Changing from Ropinirole to Buprenorphine

[Faith_Hope_1]

I started to take Buprenorphine on 14th October and have been tapering the Ropinirole. I am now taking 4mcg of Buprenorphine a day in four separate doses. I have cut back the Ropinirole to 0.5mg a day in two 0.25mg doses. I am now tapering by cutting a small amount off the 0.25mg pills and seeing how that goes. I haven't had any nausea. However, I am currently feeling low and on the edge of panic at times. I am finding that I am struggling with dark thoughts and I wonder if this could be a side effect of the Buprenorphine that may pass in time? I am trying to overcome it but it's a struggle. I am awaiting an MRI to see what is going on with the neuropathy that I have in my legs and up to my ribs and this is causing me great anxiety so, of course, it adds to any anxiety that may be caused by the Buprenorphine. Any advice welcome.

[Joolsg]

It is probably a combination of DAWS and the anxiety caused by Buprenorphine.Buprenorphine cannot completed stop dopamine withdrawal symptoms. You've flooded your brain with the pleasure hormone dopamine for years. When you reduce it- you will experience anxiety/depression.

It's very common and few people escape it.

Buprenorphine can also cause anxiety /depression.

So speak to your doctor and ask for a small dose of pregabalin to counter any opioid anxiety.

As you drop the last 0.25mg the withdrawals will get stronger.

Try not to increase the Buprenorphine above 6mcg (0.6mg) until 2 to 3 weeks after the last dose of Ropinirole because your brain's dopamine receptors need chance to settle.

And then you can start moving the daytime doses of Buprenorphine to the nighttime. Buprenorphine has a 25 hour half life so, once off Ropinirole, you should be taking it at night only to cover the RLS which will revert to evening and nighttime.

The panic/ depression will settle once off Ropinirole for around 3 weeks.

If low dose pregabalin doesn't stop the panic after 4 or 5 days, you may need to try trazodone or wellbutrin, the safe anti depressants for RLS.

Or the occasional diazepam may help stop the panic.

[Faith_Hope_1 in reply to Joolsg]

Thanks for this reply, Jools. It sounds like I have a bit of a tough road to go still. I hadn’t realised the ropinirole would take so long to get over. I’m still taking ever smaller doses but it will obviously leave some after effects for a while even when I’ve stopped taking it altogether! I have some pregabalin because I was given some to take for the restless legs but they didn’t agree with me - made me feel woozy and did nothing to stop the restless legs. Would it be worth me trying some or should I do that under the advice of my doctor? I have some lorazepam under prescription to help if I get anxious about Afib but I rarely need to take them for that - I have been taking half of 1mg tablet occasionally to try to help with this anxiety. I did check that that was okay with my GP. Thank you so much for all your help - not sure what I’d do without the advice about taking the Buprenorphine correctly.

[Ischmael in reply to Faith_Hope_1]

I had been on ropinirole for over 10 years . Weaned off 8 months ago and was started on gabepentin 1800 mg and a rotigotine , neuropatch 1x/day. All going very well. I have a follow up appointment in Dec. to wean off patch- very apprehensive about that but we’ll see. Good luck to you.

[SueJohnson in reply to Ischmael]

I gave you this advice in June, but let me give it to you again as it has been awhile. You can do the reduction in one of 2 ways. Using a 1 mg Neupro patch cut it into sixths. The easiest way is to draw lines on it. This will equal the .25 mg reduction that is advised since 1 mg of Neupro = 1.5 mg ropinirole. Or you can switch to ropinirole. Multiply the dose of Neupro you are taking by 1.5 to get the correct amount. Since you can get ropinirole in .25 tablets this is the easier way to reduce. Then reduce by this amount every 2 weeks. 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.

[Joolsg in reply to Faith_Hope_1]

Dopamine Agonists flood our brains with dopamine, the feel good/pleasure hormone. When it's reduced/taken away our mood plummets. Very few people escape withdrawal symptoms. And the worst withdrawals happen in the 2 to 3 weeks after the last dose.

I personally found pregabalin helped my anxiety/panic attacks. I emailed Dr Buchfuhrer in the USA, one of the world's top experts. He suggested adding a small dose of pregabalin, so I asked my GP and she gave me a prescription.

It may work for you or you may need another med to settle the anxiety.

But definitely discuss with your GP.

The GP needs to know how difficult getting off dopamine agonists is for patients.

[707twitcher]

Just wondering why you are taking such a low dose of buprenorphine 4 times a day? Is it handling your RLS symptoms? Do you typically have them throughout the day? Most of us take buprenorphine only once a day before bedtime. I'd ask the doctor if you can try consolidating to one pre-bedtime dose and see if that changes your anxiety/depression symptoms. In the first month on buprenorphine, the RLS relief effects seemed to last me well over 24 hours. After a year on it, it has settled to being effective for 10-12 hours. If I want to take an afternoon nap, I usually need to take some or it's a very short nap. I can then usually get by with a reduced dose that night so that I'm not doubling up my normal dose.

btw, I assume you mean your current dose is 400mcg, not 4mcg. 400mcg = .4mg.

[teakabeagle]

the feeling you have are probably related to decreasing the DA. You are now dopamine deficient and will cause depression. The receptors need to recover and that can take months. I had to do TMS treatment as it was so severe after withdrawing from Prami. Taking .5 of s a Buprenorphine

[teakabeagle in reply to teakabeagle]

Sorry hit the send button. I now take .5 mg of Bup at night and have excellent results.