Buprenorphine and Naloxone 2mg/0.5 mg sublingual film

[halperinchen]

I need help from the members who have taken it or the brand name Suboxone. The oxycodone I have been taking since 2015 has lost effect therefore Doctor B prescribed Buprenorphine and Naloxone for me. The first day I experienced horrendous side effects, severe vertigo, nausea and vomting and anxiety. The second day I cut the film in half, I am still experiencing the same symptoms plus fatigue and somnolence. I don't seem to be able to function the next day with severe nausea and vertigo and fatigue. From the post I am reading, it seems 2 mg of Buprenorphine is way much more than everyone is taking. Buprenorphine has been so effective on my RLS, I am finally able to lie in bed without kicking my legs. I'd feel very bad if I can't tolerate it. I'd appreciate If anyone with similar symptoms would respond, Thanks for advance.

[LotteM]

In your bio I read ypu were on 5 mg oxycodon. If so, the buprenorphine dose is indeed far far higher than an equivalent dose. I was on 10mg oxycontin (slow release of oxycodon) before I changed to 0.2mg buprenorphine subligual, which covered my symptom's. To get closer, you may at least have to cut your film in quarters. Can you?

I hope you can, and even smaller parts if necessary. That may help for now. But, the nausea may still sremain. See Joolsg posts. She handled the nausea with medically prescribed marihuana, like people with nausea from cancer trealent do,. I don't know the strength she used by heart. It helped and I think after two weeks she stopped and the nausea remained at bay.

You will have to talk to your doctor as soon as you can. About equivalent doses, and about the side effects. If I remember correctly, other have posted that alternatively a all aamount of pregabalin may also help with the nausea. At lower doses of buprenorphine, and after a while, it should settle.

Also, you may want to discuss taking buprenorphine only, without the naloxone. Especially at the lower doses needed for RLS there doesn't seem the need f of e the additional naloxone.

Check out the Mayo Clinic 2021 paper on treeatment of RLS, the website on the opioid survey for RLS by dr John Winkelman, and look for morphine equivalent charts, eg gloshospitals.nhs.uk/gps/gl...

Hope this helps.

[halperinchen in reply to LotteM]

Thanks, LotteM, I'd appreciate for your prompt response. I am confused as why my doctor prescribe the buprenorphine with naloxone. Do you have any idea as the reason for naloxone? What is the difference between the two. Thanks.

[dancer2]

I was prescribed Belbuca ( a form of buprenorphine without Naloxone) by Dr. B also. I have been using it for 4 to 5 years. Belbuca is a buccal film that I place inside my cheek. The dosage is 150 mcg twice a day. It had worked pretty well until recently. I the live about 1000 miles from California so have not been able to see Dr. B in a year or so. My family doctor orders it for me. She orders 150 mcg the times a day so I can take 2 in the evening if I need to. The problem with that is that the next day I am so tired and have no energy. I was wondering if anyone knows if the sublingual form or pill form is better than the buccal form? Also, Belbuca is extremely expensive. If the sublingual or pill form is cheaper, I might try that

[halperinchen in reply to dancer2]

Hi, dancer2 thanks for reply. I was prescribed by Dr B two years ago for Belbuca 300 mcg every 12 hours but I developed a severe leg calf pain so that I had to discontinue it. The Buprenorphine and Naloxone sublingual film he prescribed in 2 mg/0.5 mg seems too high a dose for me but somehow the price of it is very affordable and covered by my HMO insurance. The Belbuca was very expensive and not covered by my insurance. You may try to get your doctor to order Buprenorphine and Naloxone instead. The Buprenorphine also makes me very tired next day albeit I have just started taking it two days ago. It also gives me the side effects of nausea and vertigo. Hope you can try it without an issue since you have been taking Belbuca for a long time that your body has been adjusted to it.

[dancer2 in reply to halperinchen]

Thanks for your reply. I may have to talk with my GP to see if she can change the prescription.

