Buprenorphine, Nausea & Zofran (Ondansetron)

[davchar23]

I successfully take 0.4 mg day buprenorphine to treat RLS but the nausea side effect is very troublesome and there does not seem to be a satisfactory plan to get the better of it. I have unsuccessfully tried many anti nausea drugs and methods including Symprove probiotic and seem to be left with only one other route ie medical cannabis. My GP ,who has been very supportive and helpful throughout my "escape from DA augmentation" is dead against me trying this but has put me on a route to treating the opiate constipation which he believes is causing the nausea.

I also take Zofran (Ondansetron) (4x 2 mg per day tablets) but so far no real relief. i wondered whether anyone on the site has used Zofran to treat Buprenorphine nausea and how long it took for it to be effective? My GP said it would be 2-3 days but someone else said two weeks?

RLS is of course awful but this nausea which happens every morning(early) and lasts until midday is also very draining!

Davchar

[SueJohnson]

Do you take it at least 30 minutes before you have nausea as it is best at preventing it rather than treating it. Taking it with a little food may enhance it at least a little. Combining it with another nausea medicine also is said to help. Although difficult with nausea be sure to stay hydrated.

It is a shame your doctor your doctor won't consider Cannabinoids like Dronabinol and nabilone

[davchar23 in reply to SueJohnson]

Dear Sue,

Thanks for your reply.

I take my buprenorphine at bedtime (say 11pm) and the nausea starts at about 3/4am so it is a bit difficult to take Zofran before it starts. The nausea then goes on until about 11am and certainly by noon has gone. I have been taking the Zofran early morning say 6am and 6pm.

I was wondering about taking chloropyrazine as well but Joolsg seemed to think this was a RLS trigger? and advised against it. i could try both together?

My doctor did not say he ruled cannabis out but he feels there are other "routes" to try first.

Regards

Davchar

[SueJohnson in reply to davchar23]

I haven't found any information that says it make RLS worse however if Joolsg it does I would take her word for it. It is an antipsychotic and many antipsychotics are dopamine antagonists which make RLS worse. However it is not an antipsychotic. This may be why Joolsg said it would make RLS worse.

Do avoid Thorazine (Chlorpromazine), Reglan (Cerucal, metoclopramide), Phenergan (Promethazine, Phenadoz,Promethegan), and Motilum (Domperidone) all of which are dopamine antagonists and make RLS worse.

[Elisse3 in reply to SueJohnson]

Actually Domperidone is safe to take for RLS i have used it many times Even Dr B says it’s ok. i know it’s not available in the USA but is in Canada as seen Dr B mention on his website to those emailing him

[davchar23 in reply to SueJohnson]

Sue,I am sorry the anti nausea drug which Joolsg said i should avoid is PROCHLORPERAZINE.5mg tablets)

I am confused ... is this an antipsychotic or notie will it trigger RLS or not? Sorry to be stupid but confusing?

Davchar

[SueJohnson in reply to davchar23]

She was right. That one will make RLS worse. It is used to treat nausea, anxiety and mental conditions such as schizophrenia and yes it is an antipsychotic.

[davchar23 in reply to SueJohnson]

Tks Sue..i will avoid that

Davchar

[SueJohnson]

He also might be more inclined to use the cannabinoids I mentioned since they are prescriptions.

[Bantamdyno]

Hi, I'm 80 on one cocodamol a day for pain on top of Rl s because I know where the trigger points are so why haven't you found your s

[Shumbah]

8 mg Zofram is max dose

4 dose not work for me for nausea for any reason

For constipation

Chinese remedy that works

Stew pears with a a lot of water leave pears in juices must then leave to go cold in fridge for several hours to over night then a small bowl add cream if you wish

Alternatively MIRALAX or any kind that draws water into the bowel

The nausea will settle

Longest I have known of is 21 days

all these best for good nights sleep 😴

[davchar23 in reply to Shumbah]

Thank you for your reply and especially the Chinese laxative.

MY nausea has been present for months ie since I started buprenorphine. It starts in the middle of the night and goes on until late morning making breakfast unpleasant I am now taking 4mg Zofran before sleep and 4mg before breakfast to try combat the morning nausea.So far no improvement. Immediately after breakfast I get hot/cold sweats.

Regards

Davchar

[Virginic in reply to davchar23]

It must be very frustrating. I wish you a swift as poss solution/recovery.

[Typicallygaslit in reply to davchar23]

Just a heads up. This is just based on my own experience but I have problems with hot cold sweats also and Zofran didn’t suit me. I think that older people can have problems with serotonin metabolism in a way that goes deeper than just RLS. I suspect the hot cold sweats could be linked to this. It’s called serotonin syndrome and it’s on a spectrum so you can have it mildly. Unfortunately serotonin antagonists are just as bad as agonists in this case so Zofran an all other anti emetics would go under the same umbrella. I also use Buprenorphine but thankfully the nausea is no longer that bad. It’s possible that constipation makes it worse. I use chia seeds every day to combat gut issues.

