The attached tables are from Science Direct, 2013. They show the plasma concentration of buprenorphine from a 10mcg patch day by day, including what it looks like changing the patch every 7 days over 3 cycles. If you wait a full 7 days to switch, the level when you switch is roughly half what it is at the peak (Days 2-4). This explains why many people need to change the patch on Day 5 or 6 (even Day 4 for some). Apparently the extended release over the course of a week doesn't stay constant. (That's understandable if you think about how hard it would be to accomplish.)
This other link below shows some data about buprenorphine sublinguals timing (it is located in the Pharmacokinetics Profile paragraph a couple pages down). The summary:
- it takes 30 - 60 minutes to take effect
- peak effectiveness is from hour 1 to hour 4
- effectiveness lasts 6 - 12 hours
This seems short given the 30+ hour half-life of buprenorphine, but apparently there is a significant difference between half-life and efffective half-life. My assumption is that some of the side effects may be driven by the overall drug half-life rather than the shorter effective half-life. This would explain why side effects are less on the patch than with sublinguals - using a 30-hour half-life, there will ultimately be about 300% more buprenorphine in your system after a week with sublinguals than using the appropriate equivalent effective dose of patch.
As of today I am about a month free of all dopamine agonist with the hep of the Buprenorphine patch. The quality of my life has improved dramatically. However, as I have stated here before, the 20mg 7 day patch is only working 4 to 5 days for me. During the night of the 4th day, I start feeling symptoms, in my left leg primarily. Not severe but enough to wake me for 30 minutes to an hour 4 times a night. My neurologist has be kind enough to prescribe the bup patch in such a way that I can switch every 5 days. Switching at 4 days would eliminate the one bad day a week, but unfortunately, the patches are so expensive here in Brasil that I really would prefer not to spend the money required to switch every 4 days. And as an aside, the sub-lingual pill is not sold in Brasil. When I travel back to the states in May, I will see if I can get a sub-lingual prescription. Maybe that would be a more effective path for me.
Other than this issue and an increase in anxiety, I don't really have any other problems with the patch. I wonder if anyone has ideas about how to increase the effective life span of the patch. I place the patch according to directions and I do not cover. Is there any other approach I could try?
As always, eternally grateful for everyone's generosity. Rivers
Given the bell curve shape of the patch’s effectiveness over seven days, it’s surprising that it doesn’t come with some smaller dose patches to “top off” on days 5-7. Having some sublingual handy to backfill is probably the only way to get 7 days out of a patch. If a 20 mcg patch works well for the first 4 days, you would probably need about 600mcg of sublingual to add on days 4-7 to bring the effectiveness up to the same level as days 2-4. The above cited study is over ten years old, and still the manufacturers haven’t done anything about it.
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