BUPRENORPHINE SUBLINGUAL BREAKDOWN AFTER 9 MONTHS TOTAL TREATMENT SUCCESS.

[dickJones]

A week ago I titrated from the very successful 0.6 mg Buprenorphine sublingual I’d been on for 9 months during which time my PLMS disappeared completely. But they returned 7 days or so back so with my doctors’ reluctant support the dosage was increased to 2 x 0.4 tablets = 0.8. Five nights at the increased dosage were successful.

But tonight it has gone crazy. I’d taken 2 Zopiclone of the new course of sleeping tablets that I need to counteract the Bupe side effect of insomnia. Normally I just take one, but the insomnia was resisting their effect so I’d returned briefly to one half of a Zolpidem from my previous course , which had been completely successful.

I then lay in bed watching a video. Normally with tiredness I would switch it off, put on my CPAP mask (I also have sleep apnea) and settle down to sleep.

Tonight I just suddenly dropped off and woke abruptly with weak but clear PLMs in my left leg and no recollection of the cut-off point between sudden tiredness and the option of sleep. I walked the PLMs off quickly and then got back into bed to write this. Nothing like this has happened throughout the entire wonderfully successful Bupe course so I’m presuming that the sudden PLM attack indicates that the titration has simply been to small and that I require a dosage of up to 1 mg. If so, this is very disappointing after the 9 months of total release from a condition that had wrecked my sleep architecture. And I’ll have a dosage battle on my hands with my tremulously cautious GP practice.

Any observations, insights, suggestions and direct advice will be very welcome. Now I have to get through tonight hoping desperately that the next wake-up isn’t accompanied by PLMs.

[Joolsg]

PLMD is night time leg movements that normally do not wake the patient. It sounds more like RLS if you are being woken with the leg sensations and then have to walk them off.How did you take the 0.6ml Buprenorphine? All at once or in 2 doses?

Are you getting the same brand of buprenorphine?

I find a huge difference between UK brands. Morningside, Sandoz and Tephine cause nighttime RLS breakthrough.

Accord covers my RLS 24/7.

Have you been eating/drinking a lot of Christmas treats? The extra sugar, carbs and alcohol can trigger RLS.

Otherwise, the Massachussetts opioid study makes clear that a large number of RLS patients need an upwards adjustment in the first year. Your GP may be reluctant because he thinks you will need to keep increasing the dose, but that tends not to happen once you have settled on the correct dose.

So, check whether the Christmas food & drink has triggered the RLS, or whether the brand has changed.

Also ensure your serum ferritin is where it should be, and hasn't dropped over the last 9 months.

P.S Another thought. When were you woken with RLS? You could try splitting the dose to extend the coverage. I take 0.2mg at 9 pm and 0.2mg at midnight. If I take 0.4mg all at once at 9 pm, I am woken around 6am with RLS. Taking the split dose seems to extend the cover.

[SueJohnson]

I agree with Joolsg. It seems strange that since you were fine with .6 mg that you are now having problems with .8 mg so something else has changed.

[Jelbea]

Hi Dick Jones - I have been on sublingual bup for quite a while now and it is working well at 0.8 mg per day. I take 0.4 at bedtime and 0.2 mid-day and 0.2 about 6.00 pm.

I hope your symptoms have settled down again. I have just suffered a bad week but blame lots of extra goodies over Christmas. I have cut these out and things are settling well again. It even affected my sleep - for three or four nights I only slept 2 hours or so at most.

Good Wishes for New Year and I hope you are feeling good again.