Meds side effects

[Ephemera]

Hi everyone, does anyone know if fast heartrate, sweating and generally feeling ill can be side effects of buprenorphine patch. Getting the feeling neither the gabapentin or buprenorphine patch are working for my husband. Cannot get hold of GP or neuro and he is at wits end? Another night with no sleep, only had 3 hrs all weekend. Probably going to have to pay to see private doctor again to get fast help. Any advice???

[Joolsg]

Yes. All are known side effects of Buprenorphine.For the nausea, it generally settles after a few weeks but medical cannabis will stop it. Chemo patients use it.

For the opioid sweats and rapid heart rate, a non sedating anti histamine like cetirizine or loratedine at night helps.

I also take 25mg pregabalin and that reduces the heart rate as well.

I've had ECG and 24 hour halter tests and all came back normal despite the increase in HR just sitting down.

The side effects do settle after a few weeks. Still there but less troublesome.

[Joolsg]

Did 2 x 0.2mg Buprenorphine make any difference?If not, I suspect your husband will need a higher dose. Maybe starting at 1mg?

[Ephemera in reply to Joolsg]

Have taken patch off and taking codeine at the moment with 1200 mg gabapentin. We had to wait til yesterday for our chemist to get the pills in. Husband feely pretty lousy in an anxious way since taking patch off but getting a few hours sleep at the moment (2 to 3). Still getting PLM tightening in thigh muscles though.

[Ephemera in reply to Joolsg]

When should husband take buprenorphine. Should it be after gabapentin, just before bed?

[Joolsg in reply to Ephemera]

I take 0.2mg at 10pm and 0.2mg at midnight. I'm asleep by 1am. So adjust accordingly so he takes half just before sleep, half 2 or 3 hours before that. I take a very small dose of pregabalin (25mg) only to counter opioid induced panic/anxiety/racing heart. I take it around 1am.

If your husband responds to Buprenorphine and doesnt experience side effects or opioid 'wakefulness' he may not need gabapentin.

If he gets anxiety or wakefulness, then the gabapentin at low dose ( say up to 300 or 450mg) might help.

It's best taken before bed to help with sedation and to avoid daytime drowsiness.

Has he started the pills yet?

[Ephemera in reply to Joolsg]

Took 1st pill last night, leg played up for about 2 hrs until 12.30 then fell asleep until 7am, tired today but at least he had some sleep. Body trembling on waking presume its the pills 👍😀

[Joolsg]

That's a great start. Did he take just one 0.2mg pill or two 0.2mg pills?Hopefully the trembling will settle.

Let us know how tonight goes.

[Ephemera in reply to Joolsg]

Just took 1 x 0.2 Bup and 1000 Gabapentin

[Joolsg in reply to Ephemera]

That is very encouraging. If he takes one 0.2mg around now and the other just before bed, hopefully he won't get RLS before bed and will sleep.Fingers crossed.

If it works, you can then push for repeat prescription and tell Dr. Dhanjal.

[Ephemera in reply to Joolsg]

Pill seems to work. A few hours sleep but feeling really ill all day. Do you think this is a side effect of the buprenorphine. Forgot to say taking a cetrizine for the itching each night.

[Joolsg in reply to Ephemera]

Cetirizine is fine for RLS. The 'ill' feeling is a common side effect of Buprenorphine for the first 2 weeks. It will settle. I was bedridden for 7 days with severe nausea and occasional vomiting. As it stopped ALL my RLS, I was determined to continue. I used my medical cannabis oil with 20% THC every night because I remembered that Chemo patients use cannabis for nausea. It worked immediately. I only used the cannabis for a week and then stopped and the nausea had gone. So if you can get medical cannabis quickly, that would help.

Kwells sea sickness tablets or zofran are useful for the 'sick' feeling. Zofran is only available as a hospital prescription so ask if GP can arrange or Dr Dhanjal.

It will ease off.

Also try raw ginger grated in hot water and chewing celery can help the nausea.

I really hope it settles. Buprenorphine was my last chance as nothing else had worked for my severe RLS. The pills are definitely better for the vast majority of RLS patients.

[Ephemera in reply to Joolsg]

Thank you for the answer. No nausea/sick feeling, more of an anxious, flu like feeling, heart racing, fatigue, trembling.

[Joolsg in reply to Ephemera]

Yep- common Buprenorphine side effects. Pregabalin 25mg at night calms mine down completely.Hopefully the gabapentin that your husband is taking will counter the opioid induced anxiety/ rapid heart rate. Alternatively, he could ask for diazepam for a few weeks until his body becomes used to Buprenorphine pills. Cetirizine will help as well.

[Hidden in reply to Joolsg]

Jools, my understanding is that benzodiazepines shouldn't be taken with opioids.

[Joolsg in reply to Hidden]

I don't think they should be taken long term which is why I suggested taking diazepam for a few weeks until the anxiety settles.I take diazepam occasionally with opioids.

Pregabalin is also contraindicated but I take a small dose each evening.There are research papers and alerts on taking other classes of meds with opioids because it can cause respiratory depression.

I think that when opioids stop all RLS but cause insomnia/wakefulness or anxiety, then, adding a small dose of diazepam for short term use or intermittent use can resolve the issue.