Temgesic/Buprenorphine

[Jelbea]

Hello everyone - especially those of you on Temgesic or buprenorphine in sublingual form. Shumbah posted recently about the short half life of Temgesic as opposed to plain buprenorphine hydrochloride. At that time I did not respond as I was back on oxycodone as per suggestion of my neurologist. However, although I stuck it out for a few months this was not a success and I am back on Temgesic.

Temgesic dose lasts 6 - 8 hours at most whereas buprenorphine lasts approx. 23 - 25 hours. Some of you have managed on small doses of buprenorphine, for example Joolsg who takes 200 mcg during the evening and 200 mcg when going to bed. This keeps the RLS symptoms completely controlled. Others amongst us are on much higher doses and we seem to be the ones on Temgesic. I take 400 mcg at bedtime, 200 mcg at lunchtime and 200 mcg at 5.30 pm. - making altogether twice Joolsg amount at 800 mcg total daily which mostly covers my RLS. Bedith is on 1000 mcg = 1 mg in total in the day and she also takes Temgesic. Biscuitface is another on approximately 700 mcg Temgesic also in divided doses which does not cover her symptoms completely.

What is happening to those of us on Temgesic is that our night-time dose only lasts for at the most six hours. I awaken at 5.00 am each day and from that until I take my next dose at lunchtime I suffer depression as some of the others do as well. It is as if we were having mini-withdrawals. Bedith has recently asked her neuro to change from Temgesic to Subutex which has much better lasting powers.

Shumbah had been finding this out and the strange thing is that we cannot discover the difference in the make-up of the different brands. They all claim to be buprenorphine hydrochloride with the usual additives in the tablets. At present Jools is trying to find out for me what the difference is and I have also been searching the internet and looking at the various types to compare.

The sublingual buprenorphine tablets are much cheaper for the NHS than Temgesic so you would think most GPs would prescribe the cheapest (this is what they usually do).

If any of you have any more information or indeed anything to add please do post. In my case I feel I am being made to take a much higher dose than I would need to get proper cover.

Good Wishes from Jelbea.

[LotteM]

Hi Jelbea, quite a while ago when this came up before, I did a search through scientific papers. And wider on the internet. There should be no difference between the different forms and brands of buprenorphine. As toy may recall, I had more or less similar problems. The Temgesic worked well enough, but even at the lowest dose gave me (mini) withdrawals. After repeated dosing during the day I got switched to a 7d patch.

Re the different experiences with length of effect of buprenorphine, my educated guess is that two things play a role. First, the dose. With higher doses, more of the buprenorphine is still (and unaltered) in the body afrer the (initial) half time. But second, buprenorphine appears to have complex breakdown dynamics, that are not simply characterised by its half time. In the literature a "terminal half time" is mentioned, suggesting a complex breakdown process, but I could not find any further information or description (with data) on this process. We may beed someone with far more specialised knowledge than I have or can access on biochemical dynamics in the body.

Oh, and don't forget that we are all different!

Sorry I can't be of more help. More trial and error for you it seems.

[Typicallygaslit]

Thanks for sharing. Interesting that you don’t get along on oxycodone. I’m very confused by this medication as well, I mean Buprenorphine. I have been using sublingual and it has come with different names. I’ve tried to get on with it for months now, and have suffered all manners of side effects. Depression is a big one. Tiredness during the day - a severe form that makes it dangerous for me to drive. Also wakefulness at night and shopping at 6 am when I have little discernment but a strange amount of energy. I’ve also had severe stomach pains at one point which made me revert to Tramadol. I’m not really supposed to but I now take Tramadol first because it gets me a little sleepy, and then some Bup later if I need it. My GP is on leave so I can’t ask for more Tramadol right now. I definitely have to keep the Bup dose very low. But the RLS also varies so much from night to night that it’s hopeless trying to figure out a routine. I’m just about to try medical cannabis, let’s hope it helps.

[Jelbea in reply to Typicallygaslit]

Hi Typ - I can see you are like me and have a lot of other troubles as well as RLS. I can certainly say that opioids do seem to cause me depression but I was worse on oxycodone. I do feel very tired during the day but then I have to take a chemotherapy capsule every day and this can also cause much weariness. The BUP does not seem to upset my stomach at all. I get about 5 hours sleep each night if I am lucky but I am usually awake from 5 am onwards which again makes me tired during the day. I am 81 and still driving - only when I feel like it. I am always alert when driving and sleepiness only strikes if I sit down for a while.

You have not said what amount of BUP you take or your usual make. I am on Temgesic with a total daily dose of 800 mcg. which is almost completely dealing with RLS. Professor Walker put me on this amount

Do let me know how much you are taking and when you are supposed to take it.

[Typicallygaslit in reply to Jelbea]

Ooh, wow, you certainly have some age! And I don’t mean to sound funny about it, just that it’s amazing how you have all these problems including chemo!! AND some age, and still have some capacity left. I’m really struggling at age 56! Can’t imagine how I’d cope in a few decades. I was extremely exhausted for a while this winter, could barely move. I came off the HRT patch as I thought it was interfering with everything, and after a break, I went on to a low dose HRT gel which seems to have given me some day time energy back. Though I seem to be more used to the Bup it can still take me by surprise so that for instance if I have an appointment and haven’t slept at least 9 hours, I could be feeling excessively drowsy and shouldn’t really be on the road if it’s a longer drive.

I sometimes cope on 2x50 mg Tramadol but currently I only have enough for one a day. The amount of Bup that I take is usually around 300 mcg. I tend to spread it out as I’m trying very hard to keep it as low as possible. My guess is that it raises the dopamine and maybe that’s what’s waking me up. Spreading it out over a few hours seems to make it slightly less a problem. I can’t say I’ve noticed any difference between Bup brands. I have 200 mcg tablets that I break into quarters. I really could not take more than 300 because of indigestion, stomach pains and serious depression. Also tons of sweat on opioids, it’s dreadful.

I have gotten the Bup through my GP and I take it as I please, which is now as a last resort at night if the RLS gets to me in spite of the Tramadol.

[Biscuitface]

Hi Jelbea, I have had to swap to Buprenorphine as in my area there is a supply problem with Temgesic. I have been taking sub-lingual Buprenorphine for about 5 days now and cannot say that I have noticed any difference between this and Temgesic at this time