Butrans patch

[Pippins2]

Hi I have been on 40mg of Zomorph (slow release Morphine) for several years .I take 20mg morning and 20mg evening plus 150mg Pregablin evenings I would like to know what would be the equivalent dose of Butrans patch I would need to use weekly

Thankyou

Pipps

[Joolsg]

10ml of morphine =6.6mg Oxycontin.So 40ml of morphine = around 25mg Oxycontin.

I switched from 25mg Oxycontin to 0.4mg Buprenorphine pills.

The patch equivalent of 0.4mg Buprenorphine pills would be around 7.5mcg patch. The patch comes in 5mcg and 10mcg.

However the conversion from Buprenorphine pills to patch is not exact because of the totally different way they work. The patch takes at least 2 days to work and releases the dose equally for each hour over 24 hours.

So, to answer your question, I think you should start with the 10mcg patch and see how you get on.

If it works after a week, you could consider reducing the pregabalin very slowly.

Bear in mind that many patients report the patch loses effectiveness at day 4 or 5 and it doesnot last the full 7 days. Lotte supplements with 0.2mg pills on days 5 to 7.

You may experience nausea, which is common for the first few weeks. Cannabis is really useful for the nausea.

[Pippins2 in reply to Joolsg]

Hi Jools thankyou the information sorry for late reply only just got telephone appointment with GP.Didnt go well but has agreed to increase the Zomorph to 50 mg from 40mg daily .The Zomorph does suit me as in no side effects and got Pregablin increased to 200mg from 150 mg but he won't entertain Buprenorphine in pill form.I could have pushed bit harder for Butrans patch but I had such horrendous reaction to Neupro as in hives and very itchy rash I am going to give new dosing on Zomorph and Pregablin a go .I still have the last quarter of Neupro to wean off so going to one eigth tonight .Pipps x

[Joolsg in reply to Pippins2]

Fingers crossed the new regime works.I do remember the awful reaction you had to the Neupro patch. I know Lotte puts it on different areas to avoid the irritation.

Once off Neupro you can review.

[Pippins2 in reply to Joolsg]

Jools I also need to switch my antidepressant but I will tackle that when home for longer as it will be tricky

[LotteM]

Hi Pipps, why do you want to change to buprenorphine? Short-lived relief? Or ..? And why the patches and not the sublingual pills? Just curious.

I tend to disagree with Jools in what amount to take. There is no good conversion from any other opioid to buprenorphine. And patches are more difficult, because they last for 7d and do not allow for fast adjustment, which is better in the starting phase exactly for that reason. Sublingual pills work fast, in 20-30 min. So if one is not enough, you can add another after -say- an hour. The patch takes some 8-12h to start working and only reaches full strength / highest blood levels after 2d when applied for the first time. Afterwards, as buprenorphine has a long terminal half life, the leftovers from the previous patch allows for a more constant blood level.

The most difficult issue is that dynamics (activity, including uptake and breakdown) of buprenorphine differs a lot among individuals. Hence the lack of clear conversion numbers. Personally, I always like to go low and slow. This helps you to find the lowest effective dose and helps to minimise side effects.

Long story short, I would start with a 5 mcg/h patch and wait at least 3-4d to assess its effectiveness. If insufficient, you can add another/extra patch the next week to get to 10 mcg/h. However, if you experience side effects, you can even decide to add half or even a quarter patch (giving you 7.5mcg/h and 6.25mcg/h respectively). But - up to you and your doctor. Or maybe get pharmacist’s advice. I really hope the buprenorphine works as good for you as it does for Jools and me and quite a few others.

[Drls in reply to LotteM]

Hello I moved from 25mg oxycotin to the 5mcg patch and had horrific withdrawal symptoms for about 5 days thst I wouldn’t want anyone else to experience so I would agree that 10 mcg patch is probably required…..in the end I put two on (against my Drs instructions) and that calmed it down. I then moved to 0.8 mc sublingual tablets that I have recently increased to 1 mc - I am still taking 125mg pregabalin - hoping to reduce it further but who knows!

I think we are all different but and my rls seems to be particularly resistant - but if you are moving to the patch I’d keep the option of wearing two / moving to 10mc pretty quickly if required…… withdrawal from opioids is not a nice experience, fir me it was much worse than comjng off of DAs.

[Pippins2 in reply to Drls]

Hi Dris thankyou very much for your reply and explaining your personal experience with this med . Ihave explained in my reply to Jools about how my GP consultation went Pipps

[Pippins2 in reply to LotteM]

Hi Lotte thankyou so much for taking the time so give such a detailed reply and explanation. My RLS has been playing up some nights so I was looking into options. Please see my reply to Jools so I am not repeating myself on how my GP consultation went .Take care Pipps x

[SueJohnson]

If you decide to come off the pregabalin as Joolsg said you need to do so very slowly to avoid withdrawal effects. Reduce by 25 mg every 2 weeks. If you do so you will have very few or no withdrawal effects.

[Pippins2 in reply to SueJohnson]

Thankyou Sue I am actually going to increase my Pregablin a little (see my reply to Jools (Pipps