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PostPosted: Sat Jun 18, 2016 9:07 pm 
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I have these weird and very serious panic attacks. I abused Vicodin for 14 years and have been off of it for about 7 years. Been on Subutex for 4 years, but it started making me sick. It felt like I was taking too much of it. I'm prescribed one 2 mg pill a day, but I break it up into quarters and take it 4 times a day. As I said I went off of it and was off for 3 months and then went back on for about 2 1/2 months now I guess. My question is, by taking it as I do....that is breaking it up into 4 doses, change the way it works? I ask because it's starting to make me sick again and the last couple days I cut back to 2 doses. I wasn't just cutting it in two, I only took half a pill altogether because I just felt overmedicated and then I get these abnormal panic attacks. They don't just last a few minutes, they last hours and even days and I'm not exaggerating.

My doctor knows how I take it and hasn't told me not to take it this way, but I wonder if I just took the whole pill as prescribed, would it actually work better or does it not matter how you take it?

I'm worried because I'm afraid I'll have to stop the Subutex completely because it's making me sick and the Subutex helps with my Bi-Polar depression so much. The weird thing is, before I started getting really sick with it, it's like it slowly stopped working. I've been having muscle aches and joint pains and sweating and runny nose...you know all withdrawal symptoms. This is all before I went down to half a dose. I don't understand how I can have withdrawal symptoms while I'm taking it and again.....this was happening before I went down a couple days ago. It's like my body is refusing the Subutex, yet if I go down on it, the withdrawals are worse? I just don't understand it. I'm also taking some Xanax too. I hate that drug, but the Xanax seems to counteract the negative Subutex results I'm getting.

:TLDR: If I take a 2mg Subutex tablet and break it up into quarters and take a quarter dose for times a day, can it make you sick, because I've been getting sick from it. If I take it all at once like you're supposed to, will it go back to working again?

Thanks in advance!


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PostPosted: Sun Jun 19, 2016 10:52 am 
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I hope someone answers your questions, I have been on subutex and have had the same issues.


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PostPosted: Sun Jun 19, 2016 1:29 pm 
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Buprenorphine works in a very well-defined way, and sometimes people describe symptoms that just don't fit the chemistry of buprenorphine. When I point that out, the person complaining often insists that he/she must be different in some way. My opinion is that is just not possible; all humans have things in common, such as having our lungs in our chests, kidneys in our lower lumbar region, and opioid pathways and mu receptors in specific brain regions. So with that background, I'll share my thoughts. Maybe I'm wrong. But I'm trying to be right!

Understand that panic attacks are relatively common. Most people will have a couple panic attacks at some point in their lives. Panic disorder is when a person has repeated panic attacks, and develops a fear of having more panic attacks. BUT-- panic attacks do not occur for hours or days. It sounds like you are having anxiety, but if it lasts more than an hour or two it is not something a doctor would call a 'panic attack'. Panic attacks usually last for a few minutes, and maybe as long as 15-20 minutes. My point isn't to downplay your symptoms-- but rather to get the terminology right. If you tell your psychiatrist you are having 'panic attacks for hours or days', he/she will think you are exaggerating.

If you are having panic attack symptoms for hours or days-- i.e. extreme fear and panic, racing heartbeat (over 120 beats per minute), rapid respiration and shortness of breath, a feeling that you are dying---- then you need a good medical work-up. You could be hyperthyroid, or even have one of several rare conditions that cause high levels of adrenaline (i.e. pheochromocytoma).

As for dosing multiple times per day... the goal with buprenorphine is to keep your blood level of the drug above a critical level. People who do that will feel normal, because they are tolerant to the maximum effects of the drug. At that point, people feel little or nothing when they dose, because there is no increased effect from the spike in blood level that occurs 2 hours after dosing.

People absorb, on average, 25% of a dose. If you are taking 2 mg per day, understand that dose is lower than typical. The average is around 12 mg per day, and some people take 24 mg of buprenorphine per day-- 10 times more than you do. A person who takes smaller-than-needed doses of buprenorphine is MORE likely to have side effects, because the person never develops full tolerance to the medication. That person will feel 'narcotized' 2-4 hours after a dose, and withdrawal in the later part of the dosing interval.

