side effect from Buprenorphine and Naloxone sublingual film

[halperinchen]

I started taking Buprenorphine and Naloxone three weeks ago. Initially the RLS symptoms are pretty much relieved. Lately the same dosage I have been on which is about a little more than a quarter of the film (around 0.6-0,8 mg) not only gives me severe calf pain but also my legs still jumping all night along. This is the second night I am having this strange experience which is very discouraging. I'd like to know if any of you have this similar experience? Thanks in advance.

[ziggypiggy]

I would like to hear others opinions as well as i am eyeing a possible switch to that medication. Are you considering upping the dosage to see what happens?

[halperinchen in reply to ziggypiggy]

Hi, Ziggypiggy, thanks for your reply. please see my reply to Joolsg to know where I am as far as the Suboxone concerns.

[Joolsg]

Have you changed anything? Medications or food triggers?If not, that is still a low dose. The Mayo Clinic Algorithm states the average effective dose is 1-1.5mg.Dr Winkelman's opioid study (Massachussetts General Hospital) also states that an increase in opioid dose is common in the first year.

I started on 0.8mg ( 2 x 0.4mg pills) but had dreadful nausea and vomiting the first day. I therefore reduced to 0.2mg immediately.

That didn't cover my RLS so I went back up again to 0.4mg, taken 3 hours apart in two x 0.2mg doses.

It has worked.

In your case, I suggest you cut the film and try a quarter around 3 hours before bed, then add an eighth / quarter immediately before sleep. Do ask your doctor so he can prescribe more films.

Another issue might be different doses on different nights, so ensure you're taking the same dose by accurate cutting.

Also ensure you're using the film correctly, as there have been reports that it doesn't work if used incorrectly.

mayoclinic.org/drugs-supple....

Speak to your doctor to ensure you can receive the increased dose. The maximum for RLS is 6mg, so you are well below the average dose and the maximum dose.

[halperinchen in reply to Joolsg]

Joolsg, thanks for your prompt reply. Only other medication I am taking is Lyrica 75 mg for my irritable bowel syndrome, otherwise I have had the same lifestyle.

I am still confused as far as the dosage concerns, Suboxone (Buprenorphine and Naloxone) comes in 2mg/0.5 mg in sublingual film, 2mg almost landed me in ER the first time I was taking. Subsequently I cut the film in a little more than a quarter (approximately 0.7 to 0.8 mg as I calculate), this dosage I have been taking around 8-9 pm every night before I go to bed, it usually takes about 2 to 3 hours to have my legs calmed down. but all of sudden in this past two nights the same dosage can't cover my RLS symptoms and I am also having both calf pain. Do you think the dosage of 0.7 to 0.8 mg still too low for my case? Actually Dr B's prescription is 1/2 - 1 films twice a day, it means I should take 1 to 2 mg twice a day, right? But my initial experience with 2 mg is horrific, therefore I am confused as far as the accurate dosage is. I will try to take twice as suggested by you tonight to see what happens. Thanks greatly for your information.

[Joolsg in reply to halperinchen]

I agree that 2mg is way too high to start.But clearly 0.7-0.8mg isn't working.

It is common to make upwards adjustments in the first year.

Lyrica should help rather than hinder the Buprenorphine.

Try Dr Buchfuhrer suggestion of taking the dose twice a day. It may really help. Take 0.8mg at night and perhaps 0.4mg earlier in the day. The fact you still have a few hours in the evening where the RLS plays up shows you aren't getting the right dose. You should be completely RLS free on the right dose.

[halperinchen in reply to Joolsg]

Thanks, Joolsg, I will try to take 0.4 mg right now and again take 0.8 mg before I go to bed to see if it can cover the symptoms. I do appreciate your reply and feel very fortunate to have all the members here to share with our plight.

[TeddiJ in reply to Joolsg]

Thank you for the info and that link, Joolsg. I didn't know I was taking the Suboxone incorrectly! I'm always so worried about my teeth than I rinse right away, I also don't hold it down and I often brush my teeth too quickly, too. Thanks for all that you do for everyone on here.

Q: you say the max dose is 6 mg's but is that true for 2 mg Suboxone film, which has the added Naloxone? I've always wondered if I can compare dosages.

[Joolsg in reply to TeddiJ]

They should be comparable. The naloxone is added to stop opioid overdose, but doesn't affect the dose of Buprenorphine you're receiving.

[TeddiJ in reply to Joolsg]

Thank you! Is the naloxone part of the 2 mg calculation though-like 1 mg of each or something?

[Joolsg in reply to TeddiJ]

No, the medications set out clearly how much Buprenorphine is in each patch. Naloxone is added to it.

[TeddiJ in reply to Joolsg]

Thanks a bunch, Joolsg.

