Buprenorphine

[lorri214]

I have a question. I thought my dr. said buprenorphine comes in a patch. Is that true. Does it also come in a tablet. If so, is it better to get the tablet or patch. I am hoping to ask my dr. tomorrow for this medication, I want to make the right decision. I can't afford to make any mistakes,

[Madlegs1]

Check back on a recent post that discusses this item.

There are arguments for and against each one.

You may just have to experiment.

There is also a bucal film available. (Patch you suck)

Good luck.

[Ced60]

Hi , I am in the UK, I started with the tablets but was still getting restless legs (due I think to the slow withdrawal from Pramipexole - my consultant suggested trying the patches in the hope that they would give me a more constant dose of Buprenorphine, but I didnt feel that they patch worked as well, it seemed to stop working after 4-5 days and I was getting a lot of hot flushes with the patch that does not seem as bad with the tablets and they also itched a little too so I have gone back to the tablets - that is my opinion having tried both but others may have a different one ! Good Luck with your G.P.

[LotteM]

It comes in patches and pills. The strength of both are dependent on where you are. As you are in the US, someone from the US hopefully replies with more details.

I do know that e.g. dr Buchfuhrer prescribes buccal film (Belbuca) that come in (very) low doses. There are also skin patches and sublingual pills. In Europe where I am, there are smaller-dosed pills of 0.4mg and even 0.2mg. I think that in the US only the larger-dosed pills 1? mg and higher are available. But - you can cut them, in halves or even quarters.

As RLS is typically mainly in the evening and nights, pills are preferred. They work fairly quickly (usually 20-30min) which allows for careful and precise dosing. The patches can be useful when you have all day symptoms, or when -like me- you get mini-withdrawal symptoms in the morning after taking a pill in the evening. This can happen, as buprenorphine is known to have very different breakdown dynamics among individuals. Be also aware that the patches are 3d or 7d, so the starting period with dose adjusting to find your lowest effective dose is less easy. And starting low and building up the dose gradually can also be helpful in minimising the (usually temporal) side effects. Final warning about patches: if you apply in the morning (first thing) it should work that same evening, but sometimes takes longer. And several people have reported that the patches do mot last as long as they should.

I really hope the buprenorphine will agree well with you and will effectively control the RLS.

[Joolsg]

In the USA it comes in pills, buccal film and patches. However, the lowest dose of the pill and buccal film is 2mg.Here in Europe, we can get lower dose pills and buccal film.

The average effective dose of pills /film is 1mg as per Mayo Clinic Algorithm.

However, many of us do very, very well on lower doses. That's difficult in the USA where you will have to cut the pills into ¼ to find the best dose.

I do brilliantly on 0.4mg, taken 0.2mg at 9pm and 0.2mg at midnight. Claire does brilliantly on just 0.2mg.

Many in the USA find the buccal film is easier because they can cut the film into ¼ or ⅛ to find the right dose.

The patch gives an even dose over 24 hours so is often better for pain. Many have reported that it does NOT last the full 5 or 7 days it's supposed to. They then get RLS on from day 4. And there are reports of skin irritation where applied.

So it's probably better to start with pills, buy a pill cutter, cut in ¼ and start low.

It does help you get off dopamine agonists.

Oh, and Buprenorphine causes nausea, palpitations and sweats, so be prepared. They do reduce over the first few weeks.

For nausea, I used cannabis. But you can ask for Zofran. Other anti nausea pills can worsen RLS.

[707twitcher]

I’ve experimented with both. My suggestion would be to start with the pill or sublingual strips. Suboxone is commonly used in US in 2mg strips (it sits under the tongue and dissolves in 5 minutes or so). You can easily cut these into smaller sizes to find the minimal dose that provides complete relief for you. If you can get the pill, especially in smaller dose (.5 mg or so) that may be easier to consistently get the same size. (Eyeballing cutting a strip into sixths can lead to small variations.)

There will be a week or two adjustment period as you settle in and see what the best dose is for you. This makes sublinguals much more flexible than a once a week patch.

I think the main reasons to use a patch vs a sublingual are the mini withdrawals that Lotte mentions, although this is rare because of buprenorphine’s long half-life, and severity of side effects - you ultimately wind up using less medication via the patch because the absorption differences enable a smaller dose to be effective.

I didn’t have any nausea, but did have bad constipation. After several months, that has settled down to a very manageable level, such that a couple prunes a day handles it. Everyone handles medications a bit differently. So be prepared to experiment a little. But the RLS relief was immediate for me, as it was for many people here.