If you break a small, 2 mg dose into 4 pieces you end up dosing with very small amounts of buprenorphine. I don't know, frankly, if the percent of dose absorbed goes up or down in those situations, but it probably changes in some way. So to summarize-- if a person is taking a full dose of buprenorphine, i.e. 12-16 mg per day, then it probably doesn't matter if the dose is divided or not, since receptors will be saturated all day anyway. But a person taking very small amounts of buprenorphine will have a different experience with divided doses. In low doses buprenorphine is essentially like an agonist--- so repeated small doses will cause the same ups and downs as taking oxycodone or other agonists.

Understand that there is no way for your body to refuse something. We are talking about chemicals and layers of tissue. Buprenorphine passes through mucous membranes in your body in the exact same way that it does in other people. You might metabolize it more quickly at the liver-- and that may be an issue given that you are taking such a small dose. But the effect of that would be predictable: feeling an opioid effect about 2 hours after a dose, and getting mild withdrawal symptoms near the end of the dosing interval.

It is hard to know what to make of your other symptoms, but remember that anxiety and many of the other symptoms you describe are common in people who DON'T take buprenorphine. Panic attacks and anxiety are very common complaints. Runny noses and aching muscles are common, often because of allergies that cause the release of histamine. I get a runny nose and body aches from April to July from pollen, some days worse than others. Some people get the same during the fall, and some when there are more mold spores around. If you are absolutely positive that you are having the symptoms related to your buprenorphine dose, I recommend you have a peak and trough buprenorphine level drawn to see if you are metabolizing it more quickly than average.

You wrote that you are taking small doses of buprenorphine multiple time per day... and that the buprenorphine is 'causing' panic, lasting hours or days. If that is truly the pattern, I have a hard time seeing why you think buprenorphine is related. If on the other hand you had panic attacks starting an hour after each dose, lasting 15 minutes and then going away until an hour after your next dose, that would suggest a connection with buprenorphine.

In any case, if you were my patient I would want your dose to be higher. People on buprenorphine don't benefit from the ceiling effect if their blood levels are too low-- and the ceiling effect is the whole point of taking buprenorphine. And yes, I would recommend my patients to dose at MOST twice per day, because buprenorphine has a long halflife, and there just isn't a reason to take it more often than that. And when people are treated for addiction (i.e. not pain), we want them to dose less often to break the cycle of searching for a mood response to a medication multiple time per day.


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PostPosted: Sun Jun 19, 2016 1:35 pm 
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Hello, Welcome! I really hope that Dr. J. comes along to address these questions as he is the most knowledgeable person here! Anyway, I have some questions for you. First is are you taking the subutex four times per day because you are using it to help with pain? That is usually why people break up the dose. And, the highest dose you were on was 2mgs? Did you always feel sick? Maybe the 2mgs was not enough to cover your withdrawl symptoms? I am just trying to help you by asking these questions. I don't know much about subutex as my experience is with suboxone. I am sure someone else, with more knowledge will be along soon! Enjoy your day!


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PostPosted: Sun Jun 19, 2016 1:45 pm 
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Hi All, Thanks Dr. J. for that detailed response! I did not know you had responded when I posted my previous post! Have a great day!


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PostPosted: Mon Jun 20, 2016 2:56 am 
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Thank you for responding everyone and especially Suboxdoc. I apologize for the length, but it's important!

Ok, let me go back a bit to give some perspective. This all started originally at the end of 2014. At that time I was prescribed 2.5mg a day, so one and a half pills a day. I took it much the same way. I would break it up into quarters, but sometimes one of the doses I would end up taking half a pill and most times I only ended up taking about one pill, so only 2mg a day. I went to this concert. On days like this (which wasn't often, I don't party) I do take a little more so that I'll feel better. So on that day I probably took a total of 2.75. It's rare that I would take that much. As I said, most days I didn't even take the whole 2.5mg a day. Ok, so I noticed about half way through the concert, I started feeling....well not so good. It did sort of feel like I was overmedicated. I had never felt this before. Ok, so the next day I got up early, my schedule was different and I took a quarter dose of Sub as I usually did, but much earlier and I immediately felt worse. I still didn't put the two together and about 4 hours later I took another dose and I felt really bad. After I got home I slept a while and felt a little better. After that I started having these breathing problems. I'd have a squeezing in my chest (like I do know) and it felt like when I would take a breath I wasn't getting enough oxygen. This went on for about 3 months and I finally went off the Subutex. The thing is, I went off cold turkey and it wasn't that bad at all.

