Buprenorphine Naloxone dose

[welschrispy]

Hello again!

I have had RLS for most of my life. I was taking 6mg Pramipexol per day until given better advice here on the site. I used 100 MG of Tramadol per day and in 18 months managed to cut down to .25mg Pramipexol. Then I got stuck and couldn't cut down any more.

I found a Neurologist who prescribed Buprenorphine Naloxone .50mg/.175 per day which, after three months we have increased to 1mg/.25 but I am still stuck and have even had to increase the pramipexol back up to .5 which is very discouraging.

I have also suffered horribly from Nausea since taking the Bupenorphine.

I am very concerned about getting addicted to the opioid AND increasing the pramipexole. I see a potential one way street opening up in that direction.... and the Nausea sucks!

What should I do? Should I try to persuade the Neurologist to increase the Buprenorphine dose? Am I even on the right dose? Or..should I try to swap back to taking tramadol? My goal is to get off the dreaded pramipexol ASAP. I get chronic RLS symptoms on and off all day. I can't relax, read a book watch a movie or sleep and it seems to be getting worse.

I and feeling pretty desperate and would be so grateful if anyone can advise me

[SueJohnson]

Did you try the nausea medicines I suggested? Have you had your ferritin tested?

[SueJohnson]

You can increase the Buprenorphine Naloxone but unless you get the nausea under control, it won't be very pleasant for you. You might want to discuss other opioids with your doctor.

[Hidden]

Good evening, welschrispy. Sorry to hear of your ordeal. Subject to your discussions with a competent physician, my suggestion is that less is better. By personal experience from someone among the many here who have taken both pramipexole and tramadol long term, my observation has been that the closer one comes to zeroing out a medicine (especially pramipexole), the more difficult it becomes to do so.

If experience is any teacher, it may be very difficult (and painful) to fully abandon pramipexole ...lesser so with tramadol (if you are so inclined). If your doctor concurs with the discontinuance of pramipexole, you may wonder as I did why it ever had been prescribed in the first place. You also may find as I belatedly did, that tramadol was all that was needed and at a reduced dose taken 4 times daily rather than at a higher dose taken twice daily.

For me, however, unwillingness to sign a Pain Management Plan precluded further Rx's for tramadol. But with your doctor's concurrence, maybe that is all you may need? [Note that during my discontinuance of pramipexole, neither tramadol nor Vicodin offered any relief. If such proves to be the case with you, you also may wish to discuss with your doctor how to slowly titrate off pramipexole and whether or not any other drug may help you get through this.]

I have never taken either Buprenorphine or Naxolone and cannot comment further.

Hope things work out. Be well.

[LotteM in reply to Hidden]

I second RLSIconoclast. It may be the (earlier) reduction of pramipexole and the augmentation still continuing ad you still take it that makes the buprenorphine ineffective. It is unfortunate though that your current relatively high dose of buprenorphine is not (yet) cutting it. However difficult, you may want to consider reducing the pramipexole further, however difficult that willbe.

Joolsg had also nausea on buprenorphine when she started out on it and took for a while medical cannabis to combat it, which worked. Might that work for you? Can you access it?

Sorry that the RLS is still so severe, I hope you soon find a way to reduce it.

[Ludo1010]

Hi, I got off Parampexiol in a very unconventional way. I got drunk on red wine every night for about two weeks. No other medication at all. The first few nights it took a lot of wine then it got easier. I was on three tablets a night and suffering very badly with augmentation. I tapered off down to one and then used the wine.

[DicCarlson]

Iron status? And, what about gabapentin therapy?

[kcraig]

I was put on Ropinerole when my symptoms first started a few years ago and it made me nauseous. Gabapentin was useless. I felt horrible. A sleep specialist I went to found out I was still having leg movements during the night and tried me on Methadone (only 5mg) a few months ago. As long as I stay away from caffeine, sugar and dairy after 5-6pm, I have had zero attacks. I know it's an opioid, but it's better than nausea every night.

[ratfancy]

I think I'm a glutton for punishment. When I realized I was augmenting on my dopamine agonist (ropinerole) I went cold turkey and went on Tramadol. I had a couple of nightmare days and nights, but survived. Then after about 5 years on Tramadol, I augmented on Tramadol (not everyone does). Again I went cold turkey and switched to methadone the same day, because I finally found a doctor to give me methadone. I had a couple of nightmare days (and nights) but lived through it. It is not my advice to just quit without the supervision of a doctor - as I did. I'm sure tapering and adjusting and monitoring is a much better method. "They say" that Tramadol is not very (or less) addicting but there is a lot of controversy about this statement. At age 70, I don't care what I am addicted to!

[Hidden]

If you're still feeling nauseous after 3 plus months on buprenorphine then it's unlikely the nausea will abate.

Anti-nausea meds aren't meant for long term use.

Sounds like you'd be better off reverting to Tramadol.