![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 32 to 56 of 56. Go back in thread:
Posted by kingcolon on September 22, 2008, at 0:26:47
In reply to Re: Does anyone have the original buprenorphine st, posted by Peter S. on September 21, 2008, at 22:51:30
Hi Peter,
I split the dose in two or three times a day intervals. The studies on depression, as well as for pain, seem to use split doses even though for addiction maintenance, a single daily dose is generally used. I think the biologic half-life is very short in comparison to the pharmacologic half-life. I do notice some "slipping" of mood toward the end of the dosing interval (say 6-10 hrs). The antidepressant effects did not occur instantaneously with me (unlike what is reported by others)--it took about a week to max out. There were anxiolytic effects almost immediately however. The sense of well-being it gave as well as it's motivating and anti-anhedonic effects have been the best of any medication I've taken over 15 years.
If others want to comment on their Sub experiences or add info on it, we should change the thread title since the original study was already referenced by undopaminergic.
Posted by okydoky on September 22, 2008, at 8:39:51
In reply to Buprenorphine experiences » Peter S., posted by kingcolon on September 22, 2008, at 0:26:47
Thanks for the input. Like every other narcotic I have taken it never lasts as long as the script says. Ive been taking 6-8mg day. Was supposed to be in two doses but I take 3mg and then at some point have breakthrough pain ( usually about 7 hours into the days first dose) and take 1 or 2 mg and then at 12 hours take 2 or 3mg for my last dose. I have been taking the naproxen with it to because the first day when i took 4mg my breathing was depressed so I thought I could not take enough for the pain. I will know more soon hopefully. I don't have a set amount yet because of the flare. Yesterday I had to take so much Lyrica I had no need for the second dose of Sub but I took it anyway. Can I ask exactly where you place the tab under your lip so that it dissolves the best and i don't end up swallowing some of it? It has been three days and the rawness is starting to where off. Not sure if it was withdrawal or what? I am definitely more anxious though. I have a definite need to take a tranquilizer. I have Klonopin and perphenazine at hand. completely or at least it seems so. Does anyone have an opinion as to whether Sub would be a better antidepressant than oxycontin or morphine or any of the opiates? I have more questions but I have to get my dog to the vet.
Thanks and talk later,
Okyp.s. as soon as my need for Lyrica is gone I will start on Amineptine I think.
Posted by kingcolon on September 22, 2008, at 11:17:00
In reply to Re: Buprenorphine experiences, posted by okydoky on September 22, 2008, at 8:39:51
You clearly need to take the Sub with a frequent dosing interval for pain relief. Anyone who's been using opioids chronically before starting Sub should find a dose that alleviates any withdrawal symptoms (eg, anxiety) before adjusting the dose further for pain or depression. This can be quite high (8 mg daily and higher) for some. However, most can cut back and get good control of both relapse and pain/depression with 8 mg or less. I've heard that some opioid addicts believe that "more is less" with this drug, in the long run, and that finding the minimum dose that helps is a good idea. For depression, I doubt that higher doses correlate with increased efficacy. I put Sub under the tongue in front and sort of clamp my tongue down on it while keeping my saliva "away" from there, holding it elsewhere in the mouth. I do this until the pill completely dissolves under the tongue which you can tell by moving your tongue over it and not feeling grittiness. This takes about 10 min for me, and sometimes I keep the remaining saliva in for a while longer, swishing it around.
As for Sub vs. oxy/MS, the fact that Sub has been effective even for ECT resistant depression suggests to me that it is at least as effective as the pure agonists for depression. Someone mentioned before that it has kappa antagonism, which oxy/MS doesn't, and this adds to it's antidepressant effects. What it isn't is a drug that makes you feel good because you're high on it(ie euphoric). (If you're dysthymic or dysphoric you will feel euthymic--in other words, "normal") Hope this helps a little.
KC> Thanks for the input. Like every other narcotic I have taken it never lasts as long as the script says. Ive been taking 6-8mg day. Was supposed to be in two doses but I take 3mg and then at some point have breakthrough pain ( usually about 7 hours into the days first dose) and take 1 or 2 mg and then at 12 hours take 2 or 3mg for my last dose. I have been taking the naproxen with it to because the first day when i took 4mg my breathing was depressed so I thought I could not take enough for the pain. I will know more soon hopefully. I don't have a set amount yet because of the flare. Yesterday I had to take so much Lyrica I had no need for the second dose of Sub but I took it anyway. Can I ask exactly where you place the tab under your lip so that it dissolves the best and i don't end up swallowing some of it? It has been three days and the rawness is starting to where off. Not sure if it was withdrawal or what? I am definitely more anxious though. I have a definite need to take a tranquilizer. I have Klonopin and perphenazine at hand. completely or at least it seems so. Does anyone have an opinion as to whether Sub would be a better antidepressant than oxycontin or morphine or any of the opiates? I have more questions but I have to get my dog to the vet.
>
> Thanks and talk later,
>
>
> Oky
>
> p.s. as soon as my need for Lyrica is gone I will start on Amineptine I think.
