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PostPosted: Mon Mar 16, 2015 2:18 am 
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Hi everyone,

We often talk about ways to maximize absorption of Suboxone in order to save money, allow the medication to work as long as possible, etc, whatever your reason may be. With this in mind, I have been wondering about something for awhile. I take my Suboxone once per day in the evening, and to me, in order to get more out of your medication, it would make sense to break up your dose into multiple pieces and let them dissolve individually one by one. For instance, if you are on 4mg, break the strip/pill in half and let one 2mg half dissolve, then the other 2mg directly after. Or even breaking it into 3rds. I would think this would increase absorption because it would be less time for saliva to build up and potentially swallow/waste more of the medication. I feel like there's potentially more logic behind this method but I'm unsure as to the specific reasons why, IF this method even makes any difference at all.

Thoughts? I am inclined to steer away from Dr. Junig's method of 'painting your mouth' with the dose, just because I feel like my mouth would just end up filling with saliva and it not being effective.

Thanks :)

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PostPosted: Tue Mar 17, 2015 2:46 am 
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I posted this in another section of the forum, but didn't get a reply. Re-posting here as it seems to have a lot more activity....

Hi everyone,

We often talk about ways to maximize absorption of Suboxone in order to save money, allow the medication to work as long as possible, etc, whatever your reason may be. With this in mind, I have been wondering about something for awhile. I take my Suboxone once per day in the evening, and to me, in order to get more out of your medication, it would make sense to break up your dose into multiple pieces and let them dissolve individually one by one. For instance, if you are on 4mg, break the strip/pill in half and let one 2mg half dissolve, then the other 2mg directly after. Or even breaking it into 3rds. I would think this would increase absorption because it would be less time for saliva to build up and potentially swallow/waste more of the medication. I feel like there's potentially more logic behind this method but I'm unsure as to the specific reasons why, IF this method even makes any difference at all.

Thoughts? I am inclined to steer away from Dr. Junig's method of 'painting your mouth' with the dose, just because I feel like my mouth would just end up filling with saliva and it not being effective.

Thanks :)

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Crystal ❤

"He will cover you with his feathers, and under His wings you will find refuge" - Psalm 91:4
–Robert Green Ingersoll


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PostPosted: Tue Mar 17, 2015 10:09 am 
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I see the painting of the mouth as the best way to maximize.I also see nothing wroug with your plan of spreading out the dose.The key is to keep the saliva down as much as possible. Having the driest of mouth is important. I stumbled upon a trick one morning. To dry out my mouth i picked up my hair dryer an blew warm air i to my mouth. Talk about dry!! It did help. Crazy maybe but ..I was able to bring my dose down 2mgs quickly this way. I asume my bio rate went up.
I was able to cover more area in the mucouse membrane, more med to the bloodstream. Once this is done as I get ready for work ill let as much time go by without swollowing.
There are any ways to dose as we ve seen on the forum here lately. Sublingual is around 30%tops.Ethanol solution in 50 to 70% range.

I see nothing with breaking up the dose Crystal if you are doing this in one sitting and not over the intire day..

My 2 cents


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PostPosted: Tue Mar 17, 2015 2:36 pm 
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Hey Crystal :)

I do the exact same thing. I dose bk to bk too. I cut my dose in half and then directly after I do the other half. I started doing that because I would have issues with my strip shifting around making me paranoid it was getting on my gums lol. I always have issues with my mouth feeling not dry enough and it just made me a nervous wreck so I started doing the cutting into smaller pieces yrs ago and just never stopped. Anyway just wanted to tell ya that ur not alone, I do that too and it has worked well for me.

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PostPosted: Tue Mar 17, 2015 11:40 pm 
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My thoughts about absorption have changed a bit over the years, as I have seen the data about Bunavail and Zubsolv. The factor that drives absorption is the concentration gradient of buprenorphine. About 25% of Suboxone film gets absorbed, on average. About 35% of Zubsolv gets absorbed, and about half of Bunavail gets absorbed.

Zubsolv increases absorption by dissolving more quickly, creating a high concentration of buprenorphine in the area where the tablet dissolves. Bunavail increases absorption by creating a small 'pocket' that holds the drug against the inner cheek, protecting it from the flow of saliva.

You are correct that the saliva interferes with absorption, by diluting the buprenorphine and washing it toward the esophagus.

I suppose that taking small doses could be a positive factor-- depending on where the tab dissolved. My thoughts about coating the inside of the oral cavity were based on the idea that doing so would keep much of the dose away from the flow of saliva-- on the upper half of the oral mucosa.

I admit to some regret, though, in my emphasis on absorption, because in almost all cases, 25% of 16 mg of buprenorphine is more than enough to saturate all of the mu receptors-- and then some. I believe that almost all of the cases of my own patients complaining about 'not getting enough' are due to psychological or 'inverse placebo' factors. People will complain that they get breakthrough withdrawal symptoms-- but the symptoms are never timed in a way that is consistent with true withdrawal-- i.e. at the end of a dosing interval. In fact, many people will complain of 'withdrawal' at about 2-3 hours after dosing-- at the time when blood levels are peaking! The symptoms are also always short-lived, as opposed to true withdrawal, which gets worse and worse until more opioids are delivered. If people who get 'withdrawal' just take 10 minutes and distract themselves, the symptoms almost always disappear. If they focus on the symptoms, though, they get worse- and then they get reinforced when the person takes more buprenorphine.

Just a few thoughts to update my blog post to 2015!


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PostPosted: Wed Mar 18, 2015 12:14 am 
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Thanks Dr. Junig. 25%. Wow, seems like such a waste of medication- that's really too bad this is the case. It makes me wonder that there must be a better way that hasn't been uncovered yet. Bunavail and Zubsolv are good starts, but my guess is that these medications are probably crazy-expensive and will be for a long time.

I couldn't imagine 16mg not being enough for a person, no matter how severely dependent on opiates they were. Honestly, most of the time I feel better at say, 3-4mg than I would at 8mg. Perhaps this is part of it, that they are taking too much. I understand the usual mindset of 'more is better', but I know now that this isn't necessarily the case with Buprenorphine...which is a great thing.

I really appreciate the time you take to provide feedback and answer our at times complex questions about this drug- something my doctor unfortunately would not be able to provide.
:)

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PostPosted: Thu Mar 19, 2015 2:09 pm 
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Hi Crystal,

I noticed you had two threads going about the same topic the other day. I meant to go back and delete one, but since you have now received replies on both of them I decided to merge them together. To cut down on confusion, we like to have only one thread going at a time with the same content. I left it here in the Misc. section since that was where you put your newest one.

Back to answering your question now. :wink: I agree that it seems like I get better absorption by breaking my dose in half. Lately it seems like I get pretty much the same result from a 1mg dose that I do from my normal 2mg dose taken all at once. My issue has always been excess saliva, and this does seem to help.

Q

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PostPosted: Fri Mar 20, 2015 3:40 am 
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Thanks, Q!

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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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