Buprenorphine @ 2 weeks, issues

[Avart]

Hi,

I've been on buprenorphine (suboxone 2.0mg as i'm in USA) for little more than 2 weeks. This is after augmenting on pramipexole, getting off that last year, and having some moderate but transient response to IV Iron 5 mos ago that has mostly gone away (despite my ferritin levels still being 300).

I am struggling to tolerate the buperenorphine and would appreciate any advice:

- Started at 0.5mg and went up slowly, taking all at night. First few nights felt notably effective but effect did not last through the night.

- Biggest issue is serious sleep disruption / insomnia, even if/when RLS is improved

- Morning sedation is very significant. Will this ever go away? Although I am stimulated and awake at night (sometimes it is easy to fall back asleep othertimes not) by the time I get to 6-7am, I feel very sedated and can't get out of bed for another 1-2 hours.

- I am now on 1.5-2.0mg. I take about 0.5mg in late afternoon early evening and 1.0 before I go to bed, occasionally 0.5mg if I awaken with RLS symptoms.

- Two weeks in this dose does not seem to even be as effective in the beginning at controlling the RLS at night.

I see doctor next week but am unsure if at this point I should even try to go up on the dose to seek additional effectiveness and hope to eventually adjust to side effects, or if the morning sedation never goes away...if so it may be better to simply taper off.

- What sort of withdrawal should I expect if I go off after only 2 weeks of being on max 2.0mg?

- I am a 220lb 43 year old male

Thank you for any thoughts or tips

[ziggypiggy]

Not familiar with buprenorphine. But I have similar issues with Oxycontin. Nightime arousal and then wanting to crash in the morning. The arousal part has never gone away for myself. It comes down to whether the side effects are worth the benefits for each person. Best of luck.

[dickJones]

I experience insomnia on Buprenorphine sublinguals, currently at 0.8 mg. To counter it I take in permutation courses of Zolpidem, Melatonin and Zopiclone. The dosage of the first and last meds are kept to the prescription minimum to avoid dependency and I buy the Melatonin in the local health shop. I’m in the UK so the two Z meds are issued via the NHS. The meds more or less eliminate the insomnia, but morning tiredness remains an issue, lessened only by maximum sleep times. I hope this helps.

NB I experience only PLMD. Melatonin can exacerbate RLS so another non-pharmaceutical sleep aid might be advisable.

[davchar23]

Dear Avart,

I am very much surprised by the amount of buprenorphine you need to block your RLS. I am a 240lb 81year old male and have been on 0.4mg (yes 0.4mg) for several months. I take all the dose late evening and the side effects are early morning nausea and tiredness.

My Gp prescribed Zofran to combat the nausea but not successful and I am now searching for other ways to combat nausea.

Davchar

[707twitcher]

my experience with buprenorphine is that one’s body goes through an adjustment period when you first start taking it. It was more effective at lower dose during the first week or two, before stabilizing on slightly higher dose after that. (In my case it was going from .4mg lasting me two days to needing that amount nightly.)

It normally takes effect within 30-60 minutes, and should stay at that peak effectiveness for 10 hours or so. So I would advise only taking it right before bed. Maybe try 1.5mg at bedtime and see if that gets you through the night. The sedation effect does lessen after the first few weeks. I never had a sleep disturbance side effect, but I imagine that might also settle a bit after a few weeks. But it likely takes a few days to stabilize after you change doses, so try to find the least amount that works to stop the RLS, and stick with that for a while.

Melatonin is a bad trigger for RLS - don’t take it. Are you taking any other medications? Are you keeping a daily log that tracks different food, drug or activities that might be a trigger for you? (Like caffeine, alcohol, sugar, etc,)

I find that cannabis is an effective way to get back to sleep if you are bothered during the night, rather than taking more buprenorphine.

[restlessstoz]

Hi Avart, I have been on buprenorphine for three years and experience the night time alertness that you describe. To counteract that I take gabapentin in the evening and find it helps enormously and I sleep 'as well as can be expected'. I long to be one of the people who are sedated by opioids but alas, it is not to be. I hate taking something that I don't 'need' just to sleep but I had two years of not sleeping much, and only lightly when I did that I was so happy to find something that helped. I take 600 mg at night and a 20mcg/hr patch of buprenorphine. I'm afraid I don't know how much that would be in the tablet form. It's the only way that I can get it here in Australia- and new rules are coming in in May so I'm terrified that it will be impossible to get after that.

Be careful if you try melatonin as it can exacerbate RLS in a lot of people, me included.

Good luck with your sleeping.