>
Posted by okydoky on September 22, 2008, at 16:50:35
In reply to Re: Buprenorphine experiences » okydoky, posted by kingcolon on September 22, 2008, at 11:17:00
Thanks. Of course every input helps. I'll try the under the tongue thing. What dose do you have? Mine are 2mg and taste like orange a bit. I guess when I taste it I think I am swallowing it. It is the third day and I am much calmer. No more jitters or sweats. I see that I will most likely not need as much as I thought the first two days but the dosing will have to be three times a day not two.
I felt like I could have gone completely without my first dose today. I only took 2mg. Its difficult when I am taking other pain meds with it. I will stop the Naproxen today. I tried to stop the Lyrica but I am still in a flare. The Pharmacy cannot fill my instills now. They cannot get the Heparin because of the recall I think. Everything is so difficult. I called a pharmacy that is an hour and a half away. If they can make it perhaps they can mail it. Or I can figure out how to write the script so I can get the stuff and compound it myself. I think they will stop the flare. I also got a script for an antibiotic. I asked for Levaquin but he prescribed Cipro. Last time I went through Cipro, Levaquin and then Levaquin twice a day. Does everyone think I am stupid??? What could I do I just took it. Maybe Ill get lucky this time. It is so hared to do anything. Why does everyone make it harder?
I just saw my new pcp who refused to prescribe Parnate. Said he never prescribes it, that he felt he had no control as I was asking him specifically for Parnate, would not take the methadone he prescribed and that he did not feel that my depression was bad enough to warrant such a drug. I guess I need to change pcp's. He said he would help me find a pdoc but I don't trust his judgment. Would you??? After I left I thought perhaps I should demonstrate to him and my family etc. just exactly how depressed I am. As long as I am fairly quite about it everyone seems to ignore or just not believe it. It is more convenient I guess.
Ok, I am venting I know. I appreciate the help.
A very frustrated,
oky
Posted by Peter S. on September 22, 2008, at 18:27:25
In reply to Buprenorphine experiences » Peter S., posted by kingcolon on September 22, 2008, at 0:26:47
Thanks for the response. What side effects have you experienced? Did you have any problems getting your doctor to prescribe it for depression? I'm wondering if I can get my HMO pdoc to go for it.
Regards,
Peter
> Hi Peter,
> I split the dose in two or three times a day intervals. The studies on depression, as well as for pain, seem to use split doses even though for addiction maintenance, a single daily dose is generally used. I think the biologic half-life is very short in comparison to the pharmacologic half-life. I do notice some "slipping" of mood toward the end of the dosing interval (say 6-10 hrs). The antidepressant effects did not occur instantaneously with me (unlike what is reported by others)--it took about a week to max out. There were anxiolytic effects almost immediately however. The sense of well-being it gave as well as it's motivating and anti-anhedonic effects have been the best of any medication I've taken over 15 years.
> If others want to comment on their Sub experiences or add info on it, we should change the thread title since the original study was already referenced by undopaminergic.
Posted by okydoky on September 22, 2008, at 22:56:27
In reply to Re: Buprenorphine experiences » kingcolon, posted by Peter S. on September 22, 2008, at 18:27:25
I just wanted to thank you guys for all the input. It was my doctors suggestion to try Bup but he would not prescribe it nor would any doc I spoke with. All the information from you on the board helped me. I emailed my doctor the DEA letter, a study about depression someone posted and a few other facts I picked up from you guys mostly and looking myself. Thanks to you he finally prescribed it. And thanks to you you continue to help me through how to take It and to be patient. I am not so nervous today and feel much better. I appreciate this support greatly. I have no real life support as everyone refers to it. It is just me and my dogs.
So thanks to all that have contributed to my well being. It is appreciated more than you can imagine. If it only lasts a day I will be as grateful as if it lasted forever.
I will continue to post how the Suboxone works for others to be informed.
oky
Posted by kingcolon on September 23, 2008, at 1:26:26
In reply to Re: Buprenorphine experiences » kingcolon, posted by Peter S. on September 22, 2008, at 18:27:25
I have a history of a relatively low level opiate dependence from 8 years ago, but have not had a relapse to date. However, my addiction was directly related to poorly responsive depression, which has persisted despite many meds. My psychiatrist and psychologist are both addiction specialists and have experience using bupe for their patients, and they also see quite a few people with dual disorders (depression+substance use). They knew of a number of their patients who showed remarkable improvement of depression with bupe, and advised me of this. That's how I got started on it. I continued some of my previous meds, but I'm going to try to eventually get off as many of them as I can without losing the benefits of combining them with bupe. I tried stopping Zoloft, but I felt it increased my irritability, so that failed. I think bupe does a great deal that other antidepressants don't, but not everything--it's mechanism is mostly related to dopaminergic activation, but it also effects glutamate and serotonin, so it is quite complex. As for side effects--the main one is constipation, but I'm using Miralax + one of the dissolvable fiber supplements and that takes care of it quite well. It can be sedating at first, but you adapt to it if you don't start on too high a dose, or slowly adjust the dose. Taking too much initially can cause nausea (worse than standard opioids! people use to get high). It's definitely not a drug to try to get high on by overdosing or you're likely to get significantly ill. Otherwise, to date I've had no bad side effects. I do find that using Wellbutrin with it minimizes any fatigue I may get.
