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 Post subject: 32mg too much?
PostPosted: Sun Nov 27, 2011 6:34 pm 
Hi all, I'm so glad I found this place.
I had a oxy habit (400mg per day for 18 months) went through induction fine and now find my self on 32mg suboxone per day. I'm on day 7 now and I am progressively feeling worse, very very sleepy and after yesterdays dose had a mild panic attack, rapid heart rate etc. after about 6 hours things settle down. I'm seeing my doctor today to try to get my dose reduced. Since its only been 1 week do you think it would be ok to drop the dose to 16 mg's? without any side effects.
any feedback would be appreciated, this is all new to me.
Cheers
subie


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 Post subject: 32 mgs too much?
PostPosted: Sun Nov 27, 2011 6:55 pm 
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Subie,

In short, yes, my opinion is that 32 mg is too much. If you are taking sub for addiction issues only, and not chronic pain issues, I truly believe anything more than 8 mg a day is a waste and invites side effects.

I had an oxy habit very similar to yours and I'm doing fine on between 2 and 4 mgs per day. My opinion is you could drop to 16 very easily, and drop more slowly from there.

Also, you really don't have to tell your doc about dropping your dose. You can do like I did, just smile and say everything's fine, while you build up a large extra supply of sub.

Take care,
Jimmy


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PostPosted: Sun Nov 27, 2011 7:06 pm 
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i was on 34mg much longer than a week when i first started. no big deal subie '. you will get use to it


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PostPosted: Sun Nov 27, 2011 8:46 pm 
Thanks Jimmy and johnboy,
Unfortunately, I have to front up to a dispensing chemist every day and take whatevers prescribed. I saw the doc today and she is reluctant to reduce the dose for the time being so hopefuly things will settle down quickly.
I do have severe chronic back pain so that could be part of the reason why the dose is so high, regardless, I'm happy to be on this stuff and finally off the oxy's.
Cheers,
subie


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PostPosted: Sun Nov 27, 2011 10:40 pm 
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subie wrote:
Thanks Jimmy and johnboy,
Unfortunately, I have to front up to a dispensing chemist every day and take whatevers prescribed. I saw the doc today and she is reluctant to reduce the dose for the time being so hopefuly things will settle down quickly.
I do have severe chronic back pain so that could be part of the reason why the dose is so high, regardless, I'm happy to be on this stuff and finally off the oxy's.
Cheers,
subie


First off congrats on getting off the oxys and into treatment that is always the biggest step. As of your dose I think yes it is to high chronic pain or not, I myself was on 24mgs of suboxone for chronic pain for 5 years till I switched to methadone in hope of getting better pain management because sub didn’t work for me. I personally think once anything beyond 16mg of suboxone is just over kill no matter how bad your pain is or how often you dose. I talking from personal experience that my third dose of the day after i already took 16 really was not noticeable and my pain pretty much had leveled out for the day at 16. But I cant tell you to not listen to your DR and you even talked with him or her about this and they still didn’t lower you to at least 24mg.

I don’t know you will get to the dose over time but I do think 32 is way to much!

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PostPosted: Sun Nov 27, 2011 11:29 pm 
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subie wrote:
Hi all, I'm so glad I found this place.
I had a oxy habit (400mg per day for 18 months) went through induction fine and now find my self on 32mg suboxone per day. I'm on day 7 now and I am progressively feeling worse, very very sleepy and after yesterdays dose had a mild panic attack, rapid heart rate etc. after about 6 hours things settle down. I'm seeing my doctor today to try to get my dose reduced. Since its only been 1 week do you think it would be ok to drop the dose to 16 mg's? without any side effects.
any feedback would be appreciated, this is all new to me.
Cheers
subie


TO SUBIE: I agree with everyone else 32 mg. is way too much..i would go down to 16 and hold there for awhile..if you feel worse maybe up to 24...I just feel like 16 would cover you..I am not a doctor,however, but sometimes they don't know shit about subutex! I would save some up and work with your own dose..but that is just me,...good luck and let us hear how you are doing....Judy


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PostPosted: Mon Nov 28, 2011 7:21 am 
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I would say it's too high FOR YOU - not because it was too high for others or because it's a high number, but because of how you describe feeling. The way you said you're really sleepy - that's indicative of being on too high a dose. You could drop dose to 24 mg first and then 16 mg next or like the others said, you could probably drop straight down to 16 and you might not notice it at all.

When one is on maintenance they need to be on a dose that's comfortably ABOVE the ~ 4 mg ceiling effect. Plus, one has to consider their tolerance and how much sub they'll need to address their withdrawals as well as their unique cravings. This is why some people are on 6mg and others do better on 16.

I hope you find the right dose for you.

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PostPosted: Mon Nov 28, 2011 7:47 am 
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i feel i could also go back to 16mg from 22mg it would save me some money. and i'm starting
to feel i don't need my dose this high any more. its been 8 months on 22mg?


