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PostPosted: Wed Nov 23, 2011 2:17 am 
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This has been an ongoing issue for me and my. I'll try to paint a picture.

When I was on methadone, every few weeks I would start to feel like my dose wasn't working, that it wasn't "holding me" like it once was. I'd tell my doctor at my monthly appointment, and my dose would be raised by around 10mg. I'd start treatment on around 60mg, and end up on 100mg+.

I chose Suboxone this time because I felt it didn't have the same problems, at least nowhere near as bad. I've been on it over a year now, starting on 6mg, then shortly after going to 8mg. A couple of months later I noticed I was waking up with mild withdrawals, aches in the legs, goosebumps, and I hated getting out of the shower, and was slow to get going. My doc then split my dose, morning and evening. I actually relapsed and used heroin, and found it worked to fill these "gaps" between doses. Eventually it took over though, but I managed to pull up and get on with life.

So my dose got bumped from 8mg to 12mg, and it has been fine for a few months. Apart from the hiccups in the middle of my liver treatment, I've been withdrawal free. Until the last couple of weeks. Again I've started waking up with aches, goosebumps and shivers. It's quite mild, but it definitely makes me very slow, and it effects how my day goes. I then have to lug myself to the pharmacy to get my morning dose, but withdrawal does make me lazy. Also these withdrawals between doses have started to make me "look forward" to my Suboxone in a similar way to looking forward to heroin. It can't be healthy.

My issue is thus. I could increase my dose to fix me up again, but it will probably be a matter of time before this happens again. There is some fear that for me, Suboxone possibly like methadone in how the dose climbs over time, only it happens much slower.

I also plan to taper at some stage, and if my dose climbs to 32mg, that will be a much harder task.

Fortunately, even with my morning withdrawals, I haven't wanted to use at all. I was even getting some Viet food on the local heroin strip and I didn't even notice the dealers. So something bigger has shifted in me. But even still, I don't know what to do. Should I increase my dose and become a sexual recluse, but withdrawal free? Or stay on this dose and hope that I will eventually adjust?

It's a difficult one, really.


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PostPosted: Wed Nov 23, 2011 7:37 am 
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My first question would be are you absolutely SURE that these are really physical withdrawals? What do your pupils look like when you feel like that? Dr. Junig talks about situations like this and often says that if we distract ourselves that those feelings will go away. I'm NOT saying this automatically applies to you, as I'm aware of your issues with fast metabolism of suboxone. But it is possible that it does apply to you. I can't determine that, but I thought it should be brought up.

When you have these withdrawal symptoms, what happens, how long do they last, what exactly are they, what do you do, etc etc?

Maybe if we all put our heads together we can help you get some answers.

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PostPosted: Wed Nov 23, 2011 7:53 am 
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I first noticed it weeks ago, before the morning symptoms. I was at the beach with my girl, the water was cool and we were in wetsuits. She said the water was fine, but I was freezing my arse off. I couldn't spend more than two minutes in there. It was quite embarassing really. Usually it's the other way around.

It's also nearly summer where I'm from. It's actually quite hot already. People are wearing singlets, flip flops. And I'm waking up with goosebumps and feeling cold?

I haven't checked my pupils yet, but will go now. In the past I've only found my pupils get dialled when withdrawal gets acute. I haven't had my nightly dose yet, my pupils are open, but not dialled. There's a lot of "movement" in them when I turn the light on. And I have the goosebumps.

Why I think they're withdrawals? The moment I have my Suboxone, 15-30 minutes later the goosebumps and aches are gone, and I feel warm. My girlfriend even says my hands get warmer. The feeling is also stronger in the morning when my levels are lowest. I have 8mg in the morning, and 4mg at night before bed.

I also don't think it's interferon related, because it's only started in the last couple of weeks. I'm definitely not dwelling on them though, and getting on with life. The symptoms are not intense at this point. The concern is that they will continue to get worse, and a dose increase could be needed. It goes against the plan of tapering to 8mg after interferon. I really don't want to have to increase past 12mg unless absolutely necessary.


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PostPosted: Wed Nov 23, 2011 7:59 am 
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Well, from the very objective way you just described it, it does sound like it's withdrawals. And with all the medical things you've got going on right now, well, who's to say it's not? You had issues with your fast metabolism before you started the interferon treatment, right? Anything going on it your body could be affecting how you are metabolizing the bupe and who am I to say it's not? I mean, you know your body better than anyone.

I will also say this, if it turns out you might have to raise your dose, just remember you don't necessarily have to jump from 8 to 12. You could go to 10 and see if that helps. You might only need a slight increase. I'd make tiny increases and only go up as little as you need to - IF it turns out you need to do that. What about all those tricks that are supposed to increase absorption? Like alcohol/mouthwash? Do those really work? And might they be enough to push you over the edge with the dose you're already on?

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PostPosted: Wed Nov 23, 2011 8:22 am 
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Thanks for that hat. You are right about all the stuff going on at the moment. And I do have hope that it will die down at the end of treatment, which is 5 weeks away.

I am actually on 12mg now. I was on 8mg before, but it got bumped up to 12 a few months ago. My concern is needing to go up to 16+mg.

I've had my Subox now and already the goosebumps are nearly gone.


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PostPosted: Wed Nov 23, 2011 2:39 pm 
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What about switching around the amount you take in the am and pm? Like 6mgs am and 6pm, or 4 mgs in the am and 8mgs at night?