> Thanks for the response. What side effects have you experienced? Did you have any problems getting your doctor to prescribe it for depression? I'm wondering if I can get my HMO pdoc to go for it.
>
> Regards,
>
> Peter
>
>
> > Hi Peter,
> > I split the dose in two or three times a day intervals. The studies on depression, as well as for pain, seem to use split doses even though for addiction maintenance, a single daily dose is generally used. I think the biologic half-life is very short in comparison to the pharmacologic half-life. I do notice some "slipping" of mood toward the end of the dosing interval (say 6-10 hrs). The antidepressant effects did not occur instantaneously with me (unlike what is reported by others)--it took about a week to max out. There were anxiolytic effects almost immediately however. The sense of well-being it gave as well as it's motivating and anti-anhedonic effects have been the best of any medication I've taken over 15 years.
> > If others want to comment on their Sub experiences or add info on it, we should change the thread title since the original study was already referenced by undopaminergic.
>
>
Posted by Peter S. on September 23, 2008, at 11:58:58
In reply to Re: Buprenorphine experiences » Peter S., posted by kingcolon on September 23, 2008, at 1:26:26
Thanks for the detailed info! I'm going to see what I can do to get a prescription. Since I've tried EVERYTHING I think I've got a good case for it as a last resort.
> I have a history of a relatively low level opiate dependence from 8 years ago, but have not had a relapse to date. However, my addiction was directly related to poorly responsive depression, which has persisted despite many meds. My psychiatrist and psychologist are both addiction specialists and have experience using bupe for their patients, and they also see quite a few people with dual disorders (depression+substance use). They knew of a number of their patients who showed remarkable improvement of depression with bupe, and advised me of this. That's how I got started on it. I continued some of my previous meds, but I'm going to try to eventually get off as many of them as I can without losing the benefits of combining them with bupe. I tried stopping Zoloft, but I felt it increased my irritability, so that failed. I think bupe does a great deal that other antidepressants don't, but not everything--it's mechanism is mostly related to dopaminergic activation, but it also effects glutamate and serotonin, so it is quite complex. As for side effects--the main one is constipation, but I'm using Miralax + one of the dissolvable fiber supplements and that takes care of it quite well. It can be sedating at first, but you adapt to it if you don't start on too high a dose, or slowly adjust the dose. Taking too much initially can cause nausea (worse than standard opioids! people use to get high). It's definitely not a drug to try to get high on by overdosing or you're likely to get significantly ill. Otherwise, to date I've had no bad side effects. I do find that using Wellbutrin with it minimizes any fatigue I may get.
>
>
> > Thanks for the response. What side effects have you experienced? Did you have any problems getting your doctor to prescribe it for depression? I'm wondering if I can get my HMO pdoc to go for it.
> >
> > Regards,
> >
> > Peter
> >
> >
> > > Hi Peter,
> > > I split the dose in two or three times a day intervals. The studies on depression, as well as for pain, seem to use split doses even though for addiction maintenance, a single daily dose is generally used. I think the biologic half-life is very short in comparison to the pharmacologic half-life. I do notice some "slipping" of mood toward the end of the dosing interval (say 6-10 hrs). The antidepressant effects did not occur instantaneously with me (unlike what is reported by others)--it took about a week to max out. There were anxiolytic effects almost immediately however. The sense of well-being it gave as well as it's motivating and anti-anhedonic effects have been the best of any medication I've taken over 15 years.
> > > If others want to comment on their Sub experiences or add info on it, we should change the thread title since the original study was already referenced by undopaminergic.
> >
> >
>
>
Posted by okydoky on September 23, 2008, at 13:02:16
In reply to Re: Buprenorphine experiences » kingcolon, posted by Peter S. on September 23, 2008, at 11:58:58
My two cents. Hope it is helpful.
I have been working with constipation caused by opiates for several years and discussed it with Naturopaths, doctors and my physical therapist.
If you are interested in trying to resolve it more naturally here are a few things I have tried.
I would suggest adding soluble and insoluble fiber to your diet and increasing your liquid intake. Fresh vegetables and fruits and I have personally found steel cut oats to be most helpful. There are web sites that list foods and there soluble/insoluble fiber content if you are interested.
Some of the over the counter fiber supplements contain psyllium, which can cause a great deal of gas and discomfort but is all natural. I use Citrucel along with Phillips magnesium tablets (I take 1/2 of the magnesium as a whole is too much. Everyone is different.) Depending on how much opiate I am on I have been able to control the constipation by increasing my dietary fiber and liquid intake. When that was not enough I added the Citrucel with some magnesium and on a rare occasion Senokot (natural sennosides).When all else fails I take Miralax. It is not recommended to take for more than two weeks as you can become dependent on it. The first time I was prescribed Miralax I ended up in the hospital completely dehydrated, so be careful. If all else fails this medication works wonders for many people I am told by my physical therapist.