So about 2 months later I decide to go back on it. Oh and when I stopped the Sub, all the breathing problems went away almost immediately. My depression got worse of course and while I was doing....so so, I wanted to feel better again and I thought the breathing thing...maybe it was a temporary thing and didn't have anything to do with the Subutex. So I went back on it, this time at a lower dose, 2mg. As soon as I started taking it, I started feeling the breathing problem. It wasn't that bad and the good feeling from the Subutex outweighed the breathing problem at the time, but I started asking the doctor if the Subutex could be causing this and he said no. I'd ask my primary doctors. Then I remember one day, it got really bad. It probably lasted a few hours, but then went away. I felt an intense squeezing and I felt like I had to breath manually out of my mouth to get enough air and even that didn't feel like I was getting enough and it felt like I was going to die. This went away....that is the really bad feeling, but I always had a little breathing problem.

Then fast forward to September of 2015 and the breathing started getting worse. Not quite as bad as that one day, but bad enough. I cut down to 3 doses a day and it got a little better. Then in October of last year, we went to Las Vegas and on the day we were going, I remember not feeling good at all, my breathing was not good and had that dreaded panic sense. I took my first dose of the day and I immediately felt so much worse. We were there for 3 days and I only left the hotel room once. I was so sick and I felt like I needed to go to the ER the whole time I was there. Backing up a bit, I started taking blood pressure meds, Proprananol, 10mg and I noticed that this seem to help the panic attack, disorder....whatever it is. The whole time I was there I only took one quarter dose of Sub, it helped with withdrawal but it also made things a little worse. I didn't take another until the end of the 3rd day and it wasn't as bad when I took it. My wife thought it was a panic attack as all the doctors say since it seemed like whenever I went somewhere that this happened, but not all the time. I myself asked the doctors, how can this be a panic attack if it lasts for hours, even days and they really didn't have an answer and to this day don't have an answer.

I soon went down to 2 doses a day, so I was only take 1mg a day. It seemed like when I 'd go down it would help the breathing for a while and then it's like my body would adjust to it and get bad again. So I tapered off of it. It took a month to get off and then things got bad again. All this when I was completely off the Subutex. I even went to the ER while I was off. I was for sure that it was the Subutex, but then why was I still having this panic stuff still?

I was off the Sub for 3 months and the withdrawal symptoms never fully went away. The flu like symptoms didn't last that long, maybe a week and a half but the other stuff took a long time to go away like the sweating. The sweating and the soreness took about 2 months to go away. In the meantime, I did take some Kratom. It's not an opiate, but it does attach to the same receptors. I took that on and off for around 2 1/2 weeks. I also took some Imodium (Loperamide) in rather large doses for about a month to help with the withdrawals. I saw that was a bad idea. One of the things that never went away was my runny nose and I was constantly clearing my throat. It was so annoying and horrible doing that all the time. I started to think, maybe it is just allergies.

So, as I said I was off the Sub for 3 months and I went back on it about 2 1/2 months ago. The day I went back on it, my runny nose and throat clearing went away completely, so I know it was the Subutex. I don't know why, but 3 months after I went off taking no other opiates, I was still having withdrawals. As I said before I've had breathing problems this whole time and with the first dose of Sub, I felt better and my breathing seemed a little better for the first couple weeks, but it never went away completely. Then it started slowly getting worse again....the breathing. I was able to get Xanax in hope it would help. Before it didn't seem to help, but I was only prescribed 0.25mg, that's the lowest dose and that didn't do anything. I finally was able to get 1mg, twice a day for Xanax and that seemed to help tremendously, in fact I noticed when I took it and I know you're not supposed to take them together because of respiratory depression...I had felt the best I had in a year and a half. I believe my breathing problem even went away completely for a day or two.

I ended up taking too much Xanax and had to cut down about halfway through it because I had some life stressing events. So, now I'm taking half doses so I won't run out and everything got worse. About 3 days ago, it started getting much worse, like it was in Vegas, but didn't last as long, but even when it gets better, I still have it, so in a way this breathing problem/panic, dread I have is 24/7. Also about 3 days ago I noticed that as soon as I took the Subutex, I immediately had more trouble breathing than usual. I remember the night before it got again a few days ago, I felt that same feeling I felt at the concert. I just felt overmedicated and wasn't feeling good generally. So that night, I only took 3 doses. It wasn't as bad, but it was still getting worse and I went down to 2 doses.