[davchar23 in reply to Typicallygaslit]

Dear Typicallygaslit,

Thank you for your reply. i wondered if i might just clarify some of the meds chemistry you mention? you mean that Zofran (an anti emetic) is an antagonist for what you call serotonin syndrome and that in turn is linked to RLS?

My GP believes that constipation is the cause of my nausea and has put me on three different acting laxatives, namely lactulose, senna and docusate!

Does the serotonin syndrome affect the gut?

Regards

Davchar

[Typicallygaslit in reply to davchar23]

I’m sorry that it may sound confusing. Serotonin is namely residing in the gut so usually people with too much serotonin get diarrhoea (that’s me). It’s quite possible that your doctor is right and that being bunged up can also make you feel nauseated. But serotonin can do it, too. I’m not actually getting any constipation from Buprenorphine but sometimes low motility if I’m not careful, but it can turn into a violent diarrhoea attack also.

Zofran is a serotonin antagonist which means that it lowers serotonin and thereby lessens the serotonin metabolism that leads to nausea. Unfortunately, if you have a problem metabolising serotonin (so this could in fact be serotonin syndrome aka toxicity), which I believe more people have than doctors realise, then both serotonin antagnoists and agonists would cause you problems rather than solve them. And one such symptom could be RLS or some other form of agitation, No one really knows for sure how it works. But to me it seems that I have RLS but also a deeper problem that overlaps RLS or maybe coincides with it in some other way and that’s serotonin toxicity so it’s basically at the bottom of the iceberg. It’s quite possible to not tolerate Zofran if this is the case. Does this make any sense at all? So just keep an eye on how that Zofran really makes you feel and if you get more restless from it, could be an indication that you should not use these types of medicines. If this is the case then other anti-emetics are likely not to work either. I don’t know if you’re anything like me but thought I’d add this idea just in case.

[davchar23 in reply to Typicallygaslit]

Thank you for your detailed reply which i really appreciate.

The serotonin issue is something new to me and i would like to make sure I understand it before taking any action

So to be clear I think you are saying that Zofran lowers serotonin metabolism and this leads to nausea and possibly also RLS ?

I do not seem to get more restless from Zofran but my reaction to above is to stop taking it as it does not seem to reduce my daily nausea. My GP said i would see a reduction in the nausea within a day or two but i have been taking it for at least 2 to 3 weeks now. If your theory is correct, and it sounds plausible, then it could be that Zofran is causing the increased nausea. Please note that I also had some nausea before I started with Zofran. and in fact Zofran was one of the anti nausea drugs that does NOT trigger RLS according to many on the forum.

I would appreciate your comments please

Best regards

Davchar

[Typicallygaslit in reply to davchar23]

I’m sorry it’s difficult to explain as I’m not a doctor but I have looked into this because of my own reactions. Zofran does decrease serotonin normally and that’s why it’s usually safe for people with RLS. We tend to be sensitive to medications that increase serotonin as that usually has a negative impact on dopamine (they go hand in hand in peculiar ways).

What I’m trying to say is that some people have RLS as well as more complex problems with serotonin metabolism. Neurology is very complex, it’s not always about having too much or too little of some neurotransmitter or hormone, but rather about an inability to metabolise them normally. There is a syndrome called serotonin syndrome where serotonin builds up in the system, it’s usually because people take too many drugs that increase serotonin. But strange enough, many other drugs can contribute to this problem including serotonin antagonists AND opioids. I’m thinking that because of your age, you could have developed some such problem. Metabolism is no longer efficient when we reach old age.

It’s very difficult to say where your nausea is coming from but in my mind it’s not impossible that anti-emetics do not work for some people. They don’t work for me. I’m 58 soon and am having trouble with almost all medications as they cause side-effects that suggest serotonin syndrome. Anti-emetics don’t help me at all and they all seem to increase RLS. You say you haven’t noticed this but are you sure the Buprenorphine isn’t masking something here? You’re using it in the morning when you’re still under influence. Also: they ARE both on the black list for serotonin syndrome and it’s not impossible that they just don’t go well together if you’re more sensitive than most people.

I have not taken them for long enough to know if they could even increase the nausea. But I don’t think it’s impossible. Nausea usually comes from a centre in the brain that’s instructed by serotonin, and so we have an example of the gut-brain connection right there. If something’s wrong in the centre, anti-emetics could just be messing things up.