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PostPosted: Mon Nov 28, 2011 8:46 am 
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subie wrote:
Thanks Jimmy and johnboy,
Unfortunately, I have to front up to a dispensing chemist every day and take whatevers prescribed. I saw the doc today and she is reluctant to reduce the dose for the time being so hopefuly things will settle down quickly.
I do have severe chronic back pain so that could be part of the reason why the dose is so high, regardless, I'm happy to be on this stuff and finally off the oxy's.
Cheers,
subie


You in Australia Subie... or the UK?

Like Hatmaker said, nobody can really say whether 32mg is "too much".

I trust your doctor has reasoning behind the high dose, as no doctor would prescribe a dose like that without reasons behind it. Whether it's "too high for you" all depends on how you feel. I haven't heard of anxiety attacks from buprenorphine, but it may be possible, esp before stabilising.

The real way to tell if your dose exceeds your needs, IMO, is if you feel really "stoned", and the drowsiness is consistent with that you felt while high on Oxy. Also, if you still feel like that 24 hours later when you get your next dose, IMO that's a big sign. If that's the case, telling your doctor that Suboxone is making you feel a bit high, I guarantee they'll be more open to a dose reduction. Addiction doctors don't like it when their patients admit to those things, generally.

I've known people on 32mg. It was just the dose they needed to stop themselves using. I've also found that the higher doses of buprenorphine last much longer in the body. Are you on any other medications? Are you taking the film? There are many factors a doctor takes into account when working out a person's dose.

Edit:

I did some sniffing around. Studies into Butrans have shown that buprenorphine can cause QT interval prolongation, so if you have any history of heart arrhythmia or palpitations, let her know.


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PostPosted: Mon Nov 28, 2011 11:01 am 
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wow 400mgoxy- is a lot for 18 months'.. jimmy" i was taking close to 500mg a day for 9 months of the liquid form,and did not feel a thing from it!! i have arrithythmia/ palp-tear3" what the heck is QT- prolongation?


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PostPosted: Mon Nov 28, 2011 6:37 pm 
Hi tearj3rker, I’m in Australia.
For the time being whilst under supervised dosing I’m going to have to stick with the 32mg per day. Actually yesterday’s dose wasn’t quite as bad, still felt very sleepy but no anxiety. By the next morning I was feeling great, so I guess that’s a good sign. I have to keep in mind also that it’s only been a week since getting off a big oxy habit, that could be causing the anxiety more than the suboxone.
Thanks everyone for the good info and support, will keep in touch.
Subie


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PostPosted: Mon Nov 28, 2011 11:38 pm 
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johnboy wrote:
wow 400mgoxy- is a lot for 18 months'.. jimmy" i was taking close to 500mg a day for 9 months of the liquid form,and did not feel a thing from it!! i have arrithythmia/ palp-tear3" what the heck is QT- prolongation?


It should be alright johnboy, but may be worth mentioning to your doc.

Certain medications have been shown to mess with QT interval. For me it was Amisulpride, which is no longer prescribed for that reason, and once an accidental Seroquel overdose had me waking up to bad palpitations. QT prolongation is a form of arrhythmia, where the rhythm of the heart beat changes, gets broken up, stops / starts or brings on palpitations. In its mild form it can be quite frightening.

A lot of psych medications can cause it to varying degrees - like tricyclics, anti-psychotics, some SNRI's, also methadone, and to a lesser degree buprenorphine.

http://www.sads.org.uk/drugs_to_avoid.htm

It may be worth investigating if you believe a medication may be behind it johnboy. There are heaps of medications on that list, many which only contribute mildly to people who are already vulnerable. So don't freak out.


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PostPosted: Tue Nov 29, 2011 2:21 pm 
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thank's tear3" i won't fre-out' is there any meds that ya can take? don't see any left?