I always try to resolve my health problems the most natural way initially before I delve into chemicals. It would be easier and more direct to just take the Miralax but I prefer to do things as naturally as possible.
With all the medications I now take that comment probably sounds ridiculous but it is the truth.
Hope this helps
oky
Posted by Peter S. on September 29, 2008, at 17:14:21
In reply to Re: Buprenorphine experiences » Peter S., posted by kingcolon on September 23, 2008, at 1:26:26
Hi King,
Have you ever tried discontinuing the bup? If so what kind of withdrawal effects have you had? How long do you think it would take to get off of it? I asked an addiction specialist and she said there may be physical dependence from buprenorphine.
Thanks!
Peter
> I have a history of a relatively low level opiate dependence from 8 years ago, but have not had a relapse to date. However, my addiction was directly related to poorly responsive depression, which has persisted despite many meds. My psychiatrist and psychologist are both addiction specialists and have experience using bupe for their patients, and they also see quite a few people with dual disorders (depression+substance use). They knew of a number of their patients who showed remarkable improvement of depression with bupe, and advised me of this. That's how I got started on it. I continued some of my previous meds, but I'm going to try to eventually get off as many of them as I can without losing the benefits of combining them with bupe. I tried stopping Zoloft, but I felt it increased my irritability, so that failed. I think bupe does a great deal that other antidepressants don't, but not everything--it's mechanism is mostly related to dopaminergic activation, but it also effects glutamate and serotonin, so it is quite complex. As for side effects--the main one is constipation, but I'm using Miralax + one of the dissolvable fiber supplements and that takes care of it quite well. It can be sedating at first, but you adapt to it if you don't start on too high a dose, or slowly adjust the dose. Taking too much initially can cause nausea (worse than standard opioids! people use to get high). It's definitely not a drug to try to get high on by overdosing or you're likely to get significantly ill. Otherwise, to date I've had no bad side effects. I do find that using Wellbutrin with it minimizes any fatigue I may get.
>
>
> > Thanks for the response. What side effects have you experienced? Did you have any problems getting your doctor to prescribe it for depression? I'm wondering if I can get my HMO pdoc to go for it.
> >
> > Regards,
> >
> > Peter
> >
> >
> > > Hi Peter,
> > > I split the dose in two or three times a day intervals. The studies on depression, as well as for pain, seem to use split doses even though for addiction maintenance, a single daily dose is generally used. I think the biologic half-life is very short in comparison to the pharmacologic half-life. I do notice some "slipping" of mood toward the end of the dosing interval (say 6-10 hrs). The antidepressant effects did not occur instantaneously with me (unlike what is reported by others)--it took about a week to max out. There were anxiolytic effects almost immediately however. The sense of well-being it gave as well as it's motivating and anti-anhedonic effects have been the best of any medication I've taken over 15 years.
> > > If others want to comment on their Sub experiences or add info on it, we should change the thread title since the original study was already referenced by undopaminergic.
> >
> >
>
>
Posted by okydoky on October 14, 2008, at 13:08:59
In reply to reasons BUP is not commonly used as antidepressant, posted by Crotale on June 20, 2008, at 0:30:55
I tried Suboxone for several weeks. I became very anxious on it. I tried it with Amineptine for a little over a week and found that although my mood might have improved a bit the anxiety only continued to get worse. My mind is disorganized, I am not able to think coherently much at all, I am overwhelmed. I stopped this experiment. It was too much. If I even wanted to continue with it I was going to have to fight my insurance company and my doctor made it clear he had no wish to involve himself in helping the effort so we switched back to Avinza because he is adamant that when dealing with narcotics there is a huge problem with generics, variability of how much medication is in each capsule or tab, so he made sure to prescribe one of the few narcotics on my insurance that is not generic. It works fine for the pain and I find that it is calming at least when I first take it. So I have that to look forward to for a time and I need it badly.
As far as taking Suboxone for depression in my estimation it is not as good as other opiates. For me it was quite apparent that my depression worsened after changing from morphine to Suboxone. I started back on some morphine a few hours ago and I can already tell I am calmer. That is my experience with Suboxone. I do better on Morphine or Oxycontin. I have not tried other opiates for any length of time.
Now no one hs been willing to prescribe Parnate for me. So I ordered some myself. I could not find anywhere to order some Procardia at least in gel cap form and am asking for help here.!
Any help!
I have hade numerous spontaneous hypertensive episodes in the past. My old pdoc prescribed Procardia gel caps so I would not have to go to the hospital. I have a blood pressure monitor. I am familiar with the diet and drug contraindications. As bad as I feel I am not looking for more PAIN, physical or mental!
Can anyone help me with the Procardia problem?