There's one more thing that the Subutex is doing. At first I wasn't sure if it was the Subutex, kidney, liver or heart problems, but when I went to the ER, they ran an EKG and a chest X-ray and ran blood work and everything came back negative. I've also been to the doctor and had EKG and it's fine. My Pulse Ox also seems fine, but at the time my breathing can be really bad, but it appears that I'm getting enough O2. So the other problem, I now think is related to the Subutex is I have Edema in my lower legs. It's mostly in the ankles. I noticed it when I started up with the Subutex again this time. I noticed it before last year, but it wasn't that bad. I thought it might have something to do with my TRT (Testosterone Replacement Therapy), because I was now taking 2.5 CC's a week. I originally was taking 0.5. I had some ED and I did have a very low Testosterone level. Anyway, it's not the Test. The doc put my at a lower dose and I still have it. When I went down to half a pill a day I noticed the Edema in my legs got dramatically better, so it's the Sub for sure.

Another thing I notice (for sure) is that when I feel really bad, my pulse gets low. Of course the Sub and Xanax can do this, but when I wasn't taking any of those when I'd get bad, it would get low. That makes me wonder if it has something to do with my heart, but if so why don't any blood tests or EKG's show anything? Another question I have is why do I feel so much worse when I take Subutex? You say I'm not taking that much and I agree, but I'm certain it's doing this. The doctors think it's in my head, but it 's not. When the breathing got worse a few days ago when I'd take it, I wasn't expecting to feel bad, I wasn't anticipating feeling bad, in fact I was looking forward to feeling good. I thought, eh, maybe it didn't have anything to do with it, maybe this is in my head. Even I started thinking it was in my head, but I'm 110% certain it's the Subutex.

This is what I think it happening and maybe you can tell me why. You sound like you're a doctor. You're body can change over the course of your life. Isn't it possible that all the Vicodin I took and let me say before I stopped I was taking 100 pills a day. I'm not exaggerating that number either. I started counting. Of course I didn't take 100 pills for a day for 14 years, but I took a lot. My point is, I think my receptors are damaged, really damaged. Vicodin is a full agonist and I know the Subutex is a partial agonist, but they affect the same receptors and while I'm taking a low dose, Subutex is much stronger than Vicodin and if my receptors were compromised, couldn't something like this happen? I believe I was still withdrawing, even after 3 months. I've been taking Subutex for about 4 years now. It shouldn't take that long at all and it probably wouldn't even show up in my blood after a month, but that's the only explanation that makes sense. The only other thing I get from doctors and pharmacists when I ask them and tell them what's going on they say it's possible your body is more 'sensitive' to Subutex now. That would piss me off so much and so does hearing panic attack or panic disorder, because when it's bad, it doesn't feel like that. It feels like I'm going to die. I do not exaggerate either when I say I've felt that horrible dreaded feeling for 3 days straight either. I haven't exaggerated any of this. If you knew me, you'd know I'm not a person who does that, but I will admit I have been a hypochondriac at times. But this breathing thing and feeling like I'm gonna die isn't in my head, it's not at least a normal panic attack or disorder. I believe the Subutex is causing this. Like I said, the only thing I don't understand is why I was still having it when I was off the Subutex, unless I was still withdrawing.

There is one more thing I forgot. Actually, I had this similar feeling like the night of that concert and a few nights ago I remember going back on Vicodin for a short time, like a week or two and one day I had that same feeling like I took too much. What I'm saying is, it's not only Subutex doing this, but opiates in general. Sorry, one more thing and I'll stop. When I took the last dose of Subutex, this time for some reason it was really hard when I stopped. I was hoping if I took some Methadone for a week that would help. It was a stupid idea, but my doctor gave me a weeks supply of it. 5mg, twice a day. I remember I took that one Methadone tablet and within 5 minutes started having a harder time breathing. Since I only took one and had gone off the Sub, I just got rid of the rest of the Methadone because I knew it would only make things worse.