[Joolsg]

In the USA, doses seem to be much higher and the film seems to be most popular. I don't know why Dr B prescribed the version with naloxone. Naloxone is primarily to stop recovering addicts from over dosing. However, it can help prevent absorption in the lower gut and avoid stomach issues like constipation.

2mg is high as a starting dose in the UK. Here, we can get sub lingual pills as low as 0.2mg.

The film can be easily cut, so tonight, try quarter of the patch. 0.5mg should cover your RLS.

The severe nausea, vomiting and anxiety are very common, especially in the first week.

As you mention, Buprenorphine works brilliantly to stop all RLS and allow sleep.

I used medical cannabis every night for a week and it stopped all nausea and vomiting. (Chemo patients use cannabis to stop nausea.) My dose was 0.3ml of cannabis oil with 20%THC. It's the THC that stops the nausea.

After a week, I stopped the cannabis and the nausea was gone. You can ask for Zofran in the USA, an anti nausea med, as that also counters nausea. In the UK, only hospitals can prescribe Zofran, so it's not easy to get hold of. Dr B can prescribe it for you.

The anxiety you experienced on 2mg hit me like a truck 4 weeks after starting Buprenorphine. I had experienced it before on Oxycontin so was expecting it. I added 25mg pregabalin at night and it stopped the anxiety.

The daytime somnolence on Buprenorphine happens suddenly. Especially if I am sitting reading or after a meal. If I go for a walk, it disappears. Often, I just accept it and fall asleep for 35/40 minutes. After decades of being unable to sleep because of severe RLS, I now embrace my daytime naps.

Hope this helps.

[halperinchen in reply to Joolsg]

hi, Joolsg thanks for your valuable reply, We all benefit from your compassionate personality. Yes I definitely experienced the overdosage of Buprenorphine the first night, 2mg is way higher than what other members at this forum are taking, I almost ended up in the ER. Thanks for your advice, I cut the film to 1/4 and had reacted better than the first night. But the side effects are still overwhelming compared to the oxycodone I was taking. Now I feel better knowing the cannabis or Lyrica could help thanks to you. I have another question you may be able to help me with. If for some reason after I have been taking Buprenorphine for certain period of time, could I still find oxycodone effective to take for my RLS? In other words, would Buprenorphine being such a strong opioid compromised the effect of less potent opioid, such as oxycodone or any others? Actually this past three nights I've finally found freedom from my constant torture thanks to Buprenorphine despite the horrendous side effects. Thanks Joolsg.

[Joolsg in reply to halperinchen]

No other opioids should be taken with Buprenorphine. Buprenorphine knocks other opioids off the opioid receptors and this can cause opioid withdrawals, the main symptom of which is RLS.Buprenorphine is used to get heroin addicts off heroin for that reason.

psychiatry.uams.edu/clinica...

The side effects will definitely settle. I now have zero side effects after 10 days of constant nausea and vomiting. No panic attacks either, as the pregabalin completely resolved them.

I really hope your side effects settle soon.

It is bliss to sit through a talk, or a play or a film. Car journeys are blissful now. No need to keep stopping to walk up and down.

[teakabeagle in reply to Joolsg]

Opiods can be added to Buprenorphine for acute pain management following injuries or surgeries as there are some mu receptors open for them. I prescribe Oxycone and Gabapentin for my post op patients that are on Bup. They often require higher than usual doses, but generally only need it for a few days. You don’t want to add Bup on top of opiods as the Bup has a higher affinity for the mu receptors and will dump the opiods and precipitate acute withdrawal.

[Joolsg in reply to teakabeagle]

Thank for that clarification. Very helpful.

[halperinchen in reply to Joolsg]

Hi Joolsg, I forgot to ask you something. Since you have been taking Buprenorphine for a while, have you had to increase the dosage to keep your RLS at bay or you still keep the same dosage? How about any side effects for insomnia? Have this medication given you insomnia? Since insomnia has always been my issue therefore it is my concern. Which version of the Buprenorphine are you taking? the tablet or the film? If it is the film how do you keep your teeth or gum healthy. Sorry for all these questions. I do thank you for the information.

