cutting bup tablets - having reaction??

[Drls]

Hello - I’ve been cutting my bup tablets to take a dose of 2.5 tablets ( 1mcg) whilst reducing my pregabalin by 25 mg ( from 150 to 125)

The first 5 nights seemed to work with we managing a longer period of sleep after taking the additional half a tablet.

On the sixth night after taking the half a tablet I had a severe reaction of extreme nausea and also feeling like my throat was closing …. This lasted for ages - I felt quite woozy in the day and have also been noticing that I’ve been having increased issues walking since taking this combination of drugs - as if I can’t feel my legs properly ( the arthritis pain is less as well however the overall effect is not good).

So on the seventh night I took a quarter of a tablet and had a similar - if a little less - reaction and now feel extremely nauseous - I am also sweating profusely all over - im wondering if this is the reduction in pregabalin coming out since I do seem to get withdrawal from any lowering of a drug after a week…..

So I’m wondering if there are any warnings with cutting bup tablets, if anyone else has experienced this - or if I have inadvertently been swallowing the small pieces and that is why I am getting stomach issues…. I have cut bup tablets in the past but this is a different brand I think…

I’m now stuck nit knowing how to proceed so any suggestions would be appreciated - thanks Dawn

[SueJohnson]

I doubt that it is reducing the pregabalin but you might want to go back up to 150 mg to see.

I am no expert on opioids but hopefully someone else will be along to help you with that.

[Joolsg]

I've been cutting all brands of Buprenorphine for 3 years with no issues. Sandoz brands even have the 'score' mark to allow cutting.Are you reducing Buprenorphine as well as pregabalin? If so, I would stop and reduce only one med at a time.

I reduced from 150mg pregabalin to 25mg over about 7 or 8 months..

Maybe you are reducing pregabalin too quickly?

Pregabalin pills are easy to split. You cut the top off and pour out the powder onto a piece of card, then divide into ¼ with a knife. I reduced by a ¼ pill every 2 weeks and had no withdrawals.

[Drls in reply to Joolsg]

Hello Jules - I was increasing buprenorohine from 0.8 to 1 (my rls has been out of control) and since past discussion with prof Walker lead me to believe that 150 mg of pregabalin was too high to combine with 1mcg buprenorphine I was reducing to 125 at the same time. This has lead to confusion as to what is causing my current symptoms.

I think the 25 mg reduction in pregabalin is too much for me - I think I will increase the pregabalin by half a tablet tonight ( so taking 137.5 mg) and either keep the buprenorphine at 0.8 or add a quarter a tablet.

I’m wondering how you knew to split the 25mg tablet into four ….. had you had withdrawal symptoms before from pregabalin?

Thanks

[Joolsg in reply to Drls]

No, but I had such a terrible experience withdrawing from Ropinirole that I made sure I never suffered again. Every article I could find on pregabalin withdrawal said to reduce as slowly as possible. So I went ridiculously slowly. But, no withdrawals at all. I knew there was powder inside the pills, so I knew it would be easy to divide roughly in ¼.

[amrob123]

Pregabalin can cause muscle weakness in limbs (both as a side effect and as a withdrawal symptom. If you're going to be reducing pregabalin, the rule of thumb is to reduce by 10% each month. This helps minimise withdrawal symptoms. In your case reducing 10% monthly would look like 135mg, then 121.5mg then 108.5mg and so on. You can reduce by using the water titration method as this is considered most accurate. There are guides online as to how to do this.

[Drls in reply to amrob123]

Thanks - where are the guidelines do you know?

I have been Ill all day from the reaction I had last night ..,,, I def think I’m coming off the pregabalin too quickly for me although the official advice is 25mg a week or two weeks ….

Any info on the water titration method would be helpful …..

[amrob123 in reply to Drls]

Search "water titration medication reduction" online or join the Facebook group below (it has excellent guidance).. Some of the web results will be about benzodiazepines but can equally be used for pregabalin. Just make sure your pregabalin isn't extended release or slow release.

facebook.com/groups/beyondg...

[amrob123 in reply to Drls]

I don't know where the 25mg per fortnight comes from but anyone who knows anything about psychotropic drugs will tell you that's too fast (unless you've onky been on pregabalin for a matter of weeks). Some doctors will tell people to come off cold turkey, leaving them with protracted withdrawal and worst case permanent seizures. Interestingly, of late my GP and pharmacist have been emphasising repeatedly the need to reduce as slowly as possible. It seems there is an increasing awareness of the dangers of too fast withdrawal.

[Drls in reply to amrob123]

Hello amrob I just had a full blown panic attack and feeling like I couldn’t breath meaning I’m going back on the full dose of pregabalin for a while and then will try again …. Back to full on restless legs again and no sleep because the increase in buprenorphine did help …. So not sure how to progress with that albeit slowly - thanks for your help I will join the titration group when everything has calmed down. Thank you fir your help ( and Jools) - it’s really much appreciated

[climber54]

Hi Dawn,It sounds like you might be swallowing the Buprenorphine. That will almost certainly increase your gastro-upset. Be sure to only allow the pieces of tablets dissolve under your tongue. The Bup will not be properly absorbed through you digestive tract.

After about 20 minutes, you might try swishing some water and spitting it out rather than swallowing any left over Bup in your mouth. Good luck.

[Drls in reply to climber54]

Yes thanks - I'm definitely going to be more mindful in future about how I take any smaller pieces - however I’m now quite sure that the extent of my reactions was due to me trying to reduce the pregabalin too quickly - other users would be wise to take the advice of people like jools who reduced their pregabalin very slowly - im going to do that moving forward. I think it’s easy to underestimate how powerful pregabalin is as a drug especially when many of us are also taking opioids …..