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PostPosted: Mon Apr 19, 2010 1:34 pm 
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Ok some one explain to me the ceiling effect. Is it 4mg? Meaning to I feel anything more over 4mg? If I am taking 2mg and increase to 4mg, do I "feel" more. Also, I have heard some say that if you put 4mg in your mouth, only really 2mg is abosored?? Is this true. I never have a pill dissovle all the way. I mean if it isn't all gone, then it all didn't get abosored right???? How to I get most abosored?


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PostPosted: Mon Apr 19, 2010 4:33 pm 
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The answer to your question is that the ceiling effect is reached somewhere between2-4mg now keep in mind this means that somewhere between 2-4mgs has to actually be absorbed which means that if someone were to take 4 mgs of Suboxone (buprenorphine) only part of that amount is actually absorbed. I believe that according to the numbers I've seen somewhere between 50-60% of the medication is absorbed sublingually. There are also several other factors that effect how much of the medication is absorbed including how long the medication is under one's tongue or mouth, if the person swallows large amounts of the medication before allowing the neccessary 30 some odd minutes for the medication to be absorbed (as buprenorphine is subject to "first pass" metabolism), if the individual drinks, eats, or brushes their teeth immediately after dosing. For me what has worked in helping me reach the ceiling is taking 8mgs a day and upon placing the tablet in my mouth I "chew" the tablet into very smaller pieces ( don't swallow until after 30 mins or so) and then rub the paste like substance under my tongue and around the inside of my mouth for somewhere between 30-45 mins and then I don't drink, eat, smoke, or brush my teeth for another 30 minutes or so after. It helped me to get in the habit of taking the medication the same time everyday. I dose during my commute to school which takes a little over a half hour then once arriving in class I finally swallow the medication and don't eat or drink anything until class is over. Hope this helps and it's a good question :) I've run into some really silly people who think that high dose buprenorphine can also be abused by recovering opiate addicts. They say that when they take more than the ceiling dose of around 2-4mgs they achieve a more powerful opiate effect. Now they're obviously not aware that A. only part of the dose taken is absorbed B. the importance of allowing enough time for the medication to be absorbed C. not eating, drinking, smoking, or brushing one's teeth for a fair amount of time after dosing and finally D. alot of those individuals do not dose at the same time everyday. I hope this helps and welcome to Suboxforum keep the questions, comments, concerns, etc. coming :)

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 Post subject: MAtt
PostPosted: Mon Apr 19, 2010 6:18 pm 
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Wow, i was putting them under my tounge. Question, I am preggo and trying to get to 2mg, now I am on 4mg, so when I put the 4mg under my touge, it never dissolves all the way, so I am not getting 4mg really then right??? Maybe I am getting only 2mg, the amount I want to be down to. I got to stop before surgery so the lower I get before I have to stop the better. Then once I come home I will start taking subutex again. Subutex is really nasty should I do it the way you say???


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 Post subject: This is how I do it.
PostPosted: Tue Apr 20, 2010 1:25 am 
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Because of its ceiling effect and poor bioavailability, buprenorphine is safer in overdose than opioid full agonists. The maximal effects of buprenorphine appear to occur in the 16–32 mg dose range for sublingual tablets. Higher doses are unlikely to produce greater effects.

I found this on buprenorphine.samhsa.gov. I have also had my doc tell me the same thing.

I like to set aside at leat 15min when I take my dose. I have noticed that it does work better if I don't eat, drink, or talk while its dissolving. Personally I do "feel" the difference between 8 & 16mg doses. I'm not sure if it's psychological or not.


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PostPosted: Tue Apr 20, 2010 7:54 am 
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Kris,

I think if you are taking the 4mg under your tongue then you are doing fine. What I do after leaving the pill under my tongue for 10 minutes, if it all hasn't dissolved, then I chew what it left and put the paste all over the inside of my mouth. Then I sit for another 10 minutes letting it absorb. Then I swallow. I don't know if I get max absorption or not. What I do know is that I can feel it in the morning if I didn't have as much time to take the medicine as opposed to those days where I did have enough time. Then the next day I can wait far longer before taking it again. So I can tell the difference. The problem I have is that after the first ten minutes, my mouth is really watering and once I chew it my mouth really waters. So it is hard to get max absorption when you have so much saliva. I haven't figured out how to stop that yet.

You are getting a build up in your system over time so really, you are probably fine with the 4mg you have prior to your surgery. The question is....how are you feeling?

With that being said, I could tell the difference when I went from 16 to 12mg and although some of it was psychological, there was another part that was not. Right now I am on 8mg which works to an extent for my pain issues, but my pain was better controlled at higher doses. 8mg works enough for me.

Cherie


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PostPosted: Tue Apr 20, 2010 9:40 am 
Hey Kris - good to see you're still posting. I'm a little confused. i thought on another thread you said the doc was keeping you on 2 mg a day until a week before the C-section. That would mean just take 1 2mg tablet or 1/4 of an 8mg tablet and don't worry about calculating the absorption. Even though it doesn't seem like a lot, read Dr. Junig's latest blog post on dosages. Even a 2 mg dose is many times the amount they give for pain management, which is in MICROgrams. Staying on the low dose will help you transition much easier into what they will give you after the C-section. Hope you are feeling well.
Lilly


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PostPosted: Tue Apr 20, 2010 9:48 am 
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I feel ok, I am acutally able to skip a day, I know that may not be right, but I can. I can actually "feel" something every time I dose, maybe this is also in my head. I never thought about that. If I dose anything over the 4mg, I get very sick and sometimes I get sick at the 4mg???? I don't know why, maybe it is the difference of eating before or not eating before - or yet again all in my head. I just really hate the fact I am preggo and have to take this. I got my "own" plans as to what I want to do, I want to stop at least 10 days before if not more to ensure the baby doesn't w/d at birth and that my pain me manged - selfish??? I don't know. But will the baby be in distress if I stop during those 10days??? I don't know - will it cause early labor??? If it did, I am sure a 37 week old fetus will have no probelm surving out in the world. I know not an excuse. I am just a worried mother and it is ok to have my feelings. I am being honest with you guys and love to hear your suggestions. I have went seven days without it before, so i know I can go seven.


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