Tricyclics used in treating opioid dependance

Under_Graduate

I read a case study where amitryptiline was used to treat heroine withdrawal, where methadone did not prove effective, or became addictive in itself.

Effectively, the feedback seemed to be, it relaxed the neuroreceptors to the point where it basically took away any opioid cravings.

These old school drugs get a bad rep for their supposed side effect profile but, from what I read, in terms of efficacy, they surpass modern day SSRI's, which seem to be strongly pushed - perhaps as a marketing ploy?
Or their non-toxicity in overdose...

Case studies demonstrate that imiprimine, bares significantly greater efficacy that almost all modern neuroreceptor implicating drug, including venlefaxine, lexapro and mirtazipine.

Does anyone have experience with tricyclics?

corner of hells

Under_Graduate wrote: »

I read a case study where amitryptiline was used to treat heroine withdrawal, where methadone did not prove effective, or became addictive in itself.

Effectively, the feedback seemed to be, it relaxed the neuroreceptors to the point where it basically took away any opioid cravings.

These old school drugs get a bad rep for their supposed side effect profile but, from what I read, in terms of efficacy, they surpass modern day SSRI's, which seem to be strongly pushed - perhaps as a marketing ploy?
Or their non-toxicity in overdose...

Case studies demonstrate that imiprimine, bares significantly greater efficacy that almost all modern neuroreceptor implicating drug, including venlefaxine, lexapro and mirtazipine.

Does anyone have experience with tricyclics?

I don't , but I've worked in drug services here in Ireland.
I wonder was the case study done in a very controlled environment. Maybe in a prison or resindential treatment.

I wouldn't be too up on the ins and outs of the chemical effects other than a very basic knowledge.

I know from addicts trying to taper down their methadone use in community detox they will if struggling try different strong painkillers to sleep , ease cravings etc.bearing in mind methadone is a prolonged realease of over 24 or 36 hrs.

echo beach

Under_Graduate wrote: »

These old school drugs get a bad rep for their supposed side effect profile but, from what I read, in terms of efficacy, they surpass modern day SSRI's, which seem to be strongly pushed - perhaps as a marketing ploy?
Or their non-toxicity in overdose...

The side-effect profile isn't 'supposed,' it is real. You will get unpleasant and often intolerable side-effects like a dry mouth at doses of 10-25mg of amitriptyline while it will take 75mg -150mg or more to get an anti-depressant effect.
There are obvious reasons not to want to give a drug that is toxic, even fatal, in overdose to people who are depressed and possibly suicidal. There is also long-term toxicity even at usual doses and effects if taken with many other drugs, including alcohol and recreational drugs.
Nobody questions their efficacy and they are still used when appropriate but the side-effects are the problem and reason that the alternatives became so widely used so quickly.

Under_Graduate

I was speaking with a friend yesterday who has an interest in pharmacology, and practices in the medical profession.

We got to talking about the variety of tricyclics, and one popped up called "survector", which was apparently highly stimulating, and particularly good at treating severe cases of endogenous depression.
However, he mentioned that it had been taken off the market.

He mentioned the main tricyclic he saw that is actively prescribed now a days, is prothiaden, or dosulepin.

Researching these myself - purely because I have somewhat of an interest in area's of pharmacology and neuroscience myself - this seems to fall into the category of tricyclic that has an equal effect on serotonine, and nor-adrenaline, and is considered sedating, thus can be used to treat insomnia also.

Other TCA's have a higher affinity for nor-adrenaline, can be considered activating, to the degree where they are on occasion used to treat ADHD.

But - and here's the point, he mentioned, a lot of TCA's, such as pamalor (nortriptyline), and desipramine - which, according to research papers and clinical trials, are among the most efficacious of TCA's, are not licensed or available in Ireland.

So - anyone familiar with the area - exactly what TCA's are available within Irish shores??

It is the overdose issue which is the problem with TCA's. Main reason SSRI's are preferred.

Under_Graduate

Deleted User wrote: »

It is the overdose issue which is the problem with TCA's. Main reason SSRI's are preferred.

Mmm, that's what I figured.
A chemist I once spoke to alluded to the same thing as well.

But, apparently, many/most tricyclics have been discontinued in Ireland.
One may have to go through the special HSE application procedure to obtain them, such as nortriptyline and desiprimine.

Under_Graduate

I know Elavil or amitriptyline is available.

Prothiadine also, which is funny, cause it's been discontinued to most countries.

And Surmontil is available, but known to be heavy on the drowsy/fatigue side to things.

The most potent of the bunch, according to clinical trials - Desiprimine - does not seem to be available.
Whether it was at one point and was removed.... I don't know.

Anyone in the know regarding this matter?

Under_Graduate

Under_Graduate wrote: »

Mmm, that's what I figured.
A chemist I once spoke to alluded to the same thing as well.

But, apparently, many/most tricyclics have been discontinued in Ireland.
One may have to go through the special HSE application procedure to obtain them, such as nortriptyline and desiprimine.

I am not sure what the situation is in Ireland but the main thing you would see TCA's used (in the UK) for now is neuropathic pain.

Kurtosis

Under_Graduate wrote: »

So - anyone familiar with the area - exactly what TCA's are available within Irish shores??

Under_Graduate wrote: »

I know Elavil or amitriptyline is available.

Prothiadine also, which is funny, cause it's been discontinued to most countries.

And Surmontil is available, but known to be heavy on the drowsy/fatigue side to things.

The most potent of the bunch, according to clinical trials - Desiprimine - does not seem to be available.
Whether it was at one point and was removed.... I don't know.

Anyone in the know regarding this matter?

Mod note

OP, I've merged your latest thread in here. Opening multiple threads is welcome however please do not post a new thread on the same topic just to ask a question you didn't get an answer too.

This is a scientific discussion forum and we encourage supporting discussion with links to published literature or information from reputable sources. Please try to avoid posting just anecdotes and a series of questions with little engagement or discussion (which your posts here have mainly consisted of so far). Drop me a PM if you have any queries on this.

The HPRA website can be searched to find what products are licensed in Ireland and it also has information on whether they are marketed currently or not. The Irish Medicines Formulary and possibly the MIMS list available products by therapeutic area and (I think) drug class if you have access to them, and if you don't your doctor should, so availability and suitability of treatment choices can be discussed with them.

Under_Graduate

Thank you for the above links, just what I was looking for.

As suspected, quite a few of the tricyclics are not licensed.

Nortriptyline has just been licensed 4 months ago, however.

Under_Graduate

I spoke with my pharmacist friend today again and, they seemed to think non-licensed tricyclics are imported regularly to Ireland, at not a great added expense.