If your symptoms are worst in the morning, it makes sense that it's because that follows the lower of your two doses. If you had the lower dose in the morning, then by the time it was wearing off you'd be taking your pm dose...rather than having to drag your cold, tired, goosebumpy ass to the pharmacy :lol:

Also, our body temp goes down when we sleep and I always noticed that the cold/goosebump symptoms of withdrawal were worst upon waking, which makes sense because your metabolism is slowed down for sleep and you're colder anyway. So maybe, if you can handle it, do some jumping jacks or something first thing to get your blood moving, etc.

Last thing - I noticed when I was doing my taper that the goose-bumps/feeling cold symptoms were helped somewhat by clonidine. On the other hand, clonidine is very sedating, so it's not exactly what you want in the morning. But if you switch your doses around and you run into the problem at night, clonidine might be able to help.

I hope you figure this out. Good luck.

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PostPosted: Wed Nov 23, 2011 8:40 pm 
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You have a point there DoaQ about the 6mg and 6mg. It's a little bit less practical, as I'll be carrying around lots of 2mg tablets. But I may look into that. There's always been something about giving up my 8mg tablets. I've always preferred taking an 8mg over 4 x 2mg's for some reason I can't figure out. But I'll have to get over it at some stage I guess.


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PostPosted: Wed Nov 23, 2011 9:57 pm 
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If you are worried about having a bunch of 2 mg tabs then take half an 8 and a 2 in the morning and the same at night. I have been on 24 mgs for about 3 yrs I was on 32 for a yr and a half before that, I did the Methadone treatment at 110mg dose q.d. before going on sub. I also have Hep C. So needless to say I can relate to a lot of what you have said. The question I have is how soon do you plan to taper? The way I see it if your symptoms are not being well controlled on ur current dose, then I would go for the increase. I was reading in another post on the forum about the ceiling effect of sub, maybe once you reach that level then you will be able to jump back down to the lower dose. In my opinion I believe dosing should start at a higher level of suboxone and decrease from there; unlike methadone treatment where your tolerence for the med increases and so does your dose.
On the other hand Interferon has side effects very close to those of which you are currently experiencing: Flu-like symptoms (which include cold sweats and aches), FATIGUE, anxiety, and sleep disturbance are among some of the common side effects. This possibly could be a contributing factor to the symptoms you are having, or maybe its not, just I thought I had.
Anyway I hope in some way this helps you out.


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PostPosted: Wed Nov 23, 2011 10:52 pm 
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Hey Taran. Did you know there's some non-interferon treatments coming through in trials at the moment? It's worth keeping an eye on if you want to do treatment in coming years that's not as rough. I know someone on a trial with geno 1 who's got nearly zero side-effects, and only 6 months.

There are practical issues in splitting tablets in my country. I go to the pharmacist nearly every day to get my daily dose. Technically they're not even supposed to allow split-doses, and you're only supposed to be dosed once daily in the pharmacy. I'm lucky enough to have a pharmacist & doctor who'll give me some leniency with that.

But the pharmacist has to, I think, provide my tablets in packaging. I might be able to suss it out today and see if I can work something else out.

You're right about the flu'ey symptoms on the interferon. It has been getting gradually more intense over the course, so I'm sure that would be contributing in some way.

I'm heading to the pharmacy now to get my dose, so will ask if I can divide it differently, or split the pills. Because it sure does make more sense to have the dose evenly spread over the 24 hours.

tj.


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PostPosted: Thu Nov 24, 2011 8:45 am 
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Some good news. I asked the pharmacist today, and he said there shouldn't be any issue with me getting 6 & 6, given it's the same dose. Technically it's wrong to deviate from the script, but we have a good relationship. I'm one of the better ones on the program. Most others I see are obviously still using something, or injecting their doses.


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PostPosted: Thu Nov 24, 2011 1:27 pm 
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That is good news! I hope that it helps.

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PostPosted: Fri Nov 25, 2011 2:15 am 
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i agree with ya tear'. i had and some times still have those w/d like feelings'. and they'er there alright !!
i can get them the worst when i am working hard by sweating. so if i try to keep my self more relaxed / drink lots
of (water) they go away more faster and often. us with a fast metabolism need to drink more water/ fluids.
dehydration can and will cause W/d symtoms. i hate to drinks lots of water. and i no i better go drink a glass rite now :lol:
well these are some problems i'm working on hope it helps some.


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PostPosted: Sun Nov 27, 2011 5:42 pm 
Good Afternoon,

I am new to this forem but not new to interferon treatment and I am assuming that you are taking it 1 x week along with the daily meds. Having said that as I am sure you know the day after your shot is the worst and then it decreases from there.
The side affects from interferon are flu systems or in my own words w/d symptoms. My consideration is that you my be mistaking the side effects of the interferon as w/d symptoms. I know for myself they were the exact same minus the anxiety.
I like hatmaker suggests is to check your pupils because the will dilate when in w/d. Just my 2 cents after dealing with the hell of 48 weeks of interferon treatment

Alan


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PostPosted: Tue Nov 29, 2011 9:44 pm 
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Thanks Alan. You're definitely right about the days post-injection being difficult. 48 weeks is a long slog.

I do think though that it's mild withdrawal, given the symptoms disappear shortly after I put my Suboxone in my mouth. Also they stay consistent throughout the week, regardless of the injection. And the symptoms only really begun the last month, while treatment side-effects have been going for a while now.

I'm hoping that the Ribas or the interferon may have induced my metabolism of buprenorphine a bit. It's tenuous, given it only started recently, but removing drugs from my body (I have 4 weeks to go on tx) can only help, I hope.


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