Moving from Gabapentin to Buprenorphine

[thorp]

I have severe RLS and severe PLMD

I take the following meds; Losec (omeprazole) 10mg ( for GERD ) , Losartan 100mg ( for high blood pressure) Spironolactone 50mg ( for diuretic and heart) ) Levothyroxine 75mg for thyroid and Magnesium 375mg.

Plus of course I am currently on 1800 mg Gabapentin and 325 micrograms clonazepam every night for my RLS and PLMD

My neurologist has given permission, because I have tried most other things and they have failed, for me to move to Buprenorphine

I have an appointment with my GP for next week when i will ask for a prescription

I would be most grateful for some advice from this so knowledgeable forum

Q1 I have noted,on this forum , that there are different types and strengths of Buprenorphine. What type and strength should i ask my GP to prescribe?

Q2.. How can i best manage the switch from 1800 gabapentin and 325 clonazepam to buprenorphine?

Do I reduce the gabapentin first and by how much, at what time interval.

Or do i start by reducing the clonazepam.

Or do i reduce both at the same time etc

Q3. What kinds of side effects can i expect?

Q4 What can i do to alleviate these side effects?

Thank you all very much in advance for your help

[Madlegs1]

The omeprazole won't be doing your RLS any favours.

Sue will advise on alternatives.

[Joolsg]

Buprenorphine sub lingual pills are very effective. Start with 0.2mg at night. Add another 0.2mg next night if it doesn't cover RLS completely 24/7..Average effective dose is 1mg so you can add 0.2mg until it covers all symptoms. I find taking 0.2mg at 9pm and 0.2mg at midnight gives the best cover for me.

Side effects are nausea, constipation, anxiety, depression and sweats but all can be dealt with..

Ask for some zofran in case you develop severe nausea. It will pass but lasts 2 weeks for many people. I used medical cannabis.

The anxiety can be solved by staying on.a low dose of gabapentin and that will help sweats as well. Constipation can be solved by taking magnesium citrate every night.

When you find the dose that stops all RLS, slowly reduce gabapentin first by no more than 10% a week. You can go slower if you experience any side effects.

Once off gabapentin, you can then slowly reduce clonazepam.

As Madlegs points out omeprazole, the diuretic and the blood pressure meds all make RLS worse. You can try safe alternatives or wait until Buprenorphine completely settles your symptoms. Once you are sleeping properly, you may find your other conditions improve and you can stop the other medications. I know Shumbah could stop her blood pressure and diabetes meds when her sleeping and health improved after starting Buprenorphine.

[thorp in reply to Joolsg]

Thank you so much

so helpful

[SueJohnson]

Omeprazole makes RLS worse. Try gaviscon advance instead.

[SueJohnson]

Don't take Omeprazole within 4 hours of levothyroxine.

Time your medicines so that you take your thyroid medicine at least 4 hours away from any medicines that contain aluminum, calcium, iron, magnesium, simethicone, or sucralfate even in a multivitamin.

[SueJohnson]

On the gabapentin my advice is to reduce by 100 mg every 2 weeks to avoid withdrawal effects.

[SueJohnson]

Take the gaviscon advance 30 minutes after eating and 4 hours before or 2 hours after taking iron. Don't take it within 2 hours of taking gabapentin.or antihistamines

[SueJohnson]

Your losartan is OK.