I am looking to try Parnate again because it worked in the past when nothing else did. Amineptine did work a few times but not consistently and did not work the last few times I tried it. I do think if I had not been so agitated on the Suboxone I could have had a better judgment about it working with it. Neither drug in my experience has been calming for me so it was not worth continuing the trial. Honestly if I had not had to fight with the insurance agency and order more Amineptine in a small amount for a lot of money, I might have tried it a week or so longer but it was not in me to do it and my doctor was refusing anyway. I get a lot of side effects from Parnate like nervousness, hypotension, not being able to sleep, acne and hypertensive crisis, but it does not bother my physical ailment in my bladder. This is why I am trying it anyway. Everything I have tried in the past few years has bothered my bladder. It only makes sense to try something that worked and did not bother my physical problem in the past.My current need is for Procardia and for assistance as I try this as my mind is worse than ever. I would appreciate any and all input and support in this current endeavor.
Aware I am bouncing off walls. Apologies.
Thank you all in advance.
oky
Posted by kingcolon on October 20, 2008, at 13:26:38
In reply to Re: Buprenorphine experiences » kingcolon, posted by Peter S. on September 29, 2008, at 17:14:21
> Hi King,
>
> Have you ever tried discontinuing the bup? If so what kind of withdrawal effects have you had? How long do you think it would take to get off of it? I asked an addiction specialist and she said there may be physical dependence from buprenorphine.
>> Thanks!
>
> Peter
>Sorry to get back so late. I haven't been off the bupe, so I have no personal experience. I've read of stories of everything from no to mild to severe withdrawal occuring, based on the dose, but even present after long term use on low doses (eg, 2 mg a day). In the literature the withdrawal is always described as mild compared to other opioids. I have decreased my dose from 6 mg to 4 mg at one point with absolutely no withdrawal.
> >
Posted by okydoky on October 21, 2008, at 11:03:43
In reply to BUP as antidepressant: Parnate/Procardia help, posted by okydoky on October 14, 2008, at 13:08:59
I apologise for breaking up the thread and for my hysteria. Honestly I am not able to control it most times so I cannot promise it will not happen again. I am embarrased and no doubt will be again.
Again so sorry,
oky
Posted by Peter S. on October 21, 2008, at 14:22:35
In reply to Re: Buprenorphine experiences » Peter S., posted by kingcolon on October 20, 2008, at 13:26:38
Thanks for your response King.
Took 1 mg of subutex last night. Nausea, sweating and vomiting for 5 hours! My mood improved though. I figure I'll try again in a couple days but just start out with 1/4 mg and see if I can avoid the vomiting.
It cost me $104 for 20 2mg tablets! If it works, I'm going to have to find a cheaper source.
Posted by kingcolon on October 21, 2008, at 16:44:04
In reply to Started Buprenorphine!, posted by Peter S. on October 21, 2008, at 14:22:35
Sorry about that nausea. It's common if you start too high. I would think 0.25 mg would be OK, or even less than that--the depression studies used doses like 0.1 mg three times a day if I remember correctly, but it's hard to cut up the 2 mg tabs that small without crumbling. You can suspend 2 mg in a tiny amount of water measured out in something so you can draw out small amounts and use a dropper to squirt the liquid under the tongue. Remember to split the dose if you go higher than 1 mg a day since the biologic effects are shorter than the blood half-life. Let us know how you feel as you adjust it!
> Thanks for your response King.
>
> Took 1 mg of subutex last night. Nausea, sweating and vomiting for 5 hours! My mood improved though. I figure I'll try again in a couple days but just start out with 1/4 mg and see if I can avoid the vomiting.
>
> It cost me $104 for 20 2mg tablets! If it works, I'm going to have to find a cheaper source.
>
Posted by okydoky on October 23, 2008, at 17:46:07
In reply to Started Buprenorphine!, posted by Peter S. on October 21, 2008, at 14:22:35
I dont know if this will help but here are a few things I found:
http://www.nauseaandvomiting.co.uk/NAVRES001-4-opioid.htm#_edn4
http://www.mywhatever.com/cifwriter/library/70/4937.html
Taken from the proceeding link:
Because opioid-related nausea is so common, it will be discussed separately. Opioids result in nausea through two major mechanisms: inhibition of gut motility and stimulation of the CTZ. Stimulation of the CTZ relates more to increases in blood opioid levels than it does to absolute opioid levels. Thus, initiating opioid therapy or raising the opioid dose is likely to result in nausea. However, if a new steady-state blood level is maintained, nausea usually subsides within two to three days. During this time aggressive treatment of nausea usually allows patients to tolerate opioid therapy. This is particularly important if the oral route is used for administration. Patients may enter a vicious cycle of nausea interrupting oral opioid administration, resulting in fluctuating blood opioid levels and perpetual nausea (in addition to unnecessary pain). In severe cases a nonoral route of administration should be used, at least until nausea is under control, in order to escape this cycle. As stimulation of the CTZ is primarily mediated through D2 receptors, dopamine blockade is critical to drug therapy. Anticholinergic and antihistaminic agents are less effective for this form of nausea, although they may help with relatively minor stimulation of the vestibular apparatus by opioids. Anticholinergic and antihistaminic agents may increase undesired sedation associated with initiation or upward titration of opioids and may also exacerbate poor gut motility, adding to these serious side affects of opioids. Anticholinergic and antihistaminic agents dry the mouth, a common and troubling side effect in the seriously and terminally ill patient (also worsened in patients taking opioids). Thus, a strong argument can be made for maximizing dopamine blocking effects and minimizing anticholinergic and antihistaminic effects in choosing an antiemetic for opioids. Having said this, it is remarkable that no controlled trials (of which I am aware) have compared prochlorperazine (Compazine - relatively antidopaminergic) to promethazine (Phenergan - a weak antidopaminergic drug and strong antihistamine) in the treatment of opioid-related nausea. Given the prevalence with which both agents are used to treat opioid-related nausea, this is testimony to the fact that what often drives research is not solving common, practical problems, but pharmaceutical dollars and research ambitions.
