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 Post subject: Dosage sugestion help.
PostPosted: Tue Jan 05, 2010 7:22 pm 
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Salutations everyone, I'm very thankful to post here.

I usually take a cocktail (3 or 5 times per day) of 1 x 20MG Oxyconton + 1 x 10/325 Norco + 1 x 600MG Gabapentin. I nearly lost my left leg, luckily I had a very successful bypass surgery - Ive got a lot of nerve damage and some pain. Ive been on the opiates for over 2 years. Understand this, I hate the opiate addiction more than anything - I have already decided, in my mind that this Suboxone treatment will save me from this hell. I'm 6' 2" 250lbs 53 years old. I'm fairly healthy, I ride a stationary bike and walk. My diet is terrible but as of 2010 I am a mad juicer, fruits, vegetables - grains and lots of fish. My plan is to lose 5lbs per month.

My MD just prescribed me 30 x 8MG and said to take one per day. Luckily I did a little research and discovered that I needed to be in withdrawal before the first dose.

I took my last dose of Oxycontin at about 4am Monday morning. I took my first dose of Suboxone 8MG at 2PM today, so its been about 30 hours and I definitely am in withdrawal. Its been about an hour since my first Suboxone and I already feel better.

I am still taking my Gabapentin 4 x per day. No more Oxy, no more Norco.

I guess my question is am I doing this right? Will I need another dose today? If I can get by with one dose per day that I can taper off to nothing, that would be a blessing.


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PostPosted: Tue Jan 05, 2010 8:25 pm 
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Hi Mitch, and welcome:

Congratulations - you've taken a huge step in your recovery/healing.

The normal procedure is for the doctor to do your induction with Suboxone in his office where he/she can see how you respond, such as how long it takes for w/d's go away, and to decide on the proper dose for you. From your post it doesn't sound like your doctor did that.

Let me ask you this, did your doc tell you to take it sublingually - under the tongue? I thought I'd mention that just on the off chance you weren't informed.

If you go to Dr. Junig's "Suboxone Talk Zone" (or even look here on the forum) and search his articles for "maximum absorption", I think you'll find it helpful. He offers clear advise on the best way to take it. A valuable article.

Since he/she didn't even tell you about needing to be withdrawing, I feel the need to ask exactly what were you told? Only your doctor can decide if you need more than one per day. Again, normally they see you weekly or so for the first month, before just giving you a script for a month.

From everything your doctor DIDN'T tell you, I can clearly empathize with your confusion and frustration.

But I will say you came to the right place. You'll get lots of different experiences and perspectives from many supportive people.

I'm not a dr. or expert, but hopefully this information will help you a little bit. And be sure to check out the many informative threads here on the forum - they can be both educational and inspiring.

Keep us posted on how your doing and feel free to ask more specific questions. You got so little information from your doctor, it's difficult to know what you need to know and what you were actually told. BTW, when is your next appointment? Did the doctor leave it open for you to call for an earlier appointment?

Take care and keep up the good work. Again, welcome to a great forum.
Melissa


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 Post subject:
PostPosted: Tue Jan 05, 2010 9:01 pm 
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Hi Melissa, no he didn't tell me how to take it, again I happened to read about that beforehand too. He did give me an information pamphlet and told me I wouldn't be able to take the Oxy anymore.

After reading several articles on the web, I approached my Family MD about Suboxone. He suggested I ask my pain management MD about it first. My Pain management MD doesn't approve of Suboxone but my pain management MD is also a partner in a big rapid detox program. He would much rather have me spend my money on his rapid detox program than simply subscribe a medication. Sorry, I'm getting off topic a bit.

Anyway, considering how bad I felt this morning, I feel much better after the Suboxone dose. I think Ill just try to keep it at a once a day dose. Do you have a link to the Maximum Absorption article?

And thank you again :wink:


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 Post subject: Here's that link.
PostPosted: Tue Jan 05, 2010 9:16 pm 
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Hi again, Mitch,

Here's the link to Dr. Junig's article: http://suboxonetalkzone.com/?p=1179.

I'm stunned at how little information you were given. I hope you don't mind me saying perhaps you should consider finding another Suboxone doctor. Mine is also my primary care doctor, but most who deal with Subox are addictionologists, many of whom are psychiatrists. There are several online doctor-patient matching services, I think on the doc's blog, at NAABT.com (that's where I found my doc.), and I think Suboxone.com.

You're in an odd position, because if you weren't told what you needed to know, then you don't even know what questions to ask! (Geez, did that make sense? LOL)

I agree you should stick with one a day. The last thing you want to do on your first script is run out early!

Take care,

Melissa


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PostPosted: Tue Jan 05, 2010 9:26 pm 
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Excellent, thank you again. I don't mean to sound like I'm bashing my doctor, I really think there was a serious miss-communication though. The important thing is that its working, so far, so good.


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PostPosted: Tue Jan 05, 2010 10:16 pm 
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Glad to hear you're doing well on it.

Keep us posted.

Mel


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 Post subject:
PostPosted: Tue Jan 05, 2010 11:16 pm 
Welcome Mitch. I'm glad you are feeling better.
Hatmaker has given you some good feedback already. I don't have too much to add.
Just wanted to say that I am so glad you did your research before you started Suboxone. Unfortunately, I have to agree with Hatmaker in saying that you might not have the found yourself with the best Suboxone doctor. However if it's necessary for whatever reason to stay with him, everything might still work out okay as long as you continue to educate yourself on addiction and treatment.
As far as your dose - 8mg/day is often just right for a lot of people. However, usually (again echoing Hatmaker) your doctor should be working with you to determine what your optimal dosing regimen is. Many times, people are started with up to 3-4 doses per day at 4-8mg each dose until their withdrawal symptoms are relieved and their cravings for opiates are gone or at least become manageable. In other words, sometimes up to a total of 24mg/day at first.
But, if 8mg is working for you - that's great. Once a person is stabilized at a particular dose, it is often recommended to take that total dose all at one time once per day (to break the addictive habit of multiple dosing). If you read around the forum, you'll find all this info and more.
As far as tapering and weaning off Suboxone - again, read around the forum and you'll see valid arguments for and against this. In general, rapid tapers and weaning are NOT the recommended way to go. It takes time to work on issues that led to our addiction in the first place and it's gonna take more than a few weeks of Suboxone to fix that. Make sense?
It sounds like you are one of many here who became dependent on opiates due to significant pain issues. There is a difference between dependence and addiction. I'll bet you've done your research and know the difference. You did refer to opiate "addiction" in your original post so I'm approaching this from that angle although I understand your problems started with dependence most likely. Bottom line is...you