Sorry for the long post, but I wanted to include everything I could remember. It's probably hard to see because of the variety of symptoms, but the main thing is the hard time breathing, feeling of dread like I'm gonna die when it gets bad and I didn't really go over this, but severe depression too. I was suicidal most of the 3 months I was off the Sub and when it got bad for days.

I don't know what else to say now. I hope perhaps you can help me in some way. I will say you've shown more faith in me than any of my doctors. My pdoc that prescribed the Subutex is a horrible doctor and the only one that can prescribe it here.

What did you mean when you said this "If you are absolutely positive that you are having the symptoms related to your buprenorphine dose, I recommend you have a peak and trough buprenorphine level drawn to see if you are metabolizing it more quickly than average." ? What should I ask for specifically for this blood test?

Thank you,
Suboxdoc



suboxdoc wrote:
Buprenorphine works in a very well-defined way, and sometimes people describe symptoms that just don't fit the chemistry of buprenorphine. When I point that out, the person complaining often insists that he/she must be different in some way. My opinion is that is just not possible; all humans have things in common, such as having our lungs in our chests, kidneys in our lower lumbar region, and opioid pathways and mu receptors in specific brain regions. So with that background, I'll share my thoughts. Maybe I'm wrong. But I'm trying to be right!

Understand that panic attacks are relatively common. Most people will have a couple panic attacks at some point in their lives. Panic disorder is when a person has repeated panic attacks, and develops a fear of having more panic attacks. BUT-- panic attacks do not occur for hours or days. It sounds like you are having anxiety, but if it lasts more than an hour or two it is not something a doctor would call a 'panic attack'. Panic attacks usually last for a few minutes, and maybe as long as 15-20 minutes. My point isn't to downplay your symptoms-- but rather to get the terminology right. If you tell your psychiatrist you are having 'panic attacks for hours or days', he/she will think you are exaggerating.

If you are having panic attack symptoms for hours or days-- i.e. extreme fear and panic, racing heartbeat (over 120 beats per minute), rapid respiration and shortness of breath, a feeling that you are dying---- then you need a good medical work-up. You could be hyperthyroid, or even have one of several rare conditions that cause high levels of adrenaline (i.e. pheochromocytoma).

As for dosing multiple times per day... the goal with buprenorphine is to keep your blood level of the drug above a critical level. People who do that will feel normal, because they are tolerant to the maximum effects of the drug. At that point, people feel little or nothing when they dose, because there is no increased effect from the spike in blood level that occurs 2 hours after dosing.

People absorb, on average, 25% of a dose. If you are taking 2 mg per day, understand that dose is lower than typical. The average is around 12 mg per day, and some people take 24 mg of buprenorphine per day-- 10 times more than you do. A person who takes smaller-than-needed doses of buprenorphine is MORE likely to have side effects, because the person never develops full tolerance to the medication. That person will feel 'narcotized' 2-4 hours after a dose, and withdrawal in the later part of the dosing interval.

If you break a small, 2 mg dose into 4 pieces you end up dosing with very small amounts of buprenorphine. I don't know, frankly, if the percent of dose absorbed goes up or down in those situations, but it probably changes in some way. So to summarize-- if a person is taking a full dose of buprenorphine, i.e. 12-16 mg per day, then it probably doesn't matter if the dose is divided or not, since receptors will be saturated all day anyway. But a person taking very small amounts of buprenorphine will have a different experience with divided doses. In low doses buprenorphine is essentially like an agonist--- so repeated small doses will cause the same ups and downs as taking oxycodone or other agonists.

Understand that there is no way for your body to refuse something. We are talking about chemicals and layers of tissue. Buprenorphine passes through mucous membranes in your body in the exact same way that it does in other people. You might metabolize it more quickly at the liver-- and that may be an issue given that you are taking such a small dose. But the effect of that would be predictable: feeling an opioid effect about 2 hours after a dose, and getting mild withdrawal symptoms near the end of the dosing interval.

It is hard to know what to make of your other symptoms, but remember that anxiety and many of the other symptoms you describe are common in people who DON'T take buprenorphine. Panic attacks and anxiety are very common complaints. Runny noses and aching muscles are common, often because of allergies that cause the release of histamine. I get a runny nose and body aches from April to July from pollen, some days worse than others. Some people get the same during the fall, and some when there are more mold spores around. If you are absolutely positive that you are having the symptoms related to your buprenorphine dose, I recommend you have a peak and trough buprenorphine level drawn to see if you are metabolizing it more quickly than average.

