Buprenorphine vs. hydromorphone or other opioids

[LanaCSR]

So I noticed during and after a recent TKR that the buprenorphine that I take for my RLS interacts with the hydromorphone that my surgeon prescribed for me for pain. First, when I was taking my buprenorphine along with the hydromorphone, the hydromorphone wasn't easing my pain because the buprenorphine was preventing the hydromorphine from working and, second, my RLS was acting up when I would take the hydromorphone along with the buprenorphine because they seem to work against each other. So I had to make a decision, do I just take my buprenorphine so that my RLS is covered or do I just take the hydromorphone to cover my pain but then I am stuck suffering with my RLS because I am taking hydromorphone instead of buprenorphine. So what am I to do? Is there nothing I can take that will work for my pain but that won't prevent my RLS from coming through because I don't want to stop taking my buprenorphine since it is what helps keep my RLS at bay? I may not be explaining this right. Can anyone tell me what is happening and provide any suggestions?

[Madlegs1]

This may be simplistic, but taking paracetamol/ Acetominophen with an opioid, potentiates the opioid.

So you could check with Dr or pharmacist if this is possible in your case.

I take 250 mg paracetamol if my dose of oxycodone sometimes fails to cope with triggered RLS. Works a treat.

Hope you get relief.

[LanaCSR in reply to Madlegs1]

This is very interesting because each time the nurse brought me a pain pill during my overnight stay in the hospital after my surgery she would give me a Tylenol (acetaminophen) to take with it. So I wonder if she knew something. I wanted to ask you did you use the acetaminophen along with your pain pill because your pain pill alone wasn't covering the pain alone because your RLS medicine prevented it from working, or was it because the pain pill would cause your RLS symptoms to increase? Lastly, what medicine are you taking for your RLS? I'm just trying to see if our situations are the same before I try your suggestion. I just don't want to try taking a pain pill again if it's going to cause my RLS symptoms to increase again. Thank you so much! 😊

[Madlegs1 in reply to LanaCSR]

My medication covers the RLS completely, unless I take a trigger that overcomes the oxycodone. Such as msg in a gravy or meal.I have to watch my food intake all the time. I might like a particular biscuit but know the rising agent will come to haunt my night.

The acetaminophen effect would be well known in medical circles. Codeine is often manufactured with the acetaminophen as an added component.

[ChrisColumbus]

Someone more familiar than I am with interactions with buprenorphine may advise whether you would be better off with different pain killers as suggested here:

healthline.com/health/total...

[LanaCSR in reply to ChrisColumbus]

Thank you, Chris! 😊

[Ticki]

I would never want to keep RLS.

[LanaCSR in reply to Ticki]

Amen!! 😇

[Joolsg]

Buprenorphine blocks other opioids reaching the opioid & pain receptors. That's why it's used to get people off heroin.Therefore, your hydromorphine won't work as effectively, if at all.

I'm surprised your doctors aren't aware of this.

Buprenorphine is also used for pain, but at higher doses. So, instead of choosing one over the other, discuss an increase in dose and timing of Buprenorphine to cover both RLS and pain.

This article explains how Buprenorphine pushes other opioids off pain receptors.

ncbi.nlm.nih.gov/pmc/articl....

[LanaCSR in reply to Joolsg]

OMG, Joolsg, you got it spot on!!! Thank you!!! I will discuss this with my neurologist. I will have to go through this again before the end of the year when I get my other knee replaced. So this is VERY helpful!! 😘 😘 😘

[Heatherandgorse in reply to Joolsg]

Hello, dipping in here a little late so hope I get a response

Just wondering. If taking Buorenorphine knocks other opiods off the receptors and renders inneffective; sounds a bit obvious I suppose. but would it be the same with Codein tablet for pain, (such as Solphedein otc ones conlntaining paracetamal people take for headaches?)

smilingjane

[Joolsg in reply to Heatherandgorse]

Apparently, I was inaccurate about the interaction with other opioids. RLSlearner explained that if you take opioid pain killers after taking Buprenorphine, they do work as they bind to different receptors.So they are not completely ineffective. So, for surgery and post surgery, you can use painkillers, but the team would need to be made aware that you're taking Buprenorphine so they can adjust the dose.

Normal painkillers are listed as safe to take, but any with additional opioids, like solpadeine, would need to be used cautiously.

This article explains more about using painkillers with Buprenorphine.

bicyclehealth.com/suboxone-...

[Heatherandgorse in reply to Joolsg]

Ah thanks Jules, I've learn't something new. I always thought that Buprenorphine bound to some receptors, (hence partial) and Oxy, etc bound to all of them, not just different receptors.

So it sounds like Oxy' etc are also particialy binding?

I will read the article, thanks again

[Heatherandgorse in reply to Joolsg]

From the above article ... "However, since the use of Suboxone can decrease how effective opioid medications are, possibly causing inadequate pain control, not all providers agree on whether or not Suboxone should be stopped for elective procedures"

Which would mean you would probably need more than non Buprenorphine uses for surgery ...

It's interesting but a tricky one. Good to know that you wouldn't necessarily have to stop Buprenorphine

I will print this info out to make sure my consultants/aneathatists are aware if I need any more abdominal surgery.

Many thanks

jane x

[LanaCSR in reply to Heatherandgorse]

When I had my total knee replacements last year and was also on buprenorphine for my RLS, my neurologist said to keep taking buprenorphine the way I always had but the doctors in the hospital had to prescribe hydromorphone, a stronger opioid, to cover postop pain. Hope this helps!

[Hidden]

My understanding is that buprenorphine also relieves pain. I took buprenorphine and found it calmed my RLS and peripheral neuropathy. I also noticed it was starting to help my pain as well. I would have had to take a higher dose to get more of a pain relief effect, but I was having bad side effects so I had to stop taking the medication.

[Josana13]

The Buprenorphine 8mn works just find for my pain with Gabapentin.