I use a low dose of buprenorphine (2x 10mcg/hr weekly patches) to successfully control my RLS.
The side effects which cause me concern, in addition to the usual constipation etc., are nausea and hot sweats.
I have reduced the nausea to a nearly acceptable level by staggering the patches (they only last 4/5 days) but the hot sweats seem to be increasing and can occur not only after food and hot drinks but at any time 24/7
I have , in vain, tried antihistamines and pregabalin (50mg/day) in an attempt to reduce the severe sweating. The "sweats" only last 2-3 minutes but occur quite frequently.
I wondered what other buprenorphine users had experienced and what they had done to try reduce the sweating?
Davchar23
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davchar23
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I think I’ve said this before but it’s only in reducing opioids that I get relief from the sweats. Having said that, I’ve been able to reduce because I had other medications that were aggravating all my issues, including paracetamol. I do have a fan running all night and bring a handheld fan if it’s a warm day.
I believe you are right but it is also I believe crucial to maintain a constant level of drug in your body. This is difficult to achieve because of the half life scenario and the rapid loss of effectivity of patches after a certain period of time.
Yes, please do. I know I don’t tolerate most medications so I’m trying very hard to cut down anything that could keep me from lowering the dose over time. So far it’s going quite well. I’m on sublingual tablets. I haven’t noticed much difference in terms of time of day. I just get the sweats ‘whenever’.
I've noticed that side effect myself recently - more pronounced the last couple months (I've been on buprenorphine for 8 months). For me, it's not sweating out of the blue - it's more a matter of sweating a lot in weather that shouldn't cause that much, and bad BO.
Good evening 707twitcher good to hear from you again.
I think the only solution to the sweats problem and buprenorphine is to try maintain a constant level of the drug in your system which is enough to block RLS at night but not to initiate a "spike" in concentration which leads to sweats. You have i remember given a lot of thought to half life of Buprenorphine and opioids in general andthis is where it becomes an art not a science. For example I found that if I took a BUP tablet to boost a reducing patch (ie a patch losing it's effectivity) then a) i got insomnia and b) the sweats increased form something I could simply ignore into moisture "pouring of me!
I am concentrating on trying to get a steady (and as low as possible ie still block RLS of course) dosing form the patches in use. The other way is to go back onto tablets and try to set up a regime that does the same as patches.
I started Buprenorphine about 6 weeks ago . I take .25 mg Suboxone (Bupren/Nalox sublingual strip once daily.) I also get random sweats when I can literally wipe sweat off my arms and it doesn’t matter what the temperature is or if I’m hot or cold.. It is annoying but mine doesn’t come as often as yours. I don’t know how too stop the sweats but I get pretty quick relief exposing as much skin as possible and walking around to get some air movement around my body.
Nausea has not been a problem for me but I do have the constipation But the most troublesome side effect for me is insomnia. I no longer have RLS keeping me awake at night but have now traded the RLS with insomnia.
My sweats sound the same as your in that I can also virtually wipe the sweat of my skin. Sometimes the sweats occur perhaps only a couple of times a day and only last for a short time so i simply sit them out but perhaps i should follow your example and move around...i will give it a go. However I am currently trying to set up the patches ( I am using 20mcg/hr but 2 patches each of 10mcg/hr) by staggering them in an effort to stabilise and get a constant feed I am hoping to at least temper the sweats. The nausea seems to respond to this modus operandi as well.
The problem is that the patches don't "start up" with their full input for a few hours and then "tail off" well before their allotted time. Then their is the half life of buprenorphine to take into consideration so getting a regular constant flow is an art not a science!
In theory i take 0.48mg (compare your 0.25mg) per day and when, of if, i get it "spot on" then i hope the sweats and nausea will significantly reduce.
Now to your insomnia. i have had some problems with this but only when i had for various reasons gone over my base level of Buprenorphine in my system. It may be (only a personal opinion) that you are taking the Suboxone too late in the evening and the amount of drug in your system for the strip is peaking just when you want to go to sleep. Perhaps experimenting with the time you take the drug might help? Basically you want the drug at just a level to block out RLS and not above as it will then cause insomnia.