You wrote that you are taking small doses of buprenorphine multiple time per day... and that the buprenorphine is 'causing' panic, lasting hours or days. If that is truly the pattern, I have a hard time seeing why you think buprenorphine is related. If on the other hand you had panic attacks starting an hour after each dose, lasting 15 minutes and then going away until an hour after your next dose, that would suggest a connection with buprenorphine.

In any case, if you were my patient I would want your dose to be higher. People on buprenorphine don't benefit from the ceiling effect if their blood levels are too low-- and the ceiling effect is the whole point of taking buprenorphine. And yes, I would recommend my patients to dose at MOST twice per day, because buprenorphine has a long halflife, and there just isn't a reason to take it more often than that. And when people are treated for addiction (i.e. not pain), we want them to dose less often to break the cycle of searching for a mood response to a medication multiple time per day.


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PostPosted: Mon Jun 20, 2016 3:19 am 
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Thanks, Michelle F. for responding!

No, I taking the Subutex for two reasons. The first is because I had a 14 year addiction to Vicodin. The second is it helps tremendously with my Bipolar depression. It seems no other antidepressant helps like the Subutex. That's why I was taking the Vicodin to begin with. I hadn't been diagnosed with Bipolar II or anything yet and was self medicating with Vicodin. The problem with Vicodin is of course, you have to keep raising the dose to keep feeling good. With Subutex I found 2mg is all I needed.

The highest dose I was on was 2.5 mg, so a pill and a half a day originally until I went off of it. I think when I went off the first time, if I had stayed off of it. I don't think I'd be having these breathing problems and dreaded feeling like I'm going to die too.

Actually when I first started taking it, I didn't have any breathing issues at all, but it did make me nauseous at first. I took Zofran for that and the Zofran helped so I really had no complaints at first.

As I told Suboxdoc, I don't think this is just a problem with Subutex, but with any opiate, because I've taken a few full agonist opiates since I stopped the Vicodin. I briefly went back on Vicodin for maybe one or two weeks and had a similar feeling and then when I took that one 5mg Methadone tablet. I forgot to mention that while I was off Subutex, I think the first time I tried Methadone and took it for a short time, only a week or two as well. It too caused breathing problems. That's why I say all opiates do this to me. It's like all that Vicodin I took for 14 years really messed up my receptors and what it feels like is I'm almost allergic to opiates now. I don't understand it or know if that's even possible, but I have read that you can 'burn out' or at least damage your receptors.

I will say this also, since I've been replying, I've felt much better. What I'm saying is, since I went down on the Subutex, I feel better overall. I still have a breathing problem, but right now it's not as bad. However; I believe my body will adjust to this and even the 2 quarter doses I've been taking the past couple days will eventually be too much as well. The only thing I don't understand is why when I was completely off the Subutex, why was I still having the breathing problems and intense dread and panic that was about as bad as when I was on it? The only answer I can think of is I was still withdrawing, even after 3 months of being off of it. I took Kratom for 2 weeks or so off and on and I'm sure that didn't help, and Loperimide (Imodium) to help the withdrawals. But still, I felt bad. You have to take large doses of Loperimide to help with withdrawals, like 10 to 25 tablets....that is all at the same time. That's just one dose, but it helps for about 24 hours actually. But if you do that, you then have to take a laxitive in order to have a bowel movement, so it's not really worth it. Maybe if you take it for a couple days, because I did feel noticeably better when I did that. I wouldn't say good, but I felt better!


Michelle F. wrote:
Hello, Welcome! I really hope that Dr. J. comes along to address these questions as he is the most knowledgeable person here! Anyway, I have some questions for you. First is are you taking the subutex four times per day because you are using it to help with pain? That is usually why people break up the dose. And, the highest dose you were on was 2mgs? Did you always feel sick? Maybe the 2mgs was not enough to cover your withdrawl symptoms? I am just trying to help you by asking these questions. I don't know much about subutex as my experience is with suboxone. I am sure someone else, with more knowledge will be along soon! Enjoy your day!