[Parminter]

I was told to start on 2mg Bup at night. So, being very wary of drugs, and non-compliant in general, I took 1mg, and became very sick indeed. Nausea, dizziness, vomiting, just awful.

I settled on .5mg four times per day, and felt pretty awful and profoundly exhausted and depressed for a long time, with endless between-dose withdrawals.

I discovered recently that I had all the symptoms of hammered adrenals, which is extremely common in older women (and men) on chronic opioids.

But they don't tell us that, do they? (Actually, my dentist told me this, quite by chance, not my GP). Opioid-associated depression is common as a result.

The message is, to have ALL your sex hormones tested, ovarian and adrenal, particularly DHEA. They may be very far south of normal, and the consequences are many, including osteoporosis and hyperalgesia. And not being a contributing human.

I have very recently lowered my dose to .5mg twice per day, at noon and about 8.00 pm. It is sufficient if I get the timing right. I was very afraid to do this, but it was not as bad as I had expected. Bup has a 32-hour half-life, so there is no sudden catastrophe. For three days I managed on .5mg at night. Then I ran out of half-lives and the legs and arms told me so pdq.

I would prefer to do without, but I cannot take the other two drug types. I find Lyrica poison, a nasty drug, and my doctor agrees. We will not mention DAs.

[TeddiJ]

Hi, halperinchen. The famous Dr. B prescribed Suboxone to me and told me to cut the 2 mg film in half to (obviously) 1 mg. I realized pretty quickly that I could take much less and then deal with fewer side effects. BUT, then I often have to add a bit more overnight. I keep a scissors next to the bed or I cut pieces ahead of time.

Research does show that many opioid RLS folks do have to increase a bit during the 1st year.

I just wanted you to know what the expert told me to take. I hope you can get total relief soon!

[halperinchen in reply to TeddiJ]

Hi, Joolsg and Teddi, thanks for your reply, the previous two evening gives me totally different results. Two nights ago, I took 0.5 mg of Suboxone at 6 pm and 0.25 mg of it at 10 pm with good effects, my legs stayed calm completely, but last night for fear of exposing my teeth twice so that I took 0.7 to .8 mg ( almost the same dosage as previous night) once at 8 pm with my legs kicking all night long. The only difference is the frequency, when I take the same dosage twice I would get good results. but it won't work if I take it only once. Would you please shed the light on this? By the way the dosage I am taking gives me severe drowsiness and nausea, but why it can't relieve my symptoms. Thanks a lot from a confused RLS sufferer. Oh by the way, Teddi, what is your exact dosage you find to relieve your symptoms?

[TeddiJ]

Oh, dear-so sorry. Are you taking the usual RLS supplements, like mag and iron? For me, SUB seems to stay in my system a long time-could it be you are taking too much? Or too little is getting in-per the link on how to take it? Though the nausea and fatigue seem to say you are getting a LOT. On the other hand, my legs often start to jump before the 24 hours is up, as well. Which could be my sometimes bad diet of junk food and Diet Coke.

Early on, after taking too much myself, I cut the 2 mg strip into 1/4 of the strip, then further cut the 1/4 strip into FOURS. I just needed one teeny piece of the 1/4 strip. BUT-later I had to go up to about 3/4 of that quarter strip. So I think that is about .4 ish? I lost a lot of weight after going off the DA's so not sure if weight has anything to do with dosage; I'm about 124 lbs.

At every dose I have had a weird stomach clenching side effect, as though I am doing situps during the day. It may have gotten a bit better but I wonder if that is serious and the drug causes another area to jump?!

I also can fall asleep on a dime later in the day, and not even realize I've fallen asleep. A fantastic deep nap. But if I don't sit down or lie down, I don't notice the fatigue at all and feel normal. Very odd.

If nothing else, should you go back to the split dosage? Joolsg knows a lot about this, as you read. I asked her above if the 2mg means it is 2mg's of Suboxone only? How much of the 2 mg's is naloxone?

Which doctor prescribed it? Any help there?

I so wish I could help you more than these tidbits. Please let us know how things go!

[halperinchen in reply to TeddiJ]

Teddi, how often are you taking it? Twice a day and what time? I probably need to take it twice a day rather once a day which seems not as effective as twice a day, I wonder why?

[TeddiJ]

I take it before bed only-about 11 p.m. But sometimes I take a tiny sliver if my legs start jumping late evening.

I don't know why the twice a day works better for some but maybe it is because it takes the edge off first or maybe there is less in your system at once. So far for me, I can go all day without anything.

Yes, I think you should do that for now, until you see what your doc or Dr. B says-you can email Dr. B and he will help you. Be sure to search around this site, too-maybe you'll find some good posts.