RLS medication and day surgery

[restlegs1]

Hi everyone. I have refractory RLS and am on 2.5 microgram/hour Buprenorphine transdermal patch and one 5mg tablet Methodone daily. I am due to get a basal skin cancer removed on Tuesday next under local anaesthetic. Can anyone suggest anything I need to do so that I don't get a big flare up during or after the operation? The dermatologist does not seem very familiar with dealing with patients on buprenorphine and methodone. When he took a sample for biopsy under a local, I had ongoing pain on the site from just after the last stitch went in. He was surprised at my having pain after a local, until I mentioned the buprenorphine . He had no suggestions about what to do. Fortunately the pain was bearable and went away when I went to sleep, but I might not be so lucky the next time.

[Jelbea]

Hi restlegs1 - I was amazed when I read your post this morning. I am also going on Tuesday next to have a basal cell cancer removed from my right cheek. I had one removed a year ago from my left cheek. It was to be cut out under local anaesthetic but when dermatologist started he decided it was not deep and decided to "scrape" it out instead and then it did not require stitches.

I take 800 mcg buprenorphine sublingual in divided doses each day. I do not remember having any pain after the procedure - only a little discomfort as you would expect.

I am very interested to see any replies to your post as on this occasion I may have to have this one cut out and stitched. I also take blood thinners and dermatologist has told me not to take the one on the evening before to avoid excessive bleeding.

I shall be thinking of you on Tuesday and hope all goes well for you. Best Wishes

[Retiredlady in reply to Jelbea]

I have been taking 200mcg Buprenorphine for 2 months.

It has worked like magic until about 2 weeks ago when unfortunately I started to get break though symptoms at different times of the day and night.

2 nights ago I woke with RLS symptoms after having taken my dose at 9pm..was desperate to get back to sleep so took another one.

It worked like a charm BUT I made a huge mistake taking my usual bp medication( 80mg micardis and 5mg Nebivolol) after breakfast.

I started to feel very unwell ..my bp had plunged to 85/45.I have not taken any micardis since and only now is my bp stabilising!(still taking Nebivolol)

I read that opoids can lower bp but did not expect such a large impact after taking only 200mcg extra.

I am now too scared to up my dose again BUT my symptoms are definitely not being covered with my 200mcg.

Did anyone else experience the same thing ?

What do I do now?… my cardiologists appointment is 4 weeks away!

[Jelbea in reply to Retiredlady]

Dear Retiredlady - I feel your post should have gone up as a new posting and not as a reply to me in another post. Perhaps you should post again but not as a reply.

However, in the meantime I cannot really give you much advice - only to say that buprenorphine can lower blood pressure. At what time did you take the second 200 mcg buprenorphine? Perhaps it was a little too near taking your other drugs at breakfast.

Joolsg would probably be able to help you more than I can and you could message her. You would be best to re-post your letter as an entirely new post in case people do not see it in answer to " RLS medication and day Surgery"

[Retiredlady in reply to Jelbea]

Thank you Jelbea, I will repost

[Retiredlady in reply to Jelbea]

Your post says u take 800mcg Buprenorphine divided into 4 doses each day. Can u please tell me the break down-presume every 6 hours?

As Buprenorphine should last approximately 24 hours, why aren’t you taking the 800mcg all at once?

Is it only working for 6 hours for you?

Do u have any problems with low bp?

I just don’t understand why my bp plummeted after taking 200mcg at 9pm and another at 3am when I had break through symptoms!!!Joolsg has told me I might need to increase my dose as most oof us need 4-8 mcg.

My med is called Temgesic SL-Tablet 200 mcg

[Jelbea in reply to Retiredlady]

Hello again Retiredlady - Others are able to take the buprenorphine just in the evening (Joolgs for example). Unfortunately that does not work for me. I have been told my a hospital pharmacist that I use up medication more quickly than others and so the one daily dose does not work for me. I take 200 mcg at lunchtime, 200 mcg about 6.30 pm and 400 mcg at 10.30 pm. If I do not take it like this I get breakthrough RLS during the afternoon and evening. I was put on this by Professor Walker of University College Hospital, London.

You may not require as much as me - some take less and some more than I do.

I do have borderline hypertension and I am inclined to think that the buprenorphine has helped to keep this borderline. I have been tried on several antihypertensive drugs but my diastolic pressure always goes too low so I am on no treatment for BP.

Regarding how much BUP you should take I cannot advise on this. You say that Joolsg has told you you might need to increase your dosage as some need 400 up to 800 mcg. I cannot see this post from Joolsg.

Who is advising you regarding BUP dosage? Perhaps they can help. You may require more but with the drop in BP I feel you should be cautious. Also you say your tablets are Temgesic. Some of us on this site have discovered that the brand Temgesic are not as effective as other makes. I get one called Tephine (just the same make up and strength) and this worked much better for me than Temgesic. Joolsg gets one called Accord (again just the same make up) and she finds this is the one which works best for her. No-one can explain why there is this difference in the different makes when they should work exactly the same.

I hope this information helps. Good Wishes

[Joolsg]

You can add a pain killer to take for a short period. I had my gallbladder removed recently and I am on 0.4mg Buprenorphine.The hospital gave me paracetamol and ibuprofen for the pain. It worked really well for the week I needed it.

[restlegs1 in reply to Joolsg]

Thanks, Jools, that is very reassuring to know.

[SueJohnson]

I don't have any suggestions for your problem but do wish it goes well.

However your taking methadone along with buprenorphine is a waste since the buprenorphine will block the methadone.

[restlegs1 in reply to SueJohnson]

Hi, Sue, thanks. Yes, I have been wondering about taking the two.I only take the methadone at night The pain specialist I am seeing explained that RLS symptoms occur throughout the day and night, and we may only feel them at night (this is my case), but there is a need for a booster medication at night. Why he did not prescribe an extra dose of buprenorphine to be taken at night I don't know. So far I have been symptom free so taking the two together seems to work. I think he wants to have me on as low a dose as possible, which I am all in favour of. He also put me on 5mg nightly of amitriptyline - I know, it is supposed to exacerbate symptoms, but the funny thing is that I can tolerate it, no symptoms at all. The reason for the amitriptyline, he said, is that even methadone and buprenorphine eventually augment, though the medical term he used for that is different. This process can be slowed down by a very small dose of amitriptyline.

[SueJohnson in reply to restlegs1]

That's ridiculous!!!

Methadone and buprenorphine do not augment and amitriptyline wouldn't affect that even if they did.

And symptoms are what you feel for RLS so if you only experience RLS at night, you only need it at night especially since both at least theoretically last 24 hours.