Hi. Can anyone weigh in on their experience or knowledge of the advantages or disadvantages of the different formulations of buprenorphine? I understand there is a risk of severe tooth decay with the sublingual formulation but is that only in the drug-addicted population? Has anyone had personal experience with tooth damage from SL buprenorhine?
How about the patch? Has anyone had good or bad experiences with that?
Lastly, does anyone know if buprenorphine is any better than methadone in terms of cognitive slowing and depression?
Thanks in advance for your replies,
Paul
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Doctorplacebo
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I moved from Buprenorphine patches to the sublingual tablets in April of this year. I made the move because, as has been the experience of many who have tried the patches, the manufacturer’s claims for 7 days efficacy are nonsense (3 or 4 days is a more realistic estimation) and in any event the patches tend to unpeel before their stated life span.
I use Buprenorphine at a dosage if 0.6 mg for PLMD, not RLS, which I don’t have, so it’s possible that my experience of the tablets is relevant only to that discrete condition. However, to date and spanning the last 118 nights (you do the sums!) my nightly PLMs have ceased. I can only judge the efficacy of the tablets from one night to the next and on the back of my fairly high resistance to medication over time, I’m expecting the need to titrate to 0.8 at some point. But all in all and to date, I’m delighted with the sublingual tablets.
Now, the side effects. My teeth are in poor shape because a.) I’m in my 70s and b.) I haven’t vivsted a dentist since before lockdown. But any dental wear and tear I’m experiencing is almost certainly due to anno domini rather than Buprenorphine usage. I’m not a doctor, but at these low dosages it’s difficult to see how dissolving a tablet (in my case 2) for 10 minutes nightly under my tongue is going to wreak dental havoc. Buprenorphine abused is surely going to take place at high dosage pain killer levels. However, I shall allow Sue Johnson and the other forum experts to make more substantive comment on that!
I’ve not encountered depression on the tablets, but it’s possible that my sometimes slight brain fog is due at least in part to them. More likely, however, it’s the depredations of age and that tendency to drift mentally after years of concentrated employment! My side effect is insomnia. Unless I take something to offset the sleep deprivation I’ll lie awake for hours at a time. So far I’ve managed by dancing carefully between short-term regimes of Zopiclone, Zolpidem, Melatonin and occasional weed at night. With the two Zs, I cut the tabs in half so very rarely take them in the prescribed dosage. The melatonin works well but the regimes (as with the Zs) must be kept as far apart as can be managed. And the type of weed used has to be chosen for its soporific properties or you’ll be up all night giggling at shadow shapes on the ceiling!
A long answer to a short question. I hope some info therein is of help. I wish you the very best of luck.
I take 0.4mg sub lingual Buprenorphine.I noticed straight away that very dry mouth was a side effect. I think the theory that dissolving the 'acid' pills for 2 minutes under the tongue creates tooth decay is nonsense. Drinking orange juice slowly for 5 minutes would have the same effect.
I firmly believe it is the very dry mouth and reduced saliva that causes tooth decay, borne out by a few reports on here that the patch has also caused tooth decay for some people.
So far, my very dry mouth hasn't caused tooth decay, but I counter it by chewing gum and using salivex dry mouth spray.
Even if it does destroy my teeth, I will stay on it because it was miraculous from day 1. It stopped my very severe 36/40 RLS overnight. Sleep, and the absence of those torturous, non stop sensations, after a decade of nightly RLS is more important to me.
I've been on the same low dose of 0.4mg since June 2021 and have slept 8 hours every night ever since. No torturous sensations day or night.
Read through a number of articles headed Buprenorphine on this forum and you will get a more balanced view of the pros and cons.
We all react differently. Quite A few find the patch loses effectiveness and doesn't last 7 days. They supplement with Oxy or kratom.
Depression can be an issue for a few people as well, but adding a sedative like a small dose of pregabalin or trazodone can counter that.
Some find the patch works better for them than pills. And vice versa.
I didn't experience depression but I did have severe nausea and vomiting initially. I used medical cannabis for a week and it resolved.
I developed opioid induced panic attacks and anxiety at week 4, but was expecting it as I developed it while taking Oxycontin and kratom. I added 25 mg pregabalin at night and it disappeared.
I haven't noticed a change in my cognitive abilities on Buprenorphine.
Dr Berkowski prefers Buprenorphine over methadone because the risk of respiratory depression is lower.
Hi hon, I first tried the patch but it was not working so about 2 yr ago I started the pill and it’s done the trick. I brush right after taking it and my dentist knows what to look for. This medication has never gave me any problems.
Great info! Thanks! Ticki, what dose are you on? Is anyone using the norbuprenorphine/naloxone combo? The lowest dose of that (Suboxone) contains 2 mg buprenorphine, which is much higher than what dickJones and Joolsg are taking, are you breaking yours into small pieces or do you have a different formulation in Europe?
In Europe we get much smaller dose pills. There are around 12 brands. Temgesic brand starts at 0.2mg. Sandoz, Accord, Tephine, Morningside, subutex start at 0.4mg, but are available in 0.8mg, 1mg and 2mg pills.Suboxone is used more for opioid addiction patients and the naloxone isn't really necessary for RLS and it can affect anaesthesia, so you have to notify the hospital before surgery.Dr Berkowski comfirmed that in the USA, the smaller dose brands are not available.
