Side effects of Buprenorphine/

[nsrrider]

Hello group,

Before asking my neurologist for Buprenorphine (I've been augmenting on my long use of a DA) I wanted to get an idea what side effects users are experiencing and how likely it is to experience those side effects.

Thank you all

[SueJohnson]

Welcome to the forum. You will find plenty of help, support and understanding here.

Constipation, nausea or vomiting, sweats, insomnia, daytime drowsiness, anxiety, , dizziness, confusion, cognitive impairment, heart palpitations, itching, incontinence, difficulty urinating are possible side effects but don't let that scare you off and they often lessen in a few weeks and there are things you can do to control them. Many many forum members find buprenorphine controls their RLS.

You are using mirapex which is pramipexole so just substitute mirapex in what I am about to tell you.

First off check if you are on the slow release pramipexole. The slow release ones usually have ER or XL after their name. If so you need to switch to the regular pramipexole because the slow releases ones can't be cut.

To come off pramipexole reduce by half of a .088 [.125] tablet) (ask for a prescription of these if needed)every 2 weeks or so. You will have increased symptoms. You may need to reduce more slowly or with a smaller amount or you may be able to reduce more quickly. Wait until the increased symptoms from each reduction has settled before going to the next one. You will suffer and may need a low dose opioid temporarily to help out with the symptoms especially as you near the end. Some have used kratom or cannabis temporarily to help. But in the long run, you will be glad you came off it.

Dopamine agonists like ropinirole and pramipexole and the Neupro patch (Rotigotine)are no longer the first line treatment for RLS. Gabapentin or pregabalin are. (Pregabalin is more expensive than gabapentin in the US.) The beginning dose is usually 300 mg gabapentin (75 mg pregabalin) [Since you are over 65 if you are susceptible to falls beginning dose is 100 mg (50 mg pregabalin.)] Start it 3 weeks before you are off pramipexole although it won't be fully effective until you are off it for several weeks. After that increase it by 100 mg (25 mg pregabalin) every couple of days until you find the dose that works for you. Take it 1-2 hours before bedtime as the peak plasma level is 2 hours. If you need more than 600 mg take the extra 4 hours before bedtime as it is not as well absorbed above 600 mg. If you need more than 1200 mg, take the extra 6 hours before bedtime. (You don't need to split the doses with pregabalin) Most of the side effects will disappear after a few weeks and the few that don't will usually lessen. Those that remain are usually worth it for the elimination of the RLS symptoms.

If you take magnesium even in a multivitamin or magnesium-rich foods, take it at least 3 hours before or after taking gabapentin (it is OK with pregabalin) as it will interfere with the absorption of gabapentin and if you take calcium don't take it nor calcium-rich foods within 2 hours for the same reason (not sure about pregabalin). According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin (200 to 300 mg pregabalin)."

Have you had your ferritin checked? If so what was it? This is the first thing that should be done for RLS. Improving your ferritin to 100 or more helps 60% of people with RLS and in some cases completely eliminates their symptoms. If not ask your doctor for a full iron panel. Stop taking any iron supplements including in a multivitamin 48 hours before the test, don't eat a heavy meat meal the night before and fast after midnight. Have your test in the morning before 9 am if possible. When you get the results, ask for your ferritin and transferrin saturation (TSAT) numbers. If your ferritin is less than 100 or your transferrin saturation is less than 20% ask for an iron infusion to quickly bring it up as this will help your withdrawal. If you can't get an infusion, let us know and we can advise you further.

Check out the Mayo Clinic Updated Algorithm on RLS which will tell you everything you want to know including about its treatment and refer your doctor to it if needed as many doctors do not know much about RLS or are not up-to-date on it as yours obviously isn't or s/he would never have prescribed a dopamine agonist at Https://mayoclinicproceedings.org/a...

Some things that can make RLS symptoms worse for some people are alcohol, nicotine, caffeine, sugar, artificial sweeteners, carbs, foods high in sodium, foods that cause inflammation, foods high in glutamate, ice cream, eating late at night, oestrogen (estrogen) including HRT, dehydration, electrolyte imbalance, melatonin, Monosodium Glutamate (MSG), collagen supplements, eating late at night, stress and vigorous exercise.

Some things that help some people include caffeine, moderate exercise, weighted blankets, compression socks, elastic bandages, masturbation, magnesium glycinate, fennell, low oxalate diet, a low-inflammatory diet, selenium, 5 minute shower alternating 20 seconds cold water with 10 seconds hot water finishing with hot water for another couple of minutes, hot baths, distractions, applying a topical magnesium lotion or spray, doing a magnesium salts soak (epsom salts), vitamins B1, B3, B6, B12, D3, K2, if deficient, and potassium and copper if deficient, massage including using a massage gun, vibration devices like therapulse, using a standing desk, playing and listening to music, creative hobbies, meditation and yoga.