[Joolsg in reply to halperinchen]

I started on 0.8mg but it was too high. I reduced to 0.4mg and have been on that dose for 28 months.I've never increased the dose.

Opioids have never caused insomnia for me. I sleep 8 hours every night, with 2 loo breaks caused by my MS.

I know opioid wakefulness is a side effect for many people. I experience opioid panic attacks and take 25mg pregabalin at night to stop this. Pregabalin is a sedative and counteracts the opioid.

Buprenorphine comes as subingual pills in the UK. The buccal film is not as readily available. We can get 0.2, 0.4, 0.8, 1mg and 2mg pills. In the USA, you only seem to have 2mg pills which are difficult to cut. Hence the buccal film, which can be cut into quarters to adjust the dose.

Buprenorphine causes extremely dry mouth.I disagree with the doctors who say acid causes teeth problems.

The sub lingual pill takes a minute to dissolve. Those on the Buprenorphine patch also have teeth issues, caused by dry mouth and lack of saliva.

I use dry mouth sprays, mouthwash and toothpaste and any products that help those with Sjogrens disease.

[halperinchen in reply to Joolsg]

Thanks for your information, I cut the film into quarters as you suggested, and I am doing better with .5 mg of Buprenorphine, the anxiety I experienced last night was somewhat relieved by 75 mg of pregabalin, and I still feel sleepy during the day which is a bless since the oxycodone has made me very wakeful and I hardly could take a nap during the day. These past three days of taking Buprenorphine, I am able to sleep for more than 8 hours every night and I hope this will last. Overall I am grateful for the peaceful nights I have had since taking it. I hope every one who has refractory RLS like me has the opportunity to try this medication which is a really lifesaver.

[Joolsg in reply to halperinchen]

I completely agree.I had seriously and logically reached the conclusion that I didn't want to live any more when on Oxycontin and pregabalin. My RLS was very severe. 36/40 on the IRLS scale.

It went to 0/40 overnight on Buprenorphine and that has continued ever since.

Shumbah was the first person on this forum to tell everyone about Buprenorphine and Dr Glen Brookes in New York prescribed it.

So a huge thankyou to Shumbah.

Now we just have to inform and educate the medical profession and get official trials of Buprenorphine for RLS so it can be licensed and prescribed easily by GPs.

[LotteM in reply to halperinchen]

Good to hear that you are doing better on the quarter dosis. Can you reduce a little further? Personally, I always try to find the lowest effective dose. It will be a bit of a hassle, but maybe you can discuss afterwards with your doctor to get you lower dosed films. Dr B prescribes 0.125mg (I think) buccal films. You are also in the US?

[halperinchen in reply to LotteM]

Hi, LotteM, unfortunately, I tried cutting 1/4 of it and found it not as effective relieving my RLS. Therefore I carefully cut the film to about 0,8 mg in order to cover my symptoms completely but I do get very anxious and nervous. It is the price I have to pay to have peaceful and quiet legs during the night. Hopefully I will try Pregabalin again tonight to see if I can get relief from the anxiety. Yes I am located in California not too far from Dr.B fortunately. It is very convenient to get phone appointment with him. Thanks for your reply.

[LotteM in reply to halperinchen]

Whatever works. I hope the nausea etc wll soon dwindle. If not pregabalin, maybe some cannabis (see Joolsg's reply) will help?

[Joolsg in reply to halperinchen]

Definitely keep taking pregabalin every night. Dr Buchfuhrer emailed me about opioid induced anxiety and recommended pregabalin.You said pregabalin 75mg stopped the anxiety.

I still take a small dose of pregabalin every night and no longer have opioid anxiety.

Buprenorphine does cause a faster heart rate, pregabalin can help that as well.

For nausea, I took 0.2mg cannabis oil with THC at night for around 10 days and it stopped the nausea.