Here are a few excerpts from different sites. My computer turned off so I dont have the sites anymore:
Piperazines antihistamines are not the best for reducing nausea.
Ethanolamines Antihistamines (Diphenhydramine/Benadryl, Dimenhydrinate/Dramamine) or Promethazine work much better in my opiniontry an antihistamine like cyclizine or cinnarizine (used as travel sickness tablets, but cyclizine is also specifically used for opiate nausea in drugs likd diconal -dipipanone/cyclizine - and cyclomorph - morphine/cyclazine)
Considering it has been a week, I sure hope that the nausea has subsided by now! I just felt that I would list a few over the counter and prescription anti nausea medications (and the suggested dose) and any other medication that may help for symptoms of opioid/opiate nausea while on the subject:
Anti-emetic and Anti-histamines
50mg Dimenhydrinate (Dramamine)
25-50mg Hydroxyzine (Atarax)
25-50mg Diphenhydramine (Benedryl)Anti-acid medications
10mg Metoclopramide (Reglan)Phenothiazine derivatives
25mg Phenergan (Promethazine)
10mg Torecan (Thiethylperazine)
5mg Prochlorperazine (Compazine)Somewhere I did read that Diphenhydramine should be used at 100mg but it is not clear to me if it would hinder the analgesic affect of the opiate?
I was told to use Prilosec which worked well but I needed to find another solution because I could not tolerate it for other reasons, hence I was looking and saw your post. I really hope this helps you but hopefully you have gotten beyond the problem.
oky
Posted by Peter S. on October 24, 2008, at 17:01:06
In reply to Re: Started Buprenorphine! » Peter S., posted by okydoky on October 23, 2008, at 17:46:07
Thanks for all that info! I took a couple of days off and restarted at .5mg. Less nausea now. Now I'm just dealing with the inability to urinate, which is another common side effect. Left message with my p-doc- I wonder if this will go away, or I need to take flo-max or something like it.
Definite anti-depressant effects are showing! I should be clear that it feels nothing like an opiate type eurphoria. Will keep posting on my status.
> I dont know if this will help but here are a few things I found:
>
> http://www.nauseaandvomiting.co.uk/NAVRES001-4-opioid.htm#_edn4
>
> http://www.mywhatever.com/cifwriter/library/70/4937.html
>
> Taken from the proceeding link:
>
> Because opioid-related nausea is so common, it will be discussed separately. Opioids result in nausea through two major mechanisms: inhibition of gut motility and stimulation of the CTZ. Stimulation of the CTZ relates more to increases in blood opioid levels than it does to absolute opioid levels. Thus, initiating opioid therapy or raising the opioid dose is likely to result in nausea. However, if a new steady-state blood level is maintained, nausea usually subsides within two to three days. During this time aggressive treatment of nausea usually allows patients to tolerate opioid therapy. This is particularly important if the oral route is used for administration. Patients may enter a vicious cycle of nausea interrupting oral opioid administration, resulting in fluctuating blood opioid levels and perpetual nausea (in addition to unnecessary pain). In severe cases a nonoral route of administration should be used, at least until nausea is under control, in order to escape this cycle. As stimulation of the CTZ is primarily mediated through D2 receptors, dopamine blockade is critical to drug therapy. Anticholinergic and antihistaminic agents are less effective for this form of nausea, although they may help with relatively minor stimulation of the vestibular apparatus by opioids. Anticholinergic and antihistaminic agents may increase undesired sedation associated with initiation or upward titration of opioids and may also exacerbate poor gut motility, adding to these serious side affects of opioids. Anticholinergic and antihistaminic agents dry the mouth, a common and troubling side effect in the seriously and terminally ill patient (also worsened in patients taking opioids). Thus, a strong argument can be made for maximizing dopamine blocking effects and minimizing anticholinergic and antihistaminic effects in choosing an antiemetic for opioids. Having said this, it is remarkable that no controlled trials (of which I am aware) have compared prochlorperazine (Compazine - relatively antidopaminergic) to promethazine (Phenergan - a weak antidopaminergic drug and strong antihistamine) in the treatment of opioid-related nausea. Given the prevalence with which both agents are used to treat opioid-related nausea, this is testimony to the fact that what often drives research is not solving common, practical problems, but pharmaceutical dollars and research ambitions.
