Buprenorphine - More fatigue with patch?

[707twitcher]

I have been on buprenorphine for 8 months. I've alternated a bit between patch and sublinguals. For the last month I have been using the patch (7.5mcg). I have also had the worst fatigue over that period, often needing a 2-3 hour nap in the afternoon. I'm getting less buprenorphine in my system via the patch (180 mcg per day) vs. my usual 300 - 400 mcg via the sublinguals (taken around 8pm), so I would expect the side effects to be less. This might be coincidence, and maybe I've just really been tired. But I'm guessing the 24/7 input from the patch is having something to do with this. Just wondering if anyone else has noticed anything similar? Thanks

[Joolsg]

There are only a few people who have tried both/switched between them.DavChar mentioned fatigue.

If you had less fatigue on sub lingual pills, then perhaps switch back to that?

[RiversW]

Hey Twitcher, As we have discussed, I am also experimenting with using both patch and sublingual. For me I have had much more fatigue when just using sublingual tablets than with only the patch. But I am still trying to work out a correct dose of patch and sublingual as a supplement so it is too early it say whether I can make this work. If not, I will go back to patch only. Good luck!

[LotteM]

Hi Twitcher, interesting post for me. I have experienced fatigue ever since my RLS went through the roof and I learned about RLS. About 8+ years ago. It took me and my doctors 5+ years and quite a few different meds to find one that worked well. Initially buprenorphine sublingual, and since about 2.5y a patch of 5mcg/h. When I could sleep well again I thought my fatigue would slowly lift as I would recover from many years of extremely poor sleep. It didn’t. Physically I can do things, but I tire quickly. And mental focus is difficult. If asked, I keep saying it is most likely the buprenorphine, but I always doubted it. It couldn’t be that at such a low dose of a medicine that is supposed to have low incidence of aide effects…

So your post tells me I am mot the only one. I think I am worse too on the patch than on the sublinguals. But when I took the pills, I had mini withdrawals during the day which consisted mostly of restlessness. This restlessness kind of overruled the fatigue, I think. But if it is the bup patches, what do we do? I tried to reduce with the aim to stop a few months ago, as first part of a therapy to try to resolve the fatigue. But the RLS roared its head and didn’t settle (the therapist thought it would, but he only has experience with opioid-withdrawal-induced RLS). There is no way I can get my neurologist to ‘play’ with different opioids to see whether the fatigue can be resolved with a different type.

As my nights are good, I try to accept the fatigue. But sometimes it hits me hard and unawares, like today. It has made me behave ‘old’ well before my time. I do what I can, but I miss my old energetic self. Let me know if you find something that works!

[707twitcher]

LotteM,

This disease sucks! The side effects are almost worse than the underlying problem. I hear you regarding mini-withdrawals. The long half life is supposed to make this unlikely. But several people here have experienced them.

My poor wife lived through five years of me feeling awful with Lyme disease, and now she complains she’s living with a zombie again.

Good luck with your struggles. I’m back on sublinguals again….

[davchar23 in reply to 707twitcher]

Going back to my comments on "fatigue" which i described as "cannot be bothered.." I forgot to mention that I also find I have a general all over feeling of weakness especially in my legs. Not sure if this is what other persons call tiredness?

Davchar

[707twitcher in reply to davchar23]

For me, fatigue means crawling into bed at noon for a 3-hour nap (even after sleeping 8 hours the night before). It's been better the last two days without the patch, on sublinguals.

[davchar23]

Dear 707Twitcher,

As you know I, like you, have done a lot of experimenting with sublingual, patches, side effects and timings to try get an answer to the half life of buprenorphine.

I am currently staggering two patches (2x7.5mcg/hr and lasting only 5/6 days) and because this is not quite enough BUP to block RLS (in my case) i supplement the patches every couple of days with one 100mcg (ie half) a sublingual tablet.

Result- RLS blocked but leaves a general tiredness. I wouldn't call it fatigue but more a "cannot be bothered to do things" scenario. This approach for me seems to eliminate other side effects such as nausea and cold sweats but not anxiety/depression.

Best regards

Davchar