How much buprenorphine

[tagaxel]

Unfortunately the micro taper I was using to get off pramipexole has failed. I got all the way down from 0.875 mg to 0.5155 mg. I have tried twice but I can’t get lower. I was wondering how much buprenorphine is needed to block the withdrawal symptoms and control RLS.

[Joolsg]

Difficult to answer that. Dr Berkowski did a study in 2022 showing that Buprenorphine substantially reduced RLS symptoms and helped get patients through withdrawal.I know a few patients here in UK who used Buprenorphine while still on Pramipexole. But it worked SO WELL and stopped all augmentation symptoms immediately. So they stopped reducing Pramipexole.

So if you do use Buprenorphine- you must continue to reduce Pramipexole or you end up in a pickle.

I suggest you discuss with your doctor. If they don't know- ask Dr Andy Berkowski at

[e-mail]

Or tell your doctor to use

rlscurbside.org/

Curbside is for doctors to ask RLS experts for detailed help and advise.

0.5mg is a high dose still. So I would suggest you add 0.1mg Buprenorphine at each drop of half a 0.125mg pill. So by the time you are at the last 0.125mg pill you will be taking 0.6mg of Buprenorphine.

Try to stay at 0.6mg Buprenorphine until 2 or 3 weeks after the last dode of Pramipexole.

That leaves you some room to increase upwards if RLS isn't completely resolved.

As you're in the USA, you will likely need to ask for buccal film so you can cut the 2mg film strip into 0.1mg strips.

Cutting the pills will be too difficult.

[tagaxel in reply to Joolsg]

Thank you so much Joolsg. I passed your information along to the addiction psychiatrist who has been helping me with my pramipexole taper. I also have a neurologist who has been helping me with my RLS but I think the addiction specialist might be better here.

[tagaxel in reply to Joolsg]

Joolsg, I’m not sure what this means: “So I would suggest you add 0.1mg Buprenorphine at each drop of half a 0.125mg pill. So by the time you are at the last 0.125mg pill you will be taking 0.6mg of Buprenorphine.” The 0.125 mg pills can’t be cut but I probably could calculate the meaning of that in some liquid form. I’m just very confused as to how to use the buprenorphine.

[Joolsg in reply to tagaxel]

Every time you drop a dose of Pramipexole- you will have increased RLS. That's when you slowly add Buprenorphine. In small doses.And you can cut the 0.125mg pill. You buy a pill cutter from amazon.

When you are down to 0.125mg Pramipexole you should by then be taking 0. 6mg Buprenorphine.

Don't increase the Buprenorphine any more. Stay on 0.6mg until you've been off Pramipexole completely for 2 weeks.

This is ONLY my suggestion.

Most doctors are completely unfamiliar with Buprenorphine for RLS.

So we are very much on our own.

I only caution against using too much Buprenorphine early on- because then you end up taking a higher dose than you really need.

Dr Earley at Johns Hopkins does not allow patients to take any other meds while going through withdrawal or for 2 weeks thereafter. That way, he can determine the base level of RLS and prescribe the right dose of meds.

[tagaxel in reply to Joolsg]

My RLS is under control because I'm taking Horizant. I've been on pramipexole and Horizant for about 3 1/2 years. I haven't had any problem with RLS until I augmented with pramipexole (3 1/2 years ago) and switched to Horizant. I'm not sure why my RLS would increase if I'm tapering from pramipexole staying on Hoizant and using buprenorphine to prevent DAWS. I can reduce infinitely slower than 0.625 mg (0.125÷2).

[Joolsg in reply to tagaxel]

DAWS is different from dopamine agonist withdrawal symptoms. DAWS is when depression hits and doesn't end.

Buprenorphine may not prevent full blown DAWS.

Buprenorphine MIGHT stop the dopamine agonist withdrawal ( severe 24/7) RLS.

But just make sure you do get off Pramipexole completely.

Twitcher used bup successfully to avoid severe withdrawals.

Others have had varied success.

[SueJohnson in reply to tagaxel]

Unless 0 .125 pramipexole pills are slow release pills (have ER or XL after their name) they can be cut.

[tagaxel in reply to SueJohnson]

It's just a whole lot easier to take the pills to a compounding pharmacist so you can "cut" the pill into hundreds instead of just in half. But I'm wondering does it matter how much of a cut you make if you're taking buprenorphine.

[SueJohnson in reply to tagaxel]

Or use a jewelry scale to measure it and that way can take as little as one wants. Both your method and this would work.

[707twitcher]

My experience may be an outlier, but I was able to wean off pramipexole in just a few weeks (I was on .5mg for 12 years) thanks to buprenorphine. Finding the right dose just requires some experimentation. The good thing abut sublingual buprenorphine (Suboxone strips) it that it is fast acting. If the first dose doesn't completely relieve RLS symptoms after 30 minutes or so, you can take more. I got comlete relief from the first night, I think on about .4mg (1/5 of a 2mg Suboxone strip). As Joolsg says, you don't want to take too much because the side effects can be troublesome, and you'll want to take it slow to see how it affects you. I tapered down the prami quickly without any problems. But the tapering process needs to be tailored to you - don't go too fast or the withdrawal side effects will get you.

So my experience was different than Joolsg recommends. I got to the right bup dose for me quickly, and only then started tapering prami. Theoretically, your starting dose might be lower than you eventually need, because you will still be having the prami help. But that is easy to adjust upwards slowly as you go.

I think the 2mg suboxone strips are the most common Rx in US (I'm here also).

[tagaxel in reply to 707twitcher]

Is suboxone the same as buprenorphine?

[707twitcher]

Yes - it is the brand name for the sublingual film strips that you put under your tongue. Typical dose of each strip is 2mg buprenorphine and .5mg naloxone (which serves to make it harder to abuse this opioid, and some say it helps with constipation). I believe it's the easiest form of buprenorphine to use. Pills are harder to cut into smaller fractions, and patches are harder to get dosage right and have issues with how long they last (generally not the 7-days that manufacturers claim - and that messes with Rxs).