I started on 0.7 mg zubsolv last night at 8 pm and had no RLS. However, I have been vomiting every time I get out of bed or drink water.It is now one in the afternoon and still no improvement. I doze a lot. It's the weekend so I can't easily contact my doctor.
What should I do tonight?
I'm afraid to take it again since the half life is 24 to 42 hours. - husband Ralph for Mary
Get hold of some cannabis.I had severe nausea & vomiting for a week. However, zero RLS.
So I was determined to find a solution. I remembered chemo patients use cannabis for nausea & had some medical cannabis left over. I took 0.3ml oil with 20% THC every night for 10 days. It stopped ALL nausea & then I stopped the cannabis & it was gone.
Alternatively ask GP for zofran or buy some Kwells. It will settle after a few weeks, but the cannabis will sort it out quickly.
Settle after a few weeks?!? Yikes, I thought I was dying with the nausea (or perhaps at that point just wished I was dead!) I honestly don't think I'll have the guts to try it again!
I was extremely ill. I literally couldn't move without throwing up. Bedridden for a week. Lost 7 pounds.But desperate times..... need desperate measures.
It stopped RLS COMPLETELY.
I've been on 0.4mg for over 3 years.
Cannabis will help the nausea if you decide to try again.
In the UK, we start low. Pills come in 0.2mg, whereas the USA only has 2mg pills ( 10 times the dose).
Zubsolv's own Medication Guide (which I looked up online) says:
"The most common side effects of ZUBSOLV include:
headache, nausea, vomiting, constipation, pain, increased sweating, decrease in sleep (insomnia)"
and suggests that you should talk to your doctor if these occur.
However, you can't reach your doctor and Joolsg has given you the benefit of her own experience and her own solutions, so hopefully this will help.
Personally, if I couldn't get the cannabis or Kwells immediately, I wouldn't continue with the Zubsolv after the first night until I could get them or get a prescription for ondansetron (Zofran). But that's just me!
Right. I can't handle nausea that severe!
How long have you been on buprenorphine? How long did you go through the awful nausea phase before it subsided? I am just so scared to even try again!!
Hi Marzipana, I replied to another reply of yours in another post. And then saw this post by you. You mention that you take/took 0.7mg buprenorphine, but if I look up Zubzolv a sublingual tablet can also have 2.9mg buprenorphine combined with 0.7mg naloxone. If so, your starting dose is rather high. EDIT: ChrisColumbus pointed out to me that Zubzolv comes in various strengths and that indeed there is also a low dose with 0.7mg buprenorphine in it. Still this 0.7mg may have been too much for you, Marzipana, to start with, and starting with half or a quarter tablet may help lessen the nausea. I hope it does and that it resolves soon . I have deleted / edited some of the following text that was based on the assumption that you took a 2.9mg buprenorphine/Zubzolv tablet
As I suggested in my other reply, maybe try to start with a small amount. In Europe we have (pure) buprenorphine in 0.2’g (Temgesic) and 0.4mg (generic) tablets. For me, 0.2mg is already enough, for Joolsg and many others 0.4mg. Starting from your current 0.7mg bup in Zubzolv tablet, can you cut the tablet in quarters and see what it does? Maybe take another crumble after about an hour if the forst one doesn’t do anything/much and you don’t get any nausea. But stop there and be prepared for at least one or several nights with rls symptoms and very poor sleep. Build up slowly and remain at the same amount (1/4 or 1/2 tablet) if you start to experience nausea. If it settles, you can after a day or two increase the dose with another quarter, until you find the symptoms are covered. And hopefully the nausea remained at bay or at a level you could handle and then settles.
If you still experience nausea, follow Joolsg experiences and advice or see posts by Davchar; he still experiences nausea, but it s more or less at an acceptable level now. And he has tried all kinds of anti-nausea approaches.
Let us know how things go.
Zubsolv comes in various doses: the lowest contains 0.7 mg bup /0.18 mg naloxone. The others are 1.4 mg/0.36 mg; 2.9 mg/0.71 mg ; 5.7 mg/1.4 mg; 8.6 mg/2.1 mg; 11.4 mg/2.9 mg.
zubsolv.com/zubsolv/dosage-...
Thanks Chris. I edited my earlier reply accordingly.
I checked the box, and it is 0.7mg/0.18mg. It was a tiny oval tablet, and though I think it was scored in the middle, it said, "Do not cut, crush, break, chew, or swallow tablet". I'm not sure what the scoop is with that...maybe I would just have to wash my hands after splitting it? It's sort of like the tag on a pillow that says, "Do not remove this tag under penalty of death". Then you realize it only means that before you purchase it! I appreciate the help/advice I'm getting! Still, I'm so scared of being that sick again! Maybe more totally sleepless nights will nudge me to be brave and try a smaller amount! Thank you for your replies, Lotte!
Pills that are scored, generally means they can be cut. But if the guidance specifically states not to cut, crush break etc then I'd be checking with the pharmacist. The danger with cutting pills that aren't meant to be cut is that it affects how the medication is absorbed and how it works in the body.
