Physically cutting buprenorphine pills

[SleeplessInNS]

After going through augmentation with pramipexole and no luck with gabapentin or lyrica, I was prescribed buprenorphine about 5 weeks ago and it has been a miracle. No RLS at all. I have found that a dose of .25 mg about 45 minutes before bed works perfectly.

The problem I have is that the smallest dose available here is 2 mg (combined with .5 mg naloxone). I am currently cutting the pills into eighths to get the .25 mg dose. This works somewhat, but is not very accurate. I talked to a compounding pharmacy about having them reduce the dose but they said that the drug is not stable when crushed and they couldn't do it.

Does anyone have any experience with this? Is there an effective way to get the dose down to .25mg? Thanks.

[Joolsg]

An alternative might be to use the buccal film as that is easier to cut into ⅛.Or buy a jewellery scale off Amazon and try weighing it.

But I agree it will be difficult to get exact ⅛ dose.

Can you campaign to get smaller pills imported? Here in Europe, we have much smaller dose pills, starting at 0.2mg.

[SleeplessInNS in reply to Joolsg]

Thanks - not sure if the film is available here, but I have a telephone appointment with my neurologist on Monday so I can ask.

[SueJohnson in reply to SleeplessInNS]

On the jewelry scale you can get one Amazon for about $11 that measures down to .01 gram.

[LanaCSR in reply to SueJohnson]

Is that true that buprenorphine is unstable when cut down? What does unstable mean? When I was struggling to find someone who could prescribe buprenorphine for me and I worried about running out of the last refill I had, I was cutting the pills in half. At first, it seemed effective, but after awhile it seemed like they weren't working as well. Could that be because of the "unstable" thing?

[SueJohnson in reply to LanaCSR]

I am not an expert on opioids but as far as I know they aren't unstable. You might want to make a new post asking this question.

[SleeplessInNS in reply to LanaCSR]

I guess that's also what I'm trying to find out - the one compounding pharmacy that I called said that it was too "unstable" to compound to a lower dose. That's what the person on the phone was told and she didn't know anything more than that. You would think that if that is the case, cutting the pills (as I have been doing seemingly successfully) would not be good either. Before calling other pharmacies, I thought that I would ask here to see if anyone had any experience with it.

My neurologist said that she has other patients who have had it compounded down - I'll ask her on Monday if she knows who is doing it and if so, I'll give them a call. I'll update with any information I get.

[LanaCSR in reply to SleeplessInNS]

Yes, please keep us posted!

[Kejimkujik]

Hey What you are experiencing with cutting up the Buprenorphine is similar to me. I have now been off pramipexole completely since June 1st .. happy dance. I too have been prescribed buprenorphine 2mg with naloxone 0.5mg but find it works better for me if I take 1/4 tablet at a time. Mostly one 1/4 tablet at around 4-6pm then a second at around 10pm. Sometimes I am woken with RLS so take another 1/4 then or it kicks in bad during the day and I am stuck driving or such so need a rescue dose. My neurologist has said that severalof her other rls patients have got it compounded and it works fine for them. I asked my pharmacist if they could compound it for me and they can. There was no concerns about it being unstable. Are you getting your meds through pharmacare? If you are they will not automatically cover the different price and it is very expensive as a compounded form. Works out to be $10 per dose and as I need two to three a day that is $20-$30 daily. Weekly $210, and monthly $840. However, the pharmacist said that if the neurologist prescribes it to be compounded for safer more accurate dosing, pharmacare will cover it. If you have private insurance they will probably be fine. I will double check with same pharmicist about the unstable thing. Lastly, I was using a pill cutter but another pharmicist said I might have better cleaner splitting if I used a very sharp blade like a razor blade on a counter top and this is definitely better.

[SleeplessInNS in reply to Kejimkujik]

Thanks for the reply, Keji. Yes, I get my drugs through Senior's Pharmacare - I'll ask the neurologist about getting a prescription that specifies compounding and about a pharmacy that will do it. I use a knife to cut the pills, but it isn't very accurate and I lose one or two eighths out of each pill because they just crumble.

[teakabeagle in reply to SleeplessInNS]

I use a pill splitter to cut my 2 mg tablets in half, then use a sharp razor to splint into quarters. I then chop it up, and dissolve it in a quarter teaspoon of water, then put it under the tongue. It seems to absorb quicker and kick in sooner. I think it may be better for the teeth. Buprenorphine is hydrophilic and dissolves quickly

[SleeplessInNS]

An update for anyone interested. I called a few more compounding pharmacies and all but one said that Suboxone (buprenorphine/naloxone combo) cannot be compounded but straight buprenorphine can. One pharmacist (who seemed quite knowledgable) said that he was pretty sure that he could do the combo (not sure why that is). None suggested that cutting the pill into smaller doses was a problem (other than the physical problem of cutting it that small). Here in Nova Scotia it would cost about $200 for 100mg of the drug itself, plus about $150 for a 3 month supply of finished product. It is not covered by our government drug plan.