I feel I need to comment on here that buprenorphine as not been the miracle cure for me that it has for others … I am only persevering with it because I’m literally out of options - the patch was ‘patchy’ at its best and only really helped in the middle of the week. I am currently on 0.6 / 0.8 mg sublingual tablets- plus 150 pregabalin that I feel I need to reduce very slowly because when I have tried to reduce by 25 mg a time I get withdrawal symptoms.
The buprenorphine makes me feel sick and slows my bowel down to such an extent I have to be very careful about what and when I eat. It also causes profuse sweating and a feeling of unease that comes and goes. Also I still have pretty severe restless legs and limb movements. However I do sleep for about four hours at night ( in 1-2 hour stints) and then adding a lie in and a sleep in the afternoon I can just about function.
I think basically I need to reduce the pregabalin and up the buprenorphine - I don’t think it’s safe to take more buprenorphine at the moment because I notice the combination with this much pregabalin affects my breathing. I don’t think it’s harming my teeth.
I am posting this because I suspect there are others who have had difficulties with buprenorphine thst do not post because they don’t want to dishearten people - and I am still hoping to find some balance that works for me - but it us not the cure all that it has been for some - unfortunately - at least not for me.
I wish you and any others now able to access this drug good luck xx please keep us informed xx
Drls, I am sorry to hear about your awful RLS symptoms and drug failures and adverse effects I understand too well what it means to have run out of options, and it is certainly true that each of us has a unique situation (which the doctors try to squeeze into a single box) and responds differently to the meds. I have no illusions that buprenorphine will "give me my life back.". I have had that hope dashed too many times with other drugs. But if what I am doing now is not working I just have to try something different. Wishing you better days and nights to come.
Hello thank you for replying - I really hope it is the answer for you - it has been for many - it may give your life back - keep us informed and best wishes
For teeth they advise to rinse with water and not brush for 10 or maybe 30 min. Anything acid will cause the same or worse. If Bup works for you then you manage your teeth and thank your lucky stars...
Buprenorphine is slowly and securely marching its way into more widespread use amongst RLS sufferers. After a series of other medications, I convinced my neurologist to let me try buprenorphine 0.2mg (Temgesic) and it quelled the symptoms and let me sleep almost uninterruptedly. Unfortunately, I experienced miniwithdrawals in the morning, and in the early afternoon and evening if I took additional daytime doses to coutnteract the miniwithdrawal symptoms (RLS!). My pharmacist advised a switch to the patch to get 24/7 coverage. At the lowest dose of 5mcg/h that works well for me most of the time. Only the 7th night I regularly get mild symptoms, and when I have been too active or busy during the day. I then take (half a) Temgesic pill, thus 0.1-0.2mg extra.
Sometimes I get a few hours of insomnia after take an extra Temgesic pill late in the evening. My main problem is ongoing fatigue and brain fog. As far as currently known, these side effects are rare in buprenorphine, especially at such a low dose. But, hey, I hit the side effect jackpot 😒. Anyway, far preferable over uncontrolled RLS wrecking my sleep.
Hi Doctorplacebo - I was on oxycodone for about two years but the dosage was not quite enough to give me complete relief from RLS. My doctor at that time would not let me have a very slight increase and instead started me on buprenorphine patches. I was treated on the 15 mcg patch for about a year. At the beginning of the patch I had reasonably good success but soon this diminished. The patch was supposed to last seven days but as you will read on this site time and again it only lasted 3 - 4 days. My doctor would not listen to me and argued that it did last 7 days. I eventually got a private appointment with a consultant neurologist - Professor Walker in London - and he prescribed sublingual buprenorphine for me. My GP doctors were not pleased but do issue the prescriptions for me. It has taken some time to sort out the appropriate dosage but I now take 800 micrograms per day in divided doses. I am getting very good coverage for the RLS and although I do suffer some day-time sleepiness I am willing for this for relief. My RLS is very extreme. I now get 4 - 5 hours sleep and usually more but split up in 2 hour spells. I am 81 and suffer other ailments as well requiring fairly strong drugs.
Regarding damage to teeth it would be hard for me to know regarding this at my age and the fact that I have always had problematic teeth, but I can say that I have had no bother in the two years I have been on buprenorphine (patch and tablets). I rinse my mouth well with water after the pills and sometimes with a little milk to combat any acidity. You are not supposed to clean your teeth until at least one hour after the pill.
As Joolsg says it causes dry mouth (in my case very severe as I am on two or three other medications which also have this as a side effect). I combat this with sugar free chewing gum and sprays or gels to promote saliva production.
Buprenorphine seems to act quite differently on people. Joolsg takes a total of 400 mcg in two doses before bed. I have to have 800 mcg daily which is divided into 200 mcg at lunch, 200 mcg at 6.30 pm and 400 mcg at 10.30 pm. I would also say here that I think the sublingual form is much better than the patch which also was beginning to cause me much skin irritation as there are only a few sites on which it can be placed.
Regarding mood, Oxycodone caused me a fair bit of depression. Buprenorphine is better for me from this point of view - still somewhat low mood but also much more feeling normal (I also have other difficult ailments so low mood can partly be down to dealing with these daily. I do not think any of us want to be on opioids but to get any quality of life I think they are often very necessary. Certainly at my age and disability I could not walk the floors every night like I used to do and work every day on 2 -3 hours sleep.
I hope this helps and if I can answer any other questions please do not hesitate to get in touch. Good Wishes
Thanks everyone for your thoughtful responses. It will be a couple weeks before I can get the okay to switch meds, but I plan on requesting the sublingual tablets rather than the patch. Progress report to follow.
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