If Lotte is correct, and the Zubsolv has 2.9mg Buprenorphine, that is over 7 times the dose that made me sick! No wonder you were so ill.
You could ask for plain Buprenorphine in buccal film and cut the 2mg strip into ¼ or ⅙. That's what many in the USA do.
It's very odd that the US smallest dose is so large compared to Europe.
Edit- I see ChrisColumbus has found the dose you take.
If your RLS is very severe, and nothing else works, you may want to revisit Buprenorphine in the future, starting with 0.2mg and having medical cannabis with at least 20% THC to stop the nausea.
My husband suggested going out of insurance network to Mayo Clinic, which is based in Rochester, MN, where medical Marijuana is legal. Here in Wisconsin, right next to Minnesota, it is not. Two of my five sons would likely to be able to get me street weed, but I'm not sure I should go that route.....
Thank you Joolsg! As I don't have any meds for RLS right now, and am not sleeping, I may end up doing that. I wish I had a doctor I trust and could get good, sound advice from...and medical cannabis. Does it merely stop the nausea, or does it make you high as well? I was a wild child of the '70s and smoked weed from the time I was 12- 15, then quit after a bad trip and have never wanted to be high since!
I get medical cannabis from a cannabis clinic. They prescribe oil with 20% THC and I used 0.3ml 2 hours before bed. I'm asleep before any 'high'. When I use it in the day, I take 0.1ml & that doesn't cause the high.There are other opioids that can help RLS, but they have a short half life and sometimes don't work well.
I took Oxycontin for 5 years. No nausea. But it didn't cover my severe RLS.
So, it's a case of trial and error to find a medication that covers the RLS and doesn't produce unbearable side effects.
I've never taken buprenorphine or indeed any RLS medication: I'm lucky enough to be able to control the RLS symptoms which I had for over 40 years with magnesium and being careful with what I eat and drink and what (non-RLS) medications that I take.
Unfortunately, as SueJohnson told you in a reply to a previous post, as you augmented on long term use of ropinirole you will probably need a low dose opioid to control your symptoms.
Joolsg outlined her experience in two earlier replies above: you'll see that she's been on buprenorphine for 3 years, it completely stops her RLS, and she was able to control the side effects with other medications. Others have also found it to be a life-saver.
Nausea, vomiting and constipation are common side effects of opioids - at least in the early stages - which is why Jools suggested medical cannabis/Kwells/Zofran. You've presumably spoken to your doctor since the weekend: what did they recommend?
My doctor is nice, but she seems rather clueless (suggesting maybe I take Mirapex, even though that is a DA. Also, she is out of office SOOO MUCH! I contacted her via my portal, but she ha not gotten back to me. When I left ER, early last Sunday, I got a prescription for Zofran (ODT) and one called Famotidine (Pepcid), which is for acid reflux/GERD. I think both of those were in the IV when I went to the hospital. I'm not sure why the latter was prescribed, but maybe I had GERD and didn't even know it thanks to the severe vomiting. It was suggested by the doctor at ER (who was a sweet young woman who looked to be 17) that I just stop taking Buprenorphine. She had not even heard that Ropinerole was no longer the front line med for RLS! I feel like I'm dealing with rookies!
Odansetron (Zofran) should help. However famotidine (and cimetidine, nizatidine and ranitidine) have all been reported to make RLS worse in many.
I'm in the UK where doctors aren't trained in RLS at all and official guidelines are out of date. While the US has most of the leading experts in RLS it's also a big place which may be why it takes such a long time for best practice to filter down to local MDs. We've heard that a lot of doctors still aren't up to speed...
Your doctor would benefit from reading the Mayo Algorithm:
mayoclinicproceedings.org/a...
I see that you're in WI, which is where most of my cousins live (my aunt met and married a GI who was over here during WW2). I know that early this year there were hopes that medical marijuana might be legalised in WI this year, but maybe it got thrown out again... Hopefully the Zofran will help anyway.
That's fun to learn of your Wisconsin Connection! Yesterday I got a call from a nurse in the Neurology Department who said my doctor wants me to try taking .25mg Ropinerole 2×week (instead of me taking .5mg 1×week, as I've been doing on my own), plus 5/325mg Hydrocodone nightly. She's hoping the 2 weekly smaller doses of Ropinerole will give me at least 2 decent nights of sleep. Now the problem is that the Pharmacy may not be able to get the prescribed dosage of Hydrocodone.What is the difference between Hydrocodone and Oxycodone? I still have quite a bit of 5mg Oxycodone tablets left over from when I broke my wrist in late May. There is usually some SNAFU, either with the doctor or the pharmacy! (As my husband likes to say, "Hope for the best, expect the worst" : )
1. While I would not suggest that anyone should take a DA, I've seen it suggested that taking a DA such as ropinirole *no more than* twice a week can be OK and not lead to augmentation. I have no evidence for this. SueJohnson have you said this or have I made it up?
2. For oxycodone versus hydrocodone see this:
Burenorphine side effects
buprenorphine side effects 
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