>
>
>
> Here are a few excerpts from different sites. My computer turned off so I dont have the sites anymore:
>
> Piperazines antihistamines are not the best for reducing nausea.
> Ethanolamines Antihistamines (Diphenhydramine/Benadryl, Dimenhydrinate/Dramamine) or Promethazine work much better in my opinion
>
> try an antihistamine like cyclizine or cinnarizine (used as travel sickness tablets, but cyclizine is also specifically used for opiate nausea in drugs likd diconal -dipipanone/cyclizine - and cyclomorph - morphine/cyclazine)
>
> Considering it has been a week, I sure hope that the nausea has subsided by now! I just felt that I would list a few over the counter and prescription anti nausea medications (and the suggested dose) and any other medication that may help for symptoms of opioid/opiate nausea while on the subject:
>
> Anti-emetic and Anti-histamines
> 50mg Dimenhydrinate (Dramamine)
> 25-50mg Hydroxyzine (Atarax)
> 25-50mg Diphenhydramine (Benedryl)
>
> Anti-acid medications
> 10mg Metoclopramide (Reglan)
>
> Phenothiazine derivatives
> 25mg Phenergan (Promethazine)
> 10mg Torecan (Thiethylperazine)
> 5mg Prochlorperazine (Compazine)
>
> Somewhere I did read that Diphenhydramine should be used at 100mg but it is not clear to me if it would hinder the analgesic affect of the opiate?
> I was told to use Prilosec which worked well but I needed to find another solution because I could not tolerate it for other reasons, hence I was looking and saw your post. I really hope this helps you but hopefully you have gotten beyond the problem.
>
>
> oky
>
>
>
Posted by okydoky on October 24, 2008, at 19:19:27
In reply to Re: Started Buprenorphine!, posted by Peter S. on October 24, 2008, at 17:01:06
I could not say if I ever had the urinary side effects because I have them all the time as part of my illness. I might suggest that you keep a tube of cortizone cream handy (over the counter) and some "Claritin , Hives relief or at least Benadryl as you might find next that you are itching a lot. Both the itching and the nausea/stomach problems are generally transient. As you do not have a lot to try I would try to get through either of these without stopping your trial. The antihistamines might help both effects. I don't know more here than what I have read. The cortizone cream helps me tremendously though and the pharmacist said the Claritin (for hives) would work better than the Benadryl I had used.
You are taking souch a small amount but yu are not opiate tolerant. Not fun to discuss but make sure you are "regular" as you are on this for several days. You need to keep track of that and stay on top of it always on opiates. As long as you take fiber or whatever you decide if you need it you will be fine but if you do have that side effect it is not transient but at a small dose might be avoided or easily reslolved.
Good luck ,keep us updated,
oky
Posted by okydoky on October 26, 2008, at 12:52:35
In reply to Started Buprenorphine!, posted by Peter S. on October 21, 2008, at 14:22:35
Peter S,
Would you send a babble to me.oky
Posted by Peter S. on October 27, 2008, at 15:26:49
In reply to Re: Started Buprenorphine! » Peter S., posted by okydoky on October 26, 2008, at 12:52:35
Hey Oky,Still only doing .5mg of Bupe at night. Had a lot of sleepiness today and itching last night (just like you described. Definitely noticing an anti-depressant effect in the morning-seems to dissipate. I'm going to see about gradually increasing the dose- I'd like to start taking it in the morning- it's just the sleepiness is a killer.
Regards,
Peter
>
> Peter S,
> Would you send a babble to me.
>
> oky
>
Posted by okydoky on October 28, 2008, at 12:53:42
In reply to Re: Started Buprenorphine! » okydoky, posted by Peter S. on October 27, 2008, at 15:26:49
I'm so glad to hear this is helping you.
I had the package insert for Suboxone but I do not know what I did with it. I read the half life is 37 hours but also between 24-36 hours. I believe doctors prescribe it in 12 hour dose intervals to keep blood levels even. My old pharmacist confirmed this information to me. I had take it every twelve hours for my pain. I Hope this information helps you.
I hope the itching stops soon. On Suboxone for me it was not so bad and did not last but a couple of days. I was getting very sleepy when I restarted the Morphine but it is dissipating. I think your sleepiness will probably dissipate soon too, I hope so. I drink coffee when I get so sleepy, it helps some. I still have one or two Suboxone left that I never used and Selegaline and tianeptine if I did not already throw it away, which I never even used. I can't afford all this either. Everything is so costly you know.
Now I have Parnate and either I am afraid to start is because I will have no hope if it does not work or sometimes just too depressed to want to bother.