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PostPosted: Mon Jun 20, 2016 3:26 am 
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djmm2005, can you tell me all the symptoms you are having and what meds you are taking? If it is the same thing, I might know a couple meds that I take that will help a little. For me, these meds don't completely take it away but they do help. I take Xanax, which is a Benzodiazepine and Propanolol, which is a blood pressure medication. You have to be VERY careful with both, especially the Xanax, because Xanax combined with Subutex can make you stop breathing and normally you wouldn't take these together. You need to find a doctor to prescribe these, don't just get them from somewhere and make sure you tell the doctor what you're taking and how much. People like Michael Jackson and someone else who died about a month ago died from a combo of Xanax and other drugs. And then the Propanolol can lower your blood pressure too much if you take too much.

djmm2005 wrote:
I hope someone answers your questions, I have been on subutex and have had the same issues.


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PostPosted: Thu Jun 30, 2016 2:20 pm 
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Hi Sithtiger, I was just wondering how you are doing and if things were getting better for you? Please, post an update and let us know how it's going.


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PostPosted: Wed Aug 03, 2016 8:11 am 
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Michelle F. wrote:
Hi Sithtiger, I was just wondering how you are doing and if things were getting better for you? Please, post an update and let us know how it's going.


Hi, well, a little good news. I have been doing better, but I still have the breathing problems. In order to function, I have to take three 1mg Xanax a day with my Subutex and I'm currently taking 3 doses of Sub a day, so a total of 1.75mg of Sub a day. A couple weeks ago I got real sick and I went down to 2 doses and then 1 dose for one day. I don't know how long this Xanax trick will work, though.

It's weird....if I take too much Sub, that is the full 2mg in a 24 hour period, that's too much and my breathing gets much worse, but at the 3 doses a day, which again I take a 2mg tab and break it up into quarters and then take a quarter dose at a time 3 times a day. At this current dosage I'm soso. I notice that the longer I go after taking a dose, the better I feel. That is the further away I get from the last dose, the better I feel; however if I go too long, then I start feeling bad again and I don't just mean withdrawals, I mean my breathing gets worse.

I have a new primary doctor and she wants to start from scratch, which is fine, but I can tell she's the sort of 'by the book' doctor and currently I don't believe she knows I take Subutex, otherwise she wouldn't be prescribing Xanax with it. I have a physical coming up and I have to take a blood test and the blood test calls for a bunch of different stuff, but if she doesn't already know (and I don't believe she does) she will after that, which I take next week.

I ultimately would love to get off both the Xanax and Sub and if I knew for certain the Subutex is the cause, I'd start tapering down right now, but I don't see how she can determine that. It would also be nice if the breathing problem was something else, hopefully some other drug. So, if that was the case, I'd stay on the Subutex and stop the Xanax. I don't like it, but it's the only thing holding back the full side effects that the Sub does to me.

Oh and I still have Edema in my legs and I'm pretty certain it's the Subutex doing it. Right now, it's not that bad, but if that continues and it gets real bad, I'm not going to walk around with elephant legs, even though the Sub helps my depression greatly.

One last thing....I'm down to 25mg tablets, I actually have the 25mg tablets of Seroquel, but when I go lower than 25mg, always 8 or 9 days after I go down I get seriously intense heart palpitations. Even if I'm working out, I get them. I'd get palpitations before, but it's usually not bad at all, but at least when I was at the gym I wouldn't get them. As I said, though, if I lower the dosage on the Seroquel lower than 25mg, after 8 or 9 days, they get so bad you think you're gonna die. Not only that, I feel really tired and drained. I't not like I have a few and then they stop. They go on for maybe 5 minutes straight, then stop and then come back again and it physically hurts and exhausts me, so I hope I can eventually get off the Seroquel. I've been taking it for at least 7 or 8 years.

Overall, though, currently, I'm doing better. I just hope it stays this way, unfortunately, though, it always seems to come back and I hope I 'm wrong, but I believe it's the Subutex doing this or rather not the Subutex precisely, but any opiate and Sub is a partial agonist. I think that possibly if I stay off Subutex, the breathing problems will eventually go away. The problem is, I'm not 100% certain of this and second, I don't know how long it would take. It could take a year, I have no idea and third, I'm not ready to go through that intense panic and pain again right now, but I believe I 'll be forced to at some point in the near future. Either my new doctor will stop the Xanax because they aren't supposed to be taken together or it will just get bad on it's on.

While I still live with the breathing issue everyday, it's much better than it was and when I'm off the Sub, it gets really bad for days at a time where you feel like you're suffocating. I welcome any prayers and/or any ideas that might help.