I’m really sorry this is confusing. I’m just trying to help you be aware that we are not all the same and that the meds that are safe for some RLS sufferers aren’t necessarily safe for others, especially when we reach a certain age. I hope this helps! There are black lists online for drugs that can potentially contribute to serotonin syndrome. But don’t be surprised if your doctor doesn’t have clue what it is. It’s not so well known.

[davchar23 in reply to Typicallygaslit]

Thanks for your reply and I appreciate that not being a doctor and yet you have tried to explain a very complex scenario. I suspect most GPs will struggle with this problem.

You might be right that the buprenorphine is masking the effect of Zofran (which I took morning and evening). Anyway i think I will give the Zofran a miss for a few days and see what happens.

Kind regards

Davchar

[Typicallygaslit in reply to davchar23]

That’s a good idea. I’m sorry I don’t have any fantastic ideas other than maybe use psyllium or chia seeds to make sure the gut works. If you tolerate ginger, it has an anti-nausea effect but I don’t know how it affects RLS. I guess one point is, don’t be surprised if your doctor offers other anti-emetics and they don’t work either. My nausea has gotten better over time but I make sure not use too much Buprenorphine and I also use Tramadol from time to time.

[davchar23 in reply to Typicallygaslit]

I have today got some chia seeds to do exactly that. Tried ginger without any success.

I am trying to reduce buprenorphine a little 400-300mcg per day if RLS will allow.

Thanks and regards

Davchar

[Typicallygaslit in reply to davchar23]

I have tried to cope on 350 mcg Buprenorphine but it’s proving quite hard. Glad to hear you’re trying chia, I find it helps a lot and also adds protein which can only be a good thing for the elderly. You need to soak them but whip the mixture so it doesn’t clump as it sets. Hope you’ll find a way!

[davchar23 in reply to Typicallygaslit]

Yes I agree and last night i had to add an extra half a tablet to sleep. When do you take your buprenorphine tablets?

I have been adding the dried Chia seeds to my breakfast prunes. Is it essential to soak first? Do you take any other anti nausea med?

I appreciate your support

Kind regards

Davchar

[Typicallygaslit in reply to davchar23]

I’m happy to help as seems we are in a somewhat similar boat. I have tried different ideas such as taking some of the Buprenorphine early and some later, now I try and take it one or two hours before turning the lights off and then I may add some at bedtime if it feels like it. I do find it difficult to keep the routine as there seems to be a sweet. spot when the Buprenorphine makes me feel a bit tired before it starts to make me wide awake again.

If you’re constipated, then you should definitely soak the chia so there’s also water when you ingest them, otherwise you could make your problems worse. It’s the slippery jelly that you want as it creates bulk but also moves things along. It doesn’t take long to soak them. I tend to soak quite a bit and leave in the fridge to have over a few days, it seems to keep quite well.

No, I don’t take any other anti-emetics as I’m seriously drug intolerant. Maybe it’s time but it hasn’t been a huge problem recently. I did have severe nausea in hospital post surgery and had to stay an extra day. They had tried to make it so that I wouldn’t suffer from it, but at night I took 400 mcg Buprenorphine and that tipped me over. I declined all anti-emetics and had IV fluids instead. I was ok the following day.

do you suffer from any other health conditions that could aggravate the situation?

[davchar23 in reply to Typicallygaslit]

Thanks your informative response.

I think 400mcg is the minimum i am going to have to settle on although my GP suggested i try to cut it a little. i think that your routine is probably as good as there is to balance the insomnia (from opiates) against the RLS blocking and perhaps reduced nausea.

I took the Chai seeds because i thought they were supposed to help settle the gut and hence nausea?

I am aggressively trying to combat constipation and will be careful about the seeds in future.

I had heart surgery a few years back and am on lifetime beta blockers. and cholesterol limiters but they were on my daily take long before buprenorphine and nausea.

Kind regards

Davchar

[Typicallygaslit in reply to davchar23]

The chia seeds should help but it’s better to soak them first so you get a jelly, it’s the same with psyllium which might work for you also. Alternatively, you must make sure to drink plenty. The water part is very important when you take a lot of fibre. You don’t want any dry seeds irritating your gut as excessive dryness means constipation. You do know that beta blockers can cause RLS? But I’m sure you must have discussed this with your GP?

I’m sorry I don’t have any other ideas in regards to the nausea other than to try some other anti-emetic that’s usually considered safe. I hope you’ll find a way.

[Kejimkujik]

with respect to using cannabis. Maybe when you talk to your doctor you can point out that you would like to try canniboid which has zero THC so no high.

[davchar23 in reply to Kejimkujik]

Thanks your reply and notes for next GP discussion.

Regards

Davchar