Cutting Buprenorphine patches

[davchar23]

I recently had cause to use a cut buprenorphine patch which had been left in its partially sealed packet for perhaps 6-8 weeks. Within 24 hours of application and the loss of effectivity of the patch it was replacing the "cut" patch seemed to result in mini withdrawal symptoms and some RLS break through. The portion of the patch also caused some irritation of the skin.

I had previously read that patches could be cut and the unused portion returned to packet without loss of effectiveness? My question is whether the partially sealed patch portion lost some of its effectiveness as not fully sealed with say sellotape etc

Has anyone any experience on this issue please?

Davchar23

[Joolsg]

medicinesinformation.co.nz/...

Conflicting advice out there.

But the above link seems to say Buprenorphine patch is a Matrix - and can be cut diagonally.

But check the leaflet to make sure.

Maybe it's because you left it for 6 to 8 weeks?

[davchar23 in reply to Joolsg]

Good morning Joolsg and thank you for your reply and helpful article attached.

I am not sure whether it is cutting the patch (not on diagonal), not sealing it when cut or the time involved but something has upset my buprenorphine routine. I am getting nausea and cold sweats for a lot of the day. The only other recent event has been the prescription of Indapamide (for high blood pressure). I started taking Indapamide 4 days ago.

Over sometime now I have been controlling the opioid side effects well using a 10mcghr patch and "topping up" with portions of tablet when RLS broke through. I am now confused that the morning nausea and sweats are mini withdrawal symptoms caused by the "old" patch not being effective enough?

I would appreciate your thoughts please

In the meantime i hope your health is on an even keel?

Kind regards

Davchar23

[Joolsg in reply to davchar23]

Indapamide is the answer Davchar.It's a diuretic.

Diuretics and HBP meds trigger worsening RLS.

healthunlocked.com/rlsuk/po...

The thread above discusses safe alternatives so discuss fully with your GP.

[davchar23 in reply to Joolsg]

Dear Joolsg,

Thanks your quick reply.. much appreciated. I will discuss alternatives with GP

So it looks as if the old cut patch is not the cause renewed nausea and sweats but more likely the additional buprenorphine I have taken thinking it was?

Davchar

[SueJohnson in reply to davchar23]

Indapamide causes low potassium and low potassium makes RLS worse. You can switch to a potassium sparing diuretic or take more potassium.

[davchar23 in reply to SueJohnson]

Sue,

Thank you for your reply. Indapamide was prescribed by my cardiologist to lower blood pressure but it seems to have caused me severe nausea after only a few days days use. However alongside the use of indapamide I have been using an old cut to size buprenorphine patch and this may be the cause of the nausea through withdrawal or more likely that i have used too much in the way of tablets to try top up. I am stopping the indapamide to see if that is the cause. I have seen in side effects of indapamide that it does cause nausea. Whatever it is i have really had a bad 36 hours of constant nausea but no RLS breakthrough due to regular top up with buprenorphine tablets

I would appreciate any further comments you have?

Best regards

Davchar

[SueJohnson in reply to davchar23]

Indapamide can cause nausea so hopefully that is the cause. If you then need something for your blood pressure post back here and I can give you the names of some that are safe.

[davchar23 in reply to SueJohnson]

Sue,.

Thanks and yes please

davchar

[SueJohnson in reply to davchar23]

Some medicines that are safe for high blood pressure are propranolol (Inderal, Hemangeol, InnoPran) a beta blocker that may help RLS, Isosorbide Mononitrate (Monoket, Imdur) which is not a beta blocker nor calcium channel blocker. Other possibilities are: Clonidine (Catapres) an Alpha-2-Agonist used to treat high blood pressure which may help RLS and which also treats insomnia, tenex (Guanfacine, Intuniv), prazosin (Minipress) an alpha-adrenergic blocker that is also useful in managing sleep-related problems caused by PTSD and Tadalafil a vasodilator that in one study completely eliminated RLS. Clonidine can actually help RLS. Discuss these with your doctor. And then there is reducing salt by 1 teaspoon a day nih.gov/news-events/nih-res.... If taking an ACE inhibitor or an ARB your potassium level should be checked as they can raise potassium levels.the opposite of what you are taking now.

[Cookiebum24]

Hi, I’m a nurse and we are advised never to cut patches as it causes the medication to leak out and cause an initial overdose when applied, then it will be ineffective thereafter.

[davchar23 in reply to Cookiebum24]

Dear Cookiebum24,

Thank you for your reply and whilst there appears to be two opinions on this issue my recent experience supports the "do not cut" theory. Kind regards

Davchar

[Danni54]

Hi. I was on Buprenorphine patches for a few weeks and was told not to cut them as it might cause withdrawal. I couldn't carry on with the patches because I had a terrible red rash which drove me crazy! I then fought for a few weeks to get the Sublingual Buprenorphine tablets but then my Dr.s , in their wisdom, decided to try me on Tapentadol which didn't help and then MST Morphine pills and I had a really bad allergic reaction to them. Rang my Surgery, left a message about the allergy but heard nothing back! I rang and made an appointment to speak to my Dr. and asked him to put me back on the Sublingual tablets which he has done. They are the only things which help my RLS but I have to take 3 - 4 , 400 micrograms of the tablets .I hope that you get what you need to help your RLS . It's such a horrible thing to have. Please take care.

