Buprenorphine crash

[kirks2092]

hi

mum takes her first Buprenorphine tablet early evening and the last one before bed, )the second tablet seems to give her a bit of a high, it makes her feel good), this covers her rls but she gets this horrific anxiety in the morning, and i am wondering if its the Buprenorphine causing like a crash in her mood as the effects leave her body

can anyone advise what to do to stop this?

she take’s trazadone for depression but thats before bed

thanks

x

[LotteM]

Sorry to hear this. It does sound like some mini-withdrawal effect. I had overall body restlessness during the day when I took buprenorphine tablets (0.2mg about 8 PMish). After a while, my doctor switched me to a buprenorphine patch providing 24h/7d relief.

However, your mum van play around with the tablets. First and foremost, does she need the second tablet? Can she e.g. split the first one, and take one half early and the other half late evening? Of she really needs the two tablets, still apply the cutting in half and spread the half tablets. E.g. start a bit earlier and leave the last one until she wakes up at night.

This is more of a hassle and will require some trial and error to see if it works. Do read stories by Davchar to see how he experimented and finally found a regime that works fairly well. He had a somewhat similar problem.

[kirks2092 in reply to LotteM]

thank you 🙏

i will suggest this to her

[davchar23 in reply to kirks2092]

Dear kirks2092,

Lotte M is in my opinion correct in that I your Mum is suffering mini withdrawals by taking whole 2mg tablets over a very short evening period, This boosts the bupre level in ones system over the nausea level and this manifests itself in in nausea early in the morning and sometimes through the morning depending on a persons activities etc.

It is possible to cut the tablets into small portions (using a good tablet cutter) and spreading the required dose over a 24 hours period. However I feel the use of a small patch and using one or two 50mcg portions is the best way to eliminate nausea.

I suggest you firstly establish the daily quantity of bupre your Mum needs to block her RLS. In my case that was between 0.4 and 0.5 mg/day. I use a 10mcg/hr patch which gives me 0.24mg in 24hrs and then I top up 50mcg portions of tablet at periods during the day & night. It is a bit messy but removes the severe nausea I experienced previously.

Best wishes

Davchar

[kirks2092 in reply to davchar23]

Hi Davchar

Thank you for your reply.

Was your nausea just in the mornings? mums nausea is all day and seems to get worse after eating.

shes had every test under the sun and apart from a urology problem they are still investigating there is no answer.

she’s currently in hospital on 2 anti sickness meds which do seem to be helping.

I am not sure now if the bupre is contributing to the nausea as she only started feeling nauseous 3 months after starting it and had bouts of nausea before taking it but not this long.

I do think there is a possibility some of the nausea may be the bupre, she had terrible trouble weaning of her previous drug before going on bupre and had rls 24/7 she didn’t sleep for weeks

i do feel she has ptsd from it but of course the only safe anti depressants she can take is trazadone and it doesn’t do a lot

she is scared to alter the timing of her pills and the rls come back ( she did have breakthrough rls on patches)

at the moment she takes 1 at 630 and one just before bed around 11 and that gives total coverage. ( 0,4 in total) she is actually prescribed 0.6 so we could look at potentially adding another dose in the day but i don’t know if that willl cause more problems

x

[davchar23 in reply to kirks2092]

Dear Kirks2092,

My nausea was always in the morning starting early and often wakening me at 5am-6am but clearing by latest 12 noon. I still suspect bupre is the cause of your Mum's nausea and it may be that spreading the tablet load as follows might help.

Work on the basis of needing 0.4mg per day (ie 2 tablets) and cut the tablets into 4x 100mcg/tablet. Then take each portion at 6pm, 11pm (as now), 6am (or earlier if woken up), 12 noon as a starter plan. Another half or even a quarter if the RLS seems to be breaking through. I found that the tablets need about 45 minutes to take effect.

Breakthrough on patches is a problem because they do not last the specified 7days ...more like 5to 6. That is why a mixture of tablets & patches is more reliable

Please try the spread dose suggested but remember each person is slightly different.

I tried several anti nausea medications and none had any noticeable effect on the nausea

Good luck

Davcahr

[kirks2092 in reply to davchar23]

thank you so much for this, did you find them easy to cut?

thanks

[SueJohnson in reply to kirks2092]

You can get a jewelry scale on Amazon that measures down to .01 gram for around $11 and shave off a bit and measure that way.

[Joolsg]

I had terrible anxiety/panic attacks when I first started Buprenorphine. Every morning.I had the same when I first started Oxycontin. I emailed Dr Buchfuhrer in the USA and he suggested adding a small dose of pregabalin. Pregabalin is sedating and counters the 'opioid alerting' which causes anxiety/panic attacks.

So, you could try playing around with the timing of the dose. If that doesn't help, you could ask GP for a small dose or pregabalin. I initially took 50mg for a month. And then slowly reduced it. I now take just 6.25mg at night. I cut the 25mg pills and divide the powder with a knife.

But check with her doctor. As she's already on trazodone- that should also act as a sedative.

What Buprenorphine dose is she on ?

[kirks2092 in reply to Joolsg]

shes on 0.2 x 2

she’s currently in hospital the nausea and not eating have got extreme

she lost so much weight

[Joolsg in reply to kirks2092]

Oh wow. Nausea was overwhelming for me but medical cannabis stopped it within days. My neurologist also prescribed Zofran- an RLS safe anti nauseate.She definitely needs to ask for zofran.

And if the severe side effects do not settle within a few weeks, she needs to have an in depth discussion about a possible switch to methadone OR Oxycontin .

And make sure hospital doesn't give her meds that worsen RLS. Many anti nausea meds worsen symptoms.

Tell her team to look at RLS-UK website which sets out Medicine that worsen RLS.

[kirks2092 in reply to Joolsg]

hey jules

thanks for your reply

we tried the cannabis but it didn't stop it

i will mention the zofran to the dr. luckily her rls symptoms are well controlled by the Buprenorphine, so that does give her a window or opportunity to try a few other drug options that she would not have been able too if she wasn’t on it.

We are hopeful it’s not the Buprenorphine thats the main cause of the nausea as a lot of her symptoms are made worse by eating and she was on it 3 months before the nausea started

she has a bladder problem as well and severe ibs. we think the Buprenorphine as well as a medication shes on has made her ibs really bad.

its very long winded

xx

[Joolsg in reply to kirks2092]

Understand. I do hope they find out what's causing the problems. My mum had similar issues ( not from meds) and it was a bowel obstruction caused by diverticulitis.Sending positive thoughts.