buprenorphine with nalaxone

[kirks2092]

hello

is anyone on bupre with nalaxone please?

i was wondering is the bupre dose the same with just the nalaxone added?

many thanks

kirsty

[Joolsg]

bnf.nice.org.uk/drugs/bupre...

The doses of Buprenorphine are set out on the medication pack.

The BNF lists all the available pills with naloxone.

Which pill are you taking?

Buprenorphine without naloxone starts at 0.2mg. The average UK dose is between 0.4 and 0.8mg.

However, the lowest dose buprenorphine pill with naloxone is 1.4mg of Buprenorphine.

That's over 3 times the dose I take.

The naloxone might help reduce constipation or nausea.

[kirks2092 in reply to Joolsg]

hi jools

she’s currently prescribed 0.4 i believe

currently at the moment we are cutting individual pills in quarters so she’s taking roughly equivalent to 1 pill of 0.2 in quarters at various times. patches have made nausea worse unfortunately

as she’s prescribed 0.4 i was trying to find the equivalent dose in the bupre with naloxone

and then we continue cutting

she’s experiencing terrible nausea and the gastric issues they now believe are down to bupre unfortunately , so we think adding naloxene may be a idea but just didn’t want a different dose which may affect rls

many thanks

[Joolsg in reply to kirks2092]

The pill strengths are different. So getting 0.4mg will be difficult as the lowest dose of Buprenorphine with naloxone is 1.4mg. Cutting the pill to achieve 0.2mg will be VERY difficult.And unfortunately- naloxone isn't available as pills separately.

I am so sorry that she is still struggling with nausea.

The only alternative might be to switch to Targinact and ask for 6 x 5mg pills and take every 4 hours. Targinact is usually prescribed twice a day. But thst causes interdose rebound for many people. And so taking it more regularly through the day seems to avoid this.

This disease is horribly cruel. You find a med that stops the RLS symptoms but the side effects can be intolerable.

[kirks2092 in reply to Joolsg]

thank you, will look into this

is methadone something else she could try?

[davchar23 in reply to Joolsg]

Dear Jools,

How much evidence is there of adding naloxone to buprenorphine gives relief from nausea? I

Davchar

[Joolsg in reply to davchar23]

None. I simply suggested it because nothing else is helping the nausea for Kirks' mum.There is a research study that shows naloxone can reduce nausea but it's a wild shot/suggestion because the nausea is so overwhelming and switching to patch/patch+pills/pills alone just isn't working. Zofran and cannabis didn't stop it. Hospital seems stumped and so is saying it must be Buprenorphine.

[davchar23 in reply to Joolsg]

Dear Jools,

I have not found a "formula" that eliminates the buprenorphine caused nausea completely but by very careful monitoring of patch + tablet it can be made much more tolerable. I find that from late morning and through the rest of the day the nausea is at a low level but as soon as I get out of bed and have even the lightest of breakfast the nausea increases. I doubt naloxone is the answer.

Kind regards

Davchar

[Joolsg in reply to davchar23]

I agree Davchar. It was a wild suggestion in the hope that it might help.But nothing seems to be stopping the nausea.

[DogBella in reply to davchar23]

It took nearly a year on buprenorphine/naloxone for the nausea to lessen and even now I have periodic nausea.

[kirks2092]

hi joolsg and davchar

the only small difference we have found is keeping the bupre as low as possible and taking the tablets in quarters roughly every 6 hours. this definitely seems to help a little and we are going to continue with this ( patch just seemed to make the nausea horrific)

mum is also taking domperidone which seems to have slightly ( don’t want to jinx it) but very slightly help.

we are considering the possibility later of adding pregabalin as well

x