Best wishes

[davchar23 in reply to Danni54]

Dear Danni54,

Thank you for your useful reply.

When you refer to " withdrawal" you mean that the patch does not give enough burpe and you get RLS breakthrough or withdrawal symptoms such as nausea?

I get a rash from bupre patches but only mild and I use a recommended skin lotion after removing the patch. I certainly agree with you that buprenorphine is the only drug that works after RLS augmentation.

I think the use a cut patch has upset my routine and caused me to exceed the bupre nausea level in my system and i am having trouble getting back my default state (ie 10mch/hr patch and about 200mg of sublingual tablet cut up into 3 or 4 part. This is a total of about .44mg per day. You seem to be taking a lot more bupre (ie 3-4 ,400mcg tablets is 1.2mg to 1-6mg per day?)

Best regards

Davchar

[Danni54]

Sorry for the late reply. WhatsApp sometimes drives me mad because friends and family have been messaging for hours which is lovely because they are worried about me but when I'm really struggling I find it tiring! Anyway, withdrawal...nausea, headaches and not enough Buprenorphine which makes the RLS worse. I am supposed to take 3 , 400 micrograms of Buprenorphine Sublingual tablets a day but have told my Dr. that I sometimes have to take another tablet through the night. My RLS is aggravated by the vertebral fracture which is compressing nerves so I find that the worse my vertebrae pain gets the worse the RLS gets. It's all extremely painful and exhausting and I still have a problem coming to terms with the way that my life is so restricted because I used to do so much.

I hope that you find that your medication works and that you get some peace from this horrible ' Syndrome ' !

All the best, Danni

[davchar23 in reply to Danni54]

Dear Danni54,

Thank you for your reply just read this morning. I am sorry to hear about the reasons for your high level intake of bupre but understand.

If I understand correctly you mean you get nausea from withdrawal if you decrease the dose for 3x 400mg tablets? I cannot seem to stop the nausea I have but am nervous to increase my bupre dose.

Best regards

Davchar

[Danni54 in reply to davchar23]

Hi again. I am so sorry that you are going through all of this. I was on an Opioid called Dipipanone and Cyclizine for 20 years for Endometriosis and the pain from that which is also horrendous and adhesions from major operation's. Then, without warning and with no help or support, they were stopped and nothing put in their place so the withdrawal was , also, horrendous. Bad nausea, shaking, bad RLS, stomach cramps and bad depression but that was extreme withdrawal. That went on for almost 2 weeks 😳! Do you have a sympathetic Dr.? Are there any of them left ?! Sorry....touch of sarcasm there ! You might be able to get an anti sickness prescription . I have some and they work quite well and I wouldn't alter your dose of Buprenorphine without talking to your Dr. .I hope this helps but if you have any further questions please get in touch. Jools, Sue and other's on this Forum have helped me so much and are much more knowledgeable than I am. Not many of the medical profession seem to be interested in learning about RLS. However, I have written to a Neurologist at our hospital begging him to help me and have asked my Dr. to refer me . The waiting list for this Neurologist is 2 years ! It might be worth finding out whether you have an RLS Specialist near you and I, also, joined the RLS Society so have a look at their website and the information there should help you. They need as many people as possible to join to back them up. I know that Jools is working really hard on our behalf to make the medical profession and the public know about RLS.

Please take care and let us know how you get on . At our age we should be relaxing and enjoying life instead of being in pain and exhausted!!

Wishing you all the best,

Danni

Love to everybody here!

[davchar23 in reply to Danni54]

Dear Danni,

Thank you so much for your supportive reply. It means a lot to exchange thoughts with people who understand the RLS & opioid issue.

I think that my use of an old cut patch, which was probably not providing an effective supply of buprenorphine and as a result my body has gone into a withdrawal situation, I am unable to concentrate on anything, have hot/cold sweats, keep falling asleep and the nausea is extremely uncomfortable. I have urge to walk around rather than sit (but not RLS). Logically I think I should take additional buprenorphine to stop the withdrawal symptoms but i am nervous to do that so have stuck to the 10mcg/hr patch and 2x50mcg portions of tablet earlier this morning

I would appreciate any comments

Kind regards

Davchar

[Danni54]

I am so sorry that you are going through this. I think it would be a good idea to talk to your Dr. before you do anything with your medication or if you live in England, phone NHS 24. I'm not a medical person so I am not qualified to tell anybody about Opioid amounts. It would, also, be an idea to write again to Jools or Sue who are so knowledgeable about RLS and different medications. Opioid withdrawal is awful physically and mentally and it needs to be carefully monitored ...something that I didn't have but just know that it's the medication and the withdrawal will pass but please phone your Dr. on Monday and let us know how you get on. I hope that you sleep well tonight! Take good care.

All the very best,

Danni

[davchar23 in reply to Danni54]

Danni,

Good morning and thank you for your reply.

I slept well and followed my default amounts of bupre late yesterday and overnight. This morning I feel much better. I think the nausea etc was caused by the old cut patch and allowing my bupre level to fall too quickly but not low enough to allow RLS.

Appreciate your support and thanks

Davchar