Many medicines and OTC supplements can make RLS worse. If you are taking any I may be able to provide a safe alternative.

[Elisse3 in reply to SueJohnson]

Sue can they take the buprenorphine and reduce the pramipexole at the same time ? This is a member of a fb group i mentioned might help to ask questions on here on the side effects of buprenorphine they seem to worry more about side effects of meds then weaning off their dopamine med. I am hoping the buprenorphine will be a med they can take or at least try with minimal side effects.

[SueJohnson in reply to Elisse3]

Yes they can use buprenorphine to help wean off the pramipexole. It will make the withdrawal a lot easier.

[DesertOasis]

Hi Rider, are you on an SSRI or calcium channel blocker?

[nsrrider in reply to DesertOasis]

Hello, I don't know what a SSRI is. I recently ordered a calcium supplement (not sure what a calcium blocker is) and currently use Magnesium Citrate (which seemed to really help the RLS) I'll have to look up the Iron/Ferritin number but both were very good. thanks!

[DesertOasis in reply to nsrrider]

An SSRI is an antidepressant. It’s VERY helpful if you tell us all medications you are on.

[nsrrider in reply to DesertOasis]

no anti-depressants, just meds for cholesterol, arthritis, blood pressure.

[SueJohnson in reply to nsrrider]

Many medications for cholesterol and blood pressure make RLS worse. If you tell me what they are I can tell you if they are safe or not for RLS and if not can give you a safe substitute.

Do let us know what the ferritin number is as doctors will say it is normal but what is normal for others is not normal for those of us with RKS.

[nsrrider in reply to SueJohnson]

Atorvastin, Lisinopril and Ferritin number was 267

[SueJohnson in reply to nsrrider]

I'm assuming you meant Atorvastatin. Unfortunately all statins make RLS worse for most. Nexlizet (Nustendi) is a cholesterol lowering drug that is not a statin, but I don’t know if it exacerbates RLS symptoms. Ezetimibe (Zetia) reduces cholesterol although it doesn't reduce cholesterol as fast as the statins, but according to Chris Columbus it didn't trigger his RLS. And then there are Triglide (Fenofibrate, Fibricor, Lipantil, Lipofen, Supralip) and Bezafibrate (Bezalip) which are not statins which seem safe. You might want to discuss these with your doctor. A more difficult way to reduce cholesterol is to go vegan. My husband lowered his cholesterol from 221 to 131 this way.

If you end up taking gabapentin or pregabalin you should be closely monitored as it can raise the bad LDL and lower the good HDL.

the Lisinopril is probably OK.

[Joolsg]

Everyone is different.Common side effects are nausea, sweats, anxiety, depression, constipation.

I had severe nausea for 10 days but used medical cannabis to sort it. I have head sweats and panic attacks but take a small dose of pregabalin and 10mg cetirizine to settle them.

Not everyone experiences them though.

And if you are still on a dopamine agonist, make sure you use the Buprenorphine to get off the DA.

I know of at least one person who started Buprenorphine and it stopped all RLS instantly, but they then stayed on the DA.

Of course the augmentation broke through again.

So reduce Ropinirole by 0.25mg every 2 weeks and Pramipexole by half a 0.125mg pill every 2 weeks. Increase Buprenorphine by 0.1mg as you drop each DA dose.

In the USA Buprenorphine comes in 2mg pills or buccal film.

Here in Europe and UK we have much smaller doses. I take 0.4mg. Others manage on 0.2mg.

You can cut the 2mg pill but apparently the buccal film is easier to cut into strips.

[Johan10]

The side effects I have had are daytime drowsiness, light headiness and some nausea. I think the extent of side effects depends on the individual sensitivity to opioids and the dose needed to control the RL. For me 0.2mg or even less (ie half a tablet) are sufficient and at this level I now, after a few months on Buprenorphine, suffer next to no side effects. In my view, so far, it is extremely effective.