Good to exchange experiences and please let me know how you progress
Hi Davchar, this reduction in efficacy of the patches is a very tricky thing to negotiate. I was on 20 mcg/hour patches which lost effectiveness on about day four. My GP suggested I change the patches every five days. However, when I realised that the six patches a month weren't enough to cover this regime, he was unable/unwilling to increase to the seven a month I really need, rather than the six that he prescribed. ( Australia is following the rest of the world in making opioids very difficult to obtain, and the GP has to jump through endless hoops to prescribe it.)
My doctor has suggested using the 20mcg patch and adding a 5 or 10 mcg patch on the fourth day to compensate for the reduction in efficacy. This seems to work reasonably well with the additional 5 mcg but nowhere near as well as the 20's changed every five days. I'm left with sweats, which for me indicate the reduction in dose, as well as breakthrough RLs. which indicates the 5 isn't high enough to cover the reduction in the 20 mcg patch.
The alternative is to go to the 10 mcg which I think would be more effective but I'm not sure how long to leave the patch on for. My GP says to use them both all the time staggering them, but that will induce a higher dose of buprenorphine on the days when I am on a new 20mcg patch and then the reduction in the 10 mcg will cause the sweats as it too loses effect. I think if I keep the 10 mcg patch on from day four/five until possibly the 12 hours after starting the new 20 mcg patch to ensure the dose has reached it's optimum level.
You sound as if you have this situation under control in your own life. Can you please give me any advice? Thank you in advance.
Thank you for your response to my post. Firstly you are right in that anything to do with BUP patch efficacy and half life is an art not a science. I will relate my experiences to you below but I suspect we are both on a learning curve and need to make each other aware of our individual progress.
All the information & experiences I have come across indicate that the half life of BUP is 24-36 hours and that the weekly patches last or at least start to significantly reduce in efficacy after 5 days. The problem lies in the fact that nobody seems to have worked on how steep the build up and tail off curves are at the start and finish of the patch's use. However it does seem more that likely that a staggered approach is the best way forward as your GP suggested.
Like me you seem to need somewhere between 0.40 and 0.48 mg/day in the system to block out RLS. Your 20mcg/hr is of course giving you the 0.48mg/day
On the use of the additional 10mcg/hr patch when your 20mcg/hr starts to lose efficacy may well mean that you could have between 0.48 & 0.72mg/day in your system at some point. i suspect that would lead to you exceeding what I call the nausea barrier and the side effects of too much BUP.
My approach, supported by my GP, has been to use two 10mcg/hr patches staggered by 24-36 hours and a cut off (ie removal ) time at 5 days per patch. I am only into my 2nd week on this trial and therefore it is too early to comment on the results but i will let you know (probably with a general post) how it goes.
I cannot argue against your strategy of adding a 10mcg (ie plus a 20mcg/hr) until the new 20mcg/hr reaches its optimum. and hope you will let me know how that goes. However it is simply a trial and error situation because we do not know to what level the 20mcg/hr patch settles at and this could lead to a build up over a period of time?
The more I try to get my head around this issue the more I realise that there are too many unknowns.
I hope the above dialogue above has explained my position and that you will me know how you progress?
Thank you Davchar. I will wait to hear how your patch staggering goes over time. I will let you know how my journey goes too. Thank goodness for this forum that enables us to compare experiences and information. Without it I would be lost.
Yes the forum is not only so much comfort but I find it worrying that I have to advise my GP on developments when he should be aware from his sources. we hear so much about the internet being bad for society but never hear about the good side
Hi Sleepless82, I'm another who responds to buprenorphine with sleeplessness. I spent two years with very little sleep, but blessedly no RLS so the pay off was worth it. I then read on this forum about Gabapentin's way of calming the brain and started to experiment with a dose that would help me sleep. I'm now on 600mg per night and, except for the day that I change the patch, when i think the level of buprenorphine is highest, I can sleep relatively well. On the first day I now take a slightly higher dose and it does help. I know a lot of people suffer side effects from gabapentin but for me, it is only a help, not a hinderance.
I deal with the constipation from buprenorphine with Movicol (I"m in Australia so not sure what the same thing would be elsewhere) but also taking magnesium for cramps has a positive effect on the constipation too.
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