Butec/Buprenorphine Patches

[MumsSon1]

Hi

So, mum is currently using Butec patches (weekly)

We have worked out that on the day of changing, her RLS sysmtoms are hugely exacerbated so that she is in 'pain' most of the night

Has anybody else experienced this and if so do you have any ideas how we can manage this?

Currently increasing pregabalin with the aim of reducing Nupro slowly over the next few months

thanks for all your help!

[SueJohnson]

It is well known they don't last the full 7 days. Many people add the new one at 5 days keeping the old one on as it still has some left.

[MumsSon1 in reply to SueJohnson]

thanks Sue

[Madlegs1 in reply to SueJohnson]

You'll need to explain to your prescriber, otherwise they will think you are overdosing.

But there shouldn't be a problem ,as this is a well known and documented issue.

[707twitcher]

Here's a study with charts showing the patch effectiveness over its 7-day life. The effectiveness on day 7 is roughly half of what it is on days 2-4. Most of us switch on day 5 or 6 because of this. Either that or use sublingual pills or strips to top-up on the last day or two.

sciencedirect.com/science/a...

Just curious why she is on buprenorphine and still using Neupro? The buprenorphine should enable her to wean off the Neupro fairly quickly. Pregabalin likely does nothing while still using a DA (and maybe for a long time after quitting) because of dopamine receptor damage.

[MumsSon1 in reply to 707twitcher]

Hi

thanks for this. very helpful

Re the buprenorphine and Neupro, the buprenorphine wasnt enough, but with the Neupro added in (1mg patch only) it seems to very well control the RLS for the most part - it seems like the breakthrough pain was the real key and we never picked it up as such

I'm slowly upping hte pregabalin but am quite cautious as shes 93yrs old. She will go to 75mg prgabalin this week at night. how quickly and when can i start weaning her off the Neupro?

the Buprenorphine is currently 5mg and i'm a bt reluctant to give her 10mg 9we have available if needed and she has had in the past) as it causes her severe constipation and related issues

thanks

[LotteM in reply to MumsSon1]

Make sure you put on the new patch in the morning and do not yet remove the old patch until one or two days later. The nee patch takes time (12h +) to reach basic strength and the old patch kay still have some medicines left that may contribute to a smoother transition.

Also, if you feel the need to increase, you can also add half a patch to reach 7.5mcg/h.

[SueJohnson in reply to MumsSon1]

I agree with 707twitcher. At her age unless you expect her to live a long time, there is no point in putting her through the agony of weaning off the Neupro patch.

[707twitcher]

opioid side effects are awful for a lot of us. I found that a few prunes in the evening helps me. It’s not just fiber; there is a chemical that helps.

Given your mom’s age, it seems prudent to stay with what you’re doing. Unless augmentation kicks in with the Neupro. If that happens, check out the site for posts about weaning off Rotigotine. I was able to wean off Pramipexole quickly (2 weeks) with the help of buprenorphine, but Rotigotine might be different?

[Doctorplacebo]

Regarding her dose of 5 mcg/hr. That is the lowest dose available and an extremely low dose of opioid. Multiplied by 24 hrs/day that comes out to only 120 MICROgrams a day, or 0.12 milligrams in 24 hours. To put it in perspective people who use buprenorphine for Opioid Use Disorder use 50 to 100 times that amount.

Of all the RLS drugs your mom is taking, Nupro, pregabalin, and Bup, the buprenorphine is the safest with the fewest side effects. If it was me or my family member I would increase the buprenorphine dose and try and get completely off the other RLS meds.

FYI, I use buprenorphine transdermal 7.5mcg and nothing else. No sleep meds either. The bup takes care of my RLS and allows me to get enough sleep.