Do you have a pdoc? Maybe if you are on the Suboxone for a while and it is working you could convince him/her to write a script for it. I dont have a pdoc now but if I start the Parnate by chance it works again I plan on starting with one and trying to get them to write a script based on the fact I am already taking it and it is working.Keep us updated and again it is so good to hear you are doing better,
oky
Posted by kingcolon on November 1, 2008, at 14:51:37
In reply to Re: Started Buprenorphine! » okydoky, posted by Peter S. on October 27, 2008, at 15:26:49
> Peter,
You should split the dose up to at least twice a day to get the biologic effect which doesn't last more than about 4 hrs. The 0.5 mg piece is very small and it's difficult to cut up, but you can try, or dilute it in a tiny amount of water, as I previously suggested and use the suspension with a
dropper. Then you can measure small quantities. I definitely notice a drop off in effect, even with the larger doses I'm taking, and splitting the dose rather than raising it is what you should do. If that doesn't help, of course, you can gradually go up on the total dose. If the itching and nausea have subsided, you could probably go up to 1.0 mg daily (divided doses). I adjusted to the fatigue very slowly over a couple of months.
>Hey Oky,
>
> Still only doing .5mg of Bupe at night. Had a lot of sleepiness today and itching last night (just like you described. Definitely noticing an anti-depressant effect in the morning-seems to dissipate. I'm going to see about gradually increasing the dose- I'd like to start taking it in the morning- it's just the sleepiness is a killer.
>
> Regards,
>
> Peter
>
> >
> >
>
Posted by Peter S. on November 4, 2008, at 18:39:45
In reply to Re: Started Buprenorphine! » Peter S., posted by kingcolon on November 1, 2008, at 14:51:37
Thanks for the advice but I decided to stop the bupe. I noticed an anti-depressant effect but it really wasn't robust enough to make it worthwhile. I gave it a week and a half- maybe I should have gone longer and tried to up the dose, but the side effects were a drag. I gather that it doesn't take long to see the results- I hope I gave it a fair trial...
> > Peter,
>
> You should split the dose up to at least twice a day to get the biologic effect which doesn't last more than about 4 hrs. The 0.5 mg piece is very small and it's difficult to cut up, but you can try, or dilute it in a tiny amount of water, as I previously suggested and use the suspension with a
> dropper. Then you can measure small quantities. I definitely notice a drop off in effect, even with the larger doses I'm taking, and splitting the dose rather than raising it is what you should do. If that doesn't help, of course, you can gradually go up on the total dose. If the itching and nausea have subsided, you could probably go up to 1.0 mg daily (divided doses). I adjusted to the fatigue very slowly over a couple of months.
> >
>
> Hey Oky,
> >
> > Still only doing .5mg of Bupe at night. Had a lot of sleepiness today and itching last night (just like you described. Definitely noticing an anti-depressant effect in the morning-seems to dissipate. I'm going to see about gradually increasing the dose- I'd like to start taking it in the morning- it's just the sleepiness is a killer.
> >
> > Regards,
> >
> > Peter
> >
> > >
> > >
> >
>
>
Posted by kingcolon on November 5, 2008, at 1:07:08
In reply to Re: Started Buprenorphine!, posted by Peter S. on November 4, 2008, at 18:39:45
>
I'm really sorry your trial wasn't helpful. I'm so amazed and gratified by the exceptional response I have had over the past year that it always surprises me when other people don't respond virtually at all. A friend of mine recently started bupe and says he noted no improvement, but I go to group with him and have noticed marked improvement in his affect. Many times people who are depressed are the last to realize that they are improving--not to say that is you, but it's always a consideration to keep in mind. I suppose a week is enough for a trail at the dose of 0.5 mg, but the only way to know if a higher dose will help is to try it. If the side effects are intolerable, of course, you don't have a choice. Good luck in the future--I'm convinced there is something out there for most people.Thanks for the advice but I decided to stop the bupe. I noticed an anti-depressant effect but it really wasn't robust enough to make it worthwhile. I gave it a week and a half- maybe I should have gone longer and tried to up the dose, but the side effects were a drag. I gather that it doesn't take long to see the results- I hope I gave it a fair trial...
>> >
Posted by Peter S. on November 5, 2008, at 18:05:38
In reply to Re: Started Buprenorphine! » Peter S., posted by kingcolon on November 5, 2008, at 1:07:08
Thanks for the encouragment king. I may yet give the bupe another try. The one I'm waiting for is agomelatine. Not sure when it will be approved by the FDA. I gather it will be available in europe at the beginning of 2009. Maybe I'll fly there and see if I can get a prescription! I know some people in England who I can visit.
> >
> I'm really sorry your trial wasn't helpful. I'm so amazed and gratified by the exceptional response I have had over the past year that it always surprises me when other people don't respond virtually at all. A friend of mine recently started bupe and says he noted no improvement, but I go to group with him and have noticed marked improvement in his affect. Many times people who are depressed are the last to realize that they are improving--not to say that is you, but it's always a consideration to keep in mind. I suppose a week is enough for a trail at the dose of 0.5 mg, but the only way to know if a higher dose will help is to try it. If the side effects are intolerable, of course, you don't have a choice. Good luck in the future--I'm convinced there is something out there for most people.
>
>
>
> Thanks for the advice but I decided to stop the bupe. I noticed an anti-depressant effect but it really wasn't robust enough to make it worthwhile. I gave it a week and a half- maybe I should have gone longer and tried to up the dose, but the side effects were a drag. I gather that it doesn't take long to see the results- I hope I gave it a fair trial...
> >
>
> > >
>
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.