am taking only 2 tablets right now. Right now, I believe the Methadone is only 5Mg 12 hours apart, but after a week will go up to 5 Mg every 8 hours.

I am scared and ashamed of the Methadone, but it seems to be working. I feel sick to my stomach, but I was told this would pass. I hope this works.
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