[Anthas]

Hi! I've got no side effects a part from the ocasional dry mouth...Also when I'm about to sleep and have taken my sublingual pill, I experience a weird buzzing when I close my eyes that normally means I'm going to have a nice night of sleep! Keep in mind I only take 0.2mg and I guess that the severity of the sidde effects might be linked to the dose. But for me, after three months, I'ts been incredible

[HipHop1972]

Hi, nsrrider, I’m glad that you’re recovering from DAs. I’ve been on Buprenorphine Patches for 5 months now, RLS completely gone and sleeping like a teenager 🤣. We are all different and don’t necessarily have the same reaction to medications. I guess I’m lucky, slight headaches in the mornings, extremely vivid dreams but not nightmares and irritation where the patch was previously positioned but you have 6 options to move the patch around as instructed on the leaflet. I would definitely go for it but you can have it prescribed in tablet form that you take at night, it’s usually dependent upon your specialist and what he usually prescribes.

Best wishes and good luck HipHop1972 🤞

[intermk]

If you do get a Rx for buprenorphine (Bupr) your doctor should know you're on blood pressure med(s), if the same doctor. A common side effect of Bupr is low blood pressure. I was on both Bupr and a BP med and nearly died. My blood pressure got so low one day that I felt queasy, lite headed and was stumbling around a bit. All my doc's knew I was taking BP med and Bupr yet none were concerned about this or at least didn't know about Bupr's blood pressure lowering effect. I called the nurse triage line and they told me to have someone take me to the emergency room (ER) immediately. At the ER the nurse told me my BP was 80/46 and may have been lower before all the excitement and movement started. I had not yet taken either my Bupr or BP med yet that day. But I do take my own BP from time to time. So I knew it was getting lower but still within normal limits (WNL) two days earlier. The ER doc told me that had I taken those two meds again I might well not have made it through the night alive. So, monitor your own BP everyday if you are taking both Bupr and a BP med. Raise the issue with your doctor(s) to make sure they are aware of this possibility. The only other side effect I've had after years taking Bupr, is constipation. Note: I have been on as much as 12 mg Bupr per night. Down to 7 mg now. Most people seem to be on 1/2 to 1 mg Bupr. At that low dose there might not be a problem with taking both meds simultaneously. Again, ask/inform your doctor. I think Bupr is the best medicine for controlling severe RLS or just nocturnal myoclonus. So go for it if you think your RLS symptoms are severe enough to keep you awake all night, every night.

[Knittingasweater]

I had a little fatigue at first couldn’t stay awake.. but I was on too high of a dose , I take 2 mgs daily in the film form .I rip it in half take half in the morning and half at bed, I have zero RLS.But know it is physically addictive and you suffer severe withdrawl , it is a medication I feel I’ll be on for life but it’s better then not wanting to live anymore with severe RLS

[restlessstoz in reply to Knittingasweater]

Hi Knittingasweater, just a note on the use of the word 'addictive'. Many medications when use, cause the body to become DEPENDANT on them. This is the case with buprenorphine.

'Addiction is a neuropsychological disorder characterized by a persistent and intense urge to use a drug or engage in a behavior that produces natural reward, despite substantial harm and other negative consequences. Wikipedia'

I know it sounds pedantic but there's so much negative noise around the use of opioids that it's important for us to use the terminology that doesn't inflame the debate. I am on buprenorphine and am dependant on it for the treatment of my RLS,. I'm not addicted to it.

Isn't it absolutely amazing that there is a medication out there, like buprenorphine that stops RLS in it's tracks and enables us to live a life that doesn't revolve around constantly fighting the symptoms and the desire to not live at all.

Happy knitting.

[Retiredandrestless]

I just started Buprenorphine a couple weeks ago and its been a miracle. I'm in the US , and I have the 2 mg although I only need to use 1 mg. You can cut in half, that's what I do. I had been on hydrocodone for 14 years until it stopped working. I just get a slight headache. Maybe it will go away when all the hydro gets out of my system. Also,yes I have a little constipation, but I had that while on hydro too. If you go on it just ask for nausea medicine. I asked on here what med wouldn't interfere with the Buprenorphine and that's what my Dr prescribed. It really is a,miracle medication., good luck!

[SoundsMusic]

I’m 4 mths on Buprenorphine sublingual tablets and it has been life changing - RLS completely under control. I quarter the 0.4mg tablets - most nights I only take 1 quarter but occasionally I need to take another quarter if I feel a little breakthrough of symptoms. Side effects are 1) constipation, for which I take Sena (1 tablet) and Magnesium Citrate (300mg) at night. 2) very vivid dreams every night 3) sweats (not every night) 4) kind of numbness in back of my throat the following morning if I take second quarter tab, but it passes after being up a few hours.

[pookiebyrd]

I ha e been on it for well over a year and have not had any side effects and have also had almost no restless leg symptoms. I think ots great