Thanks!


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PostPosted: Sun Aug 28, 2016 12:42 pm 
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Update....well as of right now I'm doing better but I went to San Diego with my family to see a concert. I knew I was going to sicker. I was already slowly getting worse and it did. On the positive side it didn't get as bad as it did in Vegas, but on the negative side, I felt horrible and I felt something that I haven't felt in years.

My wife is going through mid-life crisis and in doing so it getting tattoos piercings. She used to be a Rock n' Roll person and now she's completely switched to rap and R&B, which is totally fine, but I hate that music style. It has nothing to do with race either as I'm a mixed race of 60% Caucasian 40% African American. So anyway with that out of the way, the same crap started happening again. The Subutex wasn't working right, in fact, it felt just like withdrawing from an opiate. It feels just like that. Trouble breathing is a common side effect of withdrawal, but I'm not withdrawing. If I take more, especially when the breathing attack gets worse. So it appears that Subutex is the cause in this case; however, I've seen this response to other opiates as well. If I go off all opiates for 3 months and then start back on the Sub, which is what I did, then the Subutex mostly works. I feel that nervousness in the pit of my stomach but the breathing got immediately better. Then after a couple months, it started getting bad again. So I started taking 0.5 mg of Xanax twice a day and then got moved up to 1 mg of Xanax 3 times a day.

When I did that, that helped the most of anything and for the first time in nearly two years I could breathe freely like I used to. I don't like Xanax, but if it did that, I would take it with no problem. The only thing is the Xanax isn't working as well as it did at first. After a couple months, it's all working like it used to and that's before I was taking Xanax, so basically we're back to square 1. So, FF to the present and everything is just about the same as it was before I went off of it, but I had a bad episode that lasted for 2 weeks. It wasn't as bad as prior incidents but bad enough that I was suicidal.

I have a couple more questions but first, I want to get back to the issue with the Subutex causing this. Has anyone heard of a person taking Subutex for a few years and then all of a sudden it turning on them and acts like you're going into precipitated withdrawals and you're not taking anything else (opiates), plus Subutex doesn't have Naloxone in it like Suboxone? I literally feel like I'm thrown into withdrawal episodes. What can do that if anything?

The other question I had was I wish to know the differences and people's experience between Subutex vs Suboxone, vs Zubsolv. I know that Zubsolv comes in smaller doses because it has a higher bioavailability or absorption rate than Suboxone and I assume that applies to Subutex as well since they are the same.

I'd like to know how they like Zubsolv vs the others and the pros and cons to them. My hope is that by using another drug that's basically the same but might work differently. I've heard of people having very different experiences with say Suboxone for example. They may be given the generic Buprenorphine, and Naloxone and have a very bad experience with it and then try the brand name Suboxone and have a completely different and positive experience with it. Technically it shouldn't make a difference, but it seems to in some people. It could be just a placebo effect and all psychological. Ya know what though, I don't care how or why it works, just as long as it works.

BTW, I take 2mg Subutex tabs that I break up into four 1/4 doses. I was taking 4 doses a day, but now I'm only taking 3 doses of Subutex and sometimes I have to go down to just take two doses which equal to 1mg a day. Already I'm not taking much, but it's obviously not enough. If I do that for a couple days, my breathing gets better and I can go back to the three 1/4 dose schedule a day.

Since Zubsolv is stronger than Subutex or Suboxone, they say a Zubsolv dose of 1.4mg is equal to a 2mg Sub. Again, I'd like to know people's experiences on Zubsolve. How much they took and how was that compared to Subutex or Suboxone. I'd also like to know the expense of it. My insurance carrier HMO California also called Brand New Day. It says they cover all these now or at least partially cover them. I currently pay about $12.45 and that's for 2 weeks worth, so I get 14 Subutex.
I don't know much the Suboxone is or the Zubsolv. Even partial cover may prove to be too expensive.


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PostPosted: Mon Feb 06, 2017 3:04 pm 
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I know this is old but wondering if you found a solution to your problem. I myself experience the same thing anxiety for days and it's like it flipped on me one day. Now I'm wondering if it has to do with multiple doses and not getting enough out of our system before we take more and each dose compounds on each other. But if you found a answer to this u would be more than greatfull.


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