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PostPosted: Tue Nov 29, 2011 5:22 pm 
Subie...Congrats for getting into treatment and off the oxy! It's certainly not an easy thing to do!
I'm in the U.S. and I admittedly don't know much of anything about how healthcare systems work where you live. I have, however, heard before of the requirement of taking your dose in the presence of the dispensing pharmacist (I believe you call them 'chemist'.) So I do understand that aspect of your treatment.
What I don't understand is that it seems you have no voice in your treatment plan....ie you don't get to have an opinion as to whether or not your prescribed dose is appropriate for you, or whether you'd like to try a dose reduction based on your symptoms, etc. That just doesn't seem right.
Again, things may be different there, but it was my understanding that for at least the past several months, if not over a year or so, the "best practices" for the use of buprenorphine was to not exceed 16mg/day. I think there are still some pain management patients who need more than the 16mg/day, but generally that is because they break up their total daily dose into 2 or 3 or more doses each day.
In almost any case, I personally can't see how it would be necessary to take 32 mg/day. That's a LOT of bupe and in most cases, all those huge doses do is bring on a higher liklihood of side effects and that's about it. I know it sounds hypocritical coming from an addict.....but believe it or not, I'm a firm believer (before I became an addict and now that I'm out of active addiction and in my 'right' mind) that it's always best to take the minimal dose of any medication that gets the job done! There are just so, so many of us who will agree that as we have gone through tapering of doses with bupe, that less is more when it comes to this drug. (That is, up to a certain point...below 4mg or so a day, things can get rough.)
These are just my opinions, and not intended to replace the advice of a doctor, or to step on anyone's toes. There is a very wide variation as to how different people respond to this drug and we have to figure out what works best for us as individuals. However, in my opinion and that of lots of others anecdotally, 32 mg/day of bupe is indeed a seriously high dose and seldom ever necessary to achieve addiction remission.
I'm glad that you feel better today and hope that you continue to feel better. I also encourage you to advocate for yourself, to the extent that you feel you can without losing your physician and therefore treatment. I just want to see you feeling your best and enjoying your newfound freedom from oxy! Glad you found this site...lots of great and helpful members and support here!


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 Post subject:
PostPosted: Mon Jan 09, 2012 7:32 pm 
Hi all,
Just an update on how things are going.
All in all, things are great. My life is so much better than it was just a few months ago in active oxy addiction. No more chasing pills and lying and avoiding my responsibilities as a husband.
The last month or so has been a time of re building and repairing, I really didnt comprehend the damage my addiction was doing to my life and relationship with my wife. Its going to take a while to get things back together. I think thats where Suboxone is such an amazing tool, I really feel strong and capable of staying clean, I'll stay on sub for as long as it takes.
I have to admit that I was a bit "spooked" by all the horror stories about getting off sub and wondered if I had done the right thing going on it fulltime instead of just using it for detox, but after reflecting on the way my life has been over the past few years (twice in ER for O/D, lying, stealing, doctor shopping, living in poverty, bad bad health problems, neglecting my wife) I'm sure I have make the right decision. I'm now down from 32 to 16 mg's per day and am allowed 2 take aways a week, yeah those daily visits to the pharmacy are a real pain.. but its all worth it to get my life back and thats what its all about, CHOOSING LIFE.

Cheers,
Subie


Last edited by subie on Mon Jan 09, 2012 8:36 pm, edited 1 time in total.

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PostPosted: Mon Jan 09, 2012 8:06 pm 
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Subie, I just wanted to congratulate you on realizing that one can't repair the damage active addiction has caused just by doing a detox with sub. It sounds like you are going to take the time needed to rebuild everything that needs rebuilding in your life. Thats exactly what sub. is for. Good luck, Steve


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PostPosted: Mon Jan 09, 2012 9:21 pm 
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Hi Subie. Good to see you got that dose down, and you'll be amazed at the strength, of sub around 2mg. Getting the take a ways, gives you a bit of space, to see what dose is best, ie: 4mg AM - 2mg PM, etc,.
Honestly I've never noticed the difference, between 8mg and 16mg or, 20mg for that matter. But whatever the dose your getting your life back- Beauuuutiful mate!


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PostPosted: Mon Jan 09, 2012 11:46 pm 
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OMGosh subie, I LOVE your avatar, that is priceless!!!!

Congratulations on choosing Suboxone. I understand your hesitation and your fears with coming off of Suboxone, but it sounds like being on Suboxone for a good while is the best option for you. IMO, Suboxone is best used with some kind of counseling or therapy. Personally, I used an addiction counselor during my time on Suboxone and he helped to get me ready for the day I chose to stop taking Suboxone. Suboxone and therapy can give you a great big leg up on recovery.

Rock On man!!

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PostPosted: Mon Jan 16, 2012 12:31 pm 
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It is really too much dude


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PostPosted: Sat Feb 04, 2012 10:03 am 
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Quote:
It is really too much dude

I don't know if it is really too much. Every body could work in a different way.
I personally never needed more than 8mg. If 8mg was not enough, than I had first taper down with heroin or methadone. When my consumption of heroin or methadone was too high, beprenorphine didn't work for me. I just helped a little but actually I was still feeling bad - no matter how much beprenorphine I took.

I friend of mine is has an illness that is called ADHS (in Geman). I don't know if it's the exact word but I should mean something like "attention deficit disorder with hyperactivity". As many people with illness, he tried to cure himself wit alcohol and drugs. Now he stopped heroin and started to take suboxone. He did not take really high heroin doses but now he needs 32mg suboxone to feel good. Something in his body seems to work different.
If I take diazepam, I will get tired. If he takes it, it will work as methamphetamine for me. And if he takes methamphetamine, he will get quiet and tired.

So Suboxone need not to work the same way in everybody. So I could be possible that some people need much more than others.
But my personal experience is: If 8mg do not help, more will not help either. Suboxone only works for my when I am low dosed on opiods.


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