SOVENOR PATCHES (Buprenorphine)

[rchobby]

Please could anybody using Buprenorphine confirm an article I read recently that it can block the effectiveness of other opioids needed as top up - maybe Tramadol - when the RLS just overrides the patch.

[Jelbea]

Hi rchobby - I was on buprenorphine patches (Butec) for about two years. They were supposed to last for seven days and for me they worked well for a few months. After that the patch only worked for 3 - 4 days our of the seven. I was on the 15 mcg strength.

I think the advice is that you should not take two opiates together mainly because of the risk of respiratory depression amongst other things. My doctor would not give me anything to "top up" the patch if needed and all-in-all it was not very satisfactory.

I am now on buprenorphine hydrochloride sub=lingual which is giving me a much better outcome. Hope the patch continues to work for you.

[Nanpat in reply to Jelbea]

Hi, can I ask your dose of the sublingual? Ta

[Jelbea in reply to Nanpat]

Hi Nanpat - I take 800 mcg in divided doses daily. Some folk manage on a much lower dose once daily but others like me need more. Even at 800 mcg daily this is not a high dose.

Prof. Walker advised me to take 400 mcg at bedtime, 200 mcg at lunchtime (about noon) and 200 mcg at 5 or 6.00 p.m.

This is working well and I get more sleep (about 5 hours instead of 3 which is good for me as I have neuropathy in my feet and ankles which makes staying asleep difficult). I was on Temgesic brand but this is reputed to have a half-life of only 5 - 6 hours and certainly did not last well for me. I now have a much cheaper brand which works much better. It is Tephine made by Sandoz and has a half-life of 23 hours.

I hope this answers your query but get in touch again if I can help. Good Wishes

[Joolsg]

pcssnow.org/courses/guide-f...

As Buprenorphine is used to help addicts off opioid meds, you are correct. Buprenorphine blocks other opioids. Adjustments are made when we need pain relief post operatively.

Also, adding other opioids to Buprenorphine can imcrease the risk of respiratory depression.

If you're taking Buprenorphine correctly, you shouldn't need a top up of tramadol.

Often the patch doesn't last for the stated length. So the 5 day patch only covers 3 days. Many people report this.

It may be better to switch to the equivalent sublingual pill as that is taken at night and covers RLS for over 25 hours.

[rchobby in reply to Joolsg]

Thank you all for coming back to me. Unfortunately we cannot get Temgesic in South Africa anymore - the only Buprenorphine available is the Sovenor patch. If mixing opioids is not advisable I suppose the only solution is to increase the patch from his 10mg to 15 and hope for the best.

[Joolsg in reply to rchobby]

Or ask for renewal of the patch sooner than the prescribed 4/5/7 days it's supposed to last. Do you get breakthrough every day or just as the patch wears off? If every day, then the dose isn't high enough. If the RLS starts as the patch wears off, then asj to replace them sooner. It's a tough one.

[rchobby in reply to Joolsg]

He is getting breakthrough in the afternoons. I'll ask our GP to increase the dose. Thank you so much.

[RiversW in reply to rchobby]

Hey, It does sound like the patch is not strong enough. When I started on a 10mg 7 day patch, I was experiencing RLS symptoms during the day as well. Now I am on 20 mg 7day patch which works better. However, my neurologist approved changing the patch every 5 days because as has been noted the patch only last 4 or 5 days. Now I am usually ok until the 5th day when I get minor symptoms. Overall though I am very happy. Rivers

[wildlegs]

Tramadol works - I’ve been taking it for 15 years and it is the best.

[rchobby in reply to wildlegs]

thanks Wildlegs, yes Tramadol used to work but no longer! Temgesic was the best and gave him relief for a few years until the distributors stopped providing South Africa and (I think) Austria !

[Nanpat]

I use the patch and top up when needed with codeine or oxycodone,

They settle things for me, but yes can cause respiratory depression

[LotteM]

Like Nanpat, I have also topped up the buprenorphine (patch) with other opioid-like substances. A few times some oxycodon I had still left over, but more frequently kratom. Whereas kratom is not strictly an opioid, it also binds to the opioid receptors.

I would say, trial and error. Try if you meed a small dose top up and see whether it works. Madlegs also claims that paracetamol strengthens the effect of other painkiller, so adding a paracetamol may also be an option to try.

Oh, and of course, if the patch is failing you on a daily basis, then a slightly higher dose is the obvious route