Butrans

[keiralee]

I have been on 10mg Butrans since Saturday following a period of extreme augmenting on prami. The first night was amazing, slept right through. Since,then, less effective each night .Very little last night and tonight seems to be going the same way.

I only take bp meds and these are OK with rls.

So disappointing, absolutely shattered.

Any ideas anyone.

[Joolsg]

Yes.It's the patch.

It loses effectiveness at day 4.

Many patients report this. So, they either put the new patch on on Day 5 rather than after 7 days, or add Buprenorphine pills for days 4 to 7.

Alternatively, switch to Buprenorphine pills.

[keiralee in reply to Joolsg]

The worrying thing is my patch is changed after 3 days.

[LotteM in reply to keiralee]

Ah. We -incorrectly- assumed you had a 7d patch. But are you saying you have a 3d patch? If so, you should put on a new patch the morning of the 4th day. Does that change anything?

Incidentally, what is the dose of the patch? I ask, because the 3-4d patches usually release higher doses (35-52,5-70mcg/h) compared to the 7d patches (starting at 5 mcg/h). As far as I am aware, most people here on buprenorphine patches require 10-15mcg/h patches to control their symptoms

[Joolsg in reply to keiralee]

That changes things.Ask to switch to a higher dose patch as

1. You have only just stopped Pramipexole and severe withdrawals WILL break through. Withdrawals are usually hellish for the 3 weeks after the last Pramipexole.

2. 10mcg is actually a low dose and you could increase to 15mcg temporarily until the RLS settles.

You should expect a rough 4 to 6 weeks so soon after stopping Pramipexole, but it will settle.

If not, you can ask to switch to sub lingual pills.

[RiversW]

If I understand correctly, you are using a 10mg patch. Perhaps your dose is too small and the patch is losing effectiveness.

I started with a 10 mg Buprenorphine 7 day patch 5 months ago as I weened off of Neupro. Initially my symptoms were covered well but then I noticed RLS creeping back in. My doctor increased the dose to 20 mgs. My symptoms were again covered well but this time I suffered moderate to mild symptoms after 4 or 5 days. As Jools stated the patches often do not last the full 7 days. To counter this I began switching the 7 day patch after 5 days and I faired very well. Very mild symptoms at times after 4 or 5 days but not bad at all.

Hopefully this will help. Good luck.

[ChrisColumbus]

I don't use buprenorphine but I guessed from yesterday's post that you're applying 2 x BuTrans 5 mcg/h patches at a time and these are supposed to be 7 day patches? As Jools wrote yesterday and today many users report these lose effectiveness by day 4 and you need to apply further patches following the package leaflet guidance.

When you say that "The worrying thing is my patch is changed after 3 days" do you mean that you already put on more patches to little or no effect? Or that you're only putting on one 5 mcg/h patch and then adding a second after 3 days?

As Rivers suggests, perhaps you need a stronger patch: Butrans also comes in 10, 15 and 20 mcg/h patches. Lotte mentions people needing 15 mcg/h, Rivers that he had to go to 20 mcg/h. And Jools mentioned yesterday that you might find using pills (as she does) more effective than patches.