[teakabeagle in reply to Joolsg]

You should not take Zofran with Buprenorphine if you have cardiac rhythm disorders, especially long QT syndrome

[Joolsg in reply to teakabeagle]

In the UK, zofran can only be prescribed on a hospital prescription. Our NHS does not allow it to be prescribed by GPs ( Primary Care). Even specialist neurologists struggle to prescribe it as it has to be prescribed by a hospital. It can be sorted, but as waiting lists for specialists are so long now, it would take months to sort.

That's why I originally started taking cannabis for Buprenorphine induced nausea.

But it's interesting to hear it helps long QT syndrome. I will discuss it with my 2 neurologists at my yearly MS /RLS appointments.

[teakabeagle in reply to Joolsg]

It does NOT help long QT syndrome it can make it worse and potential cause cardiac arrest. Rate, but it can happen. I prescribe it for post op nausea, but not until they have had their preop EKG. I usually prescribe Compazine or nausea, but not in my patients with RLS!

[Joolsg in reply to teakabeagle]

Sorry, misunderstood your original post. Luckily we can't get zofran easily here in the UK!

[ziggypiggy]

From what I have read the naloxone is included to avoid abuse of the medication by altering it's form of use. As a sublingual the naloxone is poorly absorbed. Less the ten percent. This is intentional.

[halperinchen in reply to ziggypiggy]

Thanks Ziggypiggy, Somehow I think it helps with the bowel motility because my constipation is getting better since taking it.

[teakabeagle in reply to ziggypiggy]

Naloxone is traditionally added to avoid abuse during addiction rehab, but is helpful for the constipation so alot of TLS are on Suboxone instead of subutex

[Snowy56]

Hi, I too was on Oxy’s for years & same thing lost its affect. My pain specialist put me on Suboxone & it’s been a life saver. I have a whole new lease on life but my specialist when he put me on Suboxone he did it slowly while I was still taking Oxy I was incorporating Suboxone. I think I had to do that for a month bc the doc started me off on 2mg & went up from there until I got to what I needed that helped me live. It was a trial & now i’m happy to say I take 8mg 3 times day, every 8hrs. He did not start me on a full dose of Suboxone, that’s crazy ti me. I hope this helps you bc if you get on Suboxone you will be amazed. I still have my bad days but not near as bad as before. I’ll be thinking of you, Good luck friend

[halperinchen in reply to Snowy56]

Hi, Snowy, how much dosage of Suboxone are you taking? Are you taking 8 mg 3 times a day? that sounds quite a lot of dosage for Suboxone?

[Jules1953]

I take Temgesic, which is a low dosage of Buprenorphine. I place 2 Temgesic sublingual tablets under my tongue just before going to bed each night. Each tablet contains 0.2mg of Buprenorphine. So taking 2 tablets each night is equivalent to 0.4mg of Buprenorphine. So this is a lot less than what you have been prescribed.You can cut your 2.00mg tablets into quarters and see how you go.

I wish you all the best, kind regards Julie from Western Australia

[halperinchen in reply to Jules1953]

Thanks, Julies and Snowy. haven't turn on my computer for a few days until now. Thanks for your kindly reply. I have cut the Buprenorphine Naloxone film equivalent to about 0.6-0.8 mg to be effective controlling my symptoms. Initially, I experienced severe calf pain and mouth and tongue sore, gradually the side effects subsided to the point I could tolerate it albeit I still experience some side effects as back pain and sore tongue but it is ok as long as my RLS doesn't torture me as before when I was on oxycodone, beside I am sleeping much better. I am happy that Dr B prescribed it to me and made my life bearable now. I am luck to have belonged to the forum where I get a lot of comfort and information Thanks a lot. God bless all of us the RLS sufferers.

[teakabeagle]

I take subutex. In the US the smallest dose is 2mg. I thought I was overdosing. I was quickly taken down to half a tablet and still too much, now on 1/4 tablet and holding steady. I thought I’d need to up the dose when I withdrew from the Pramipexoled, but it’s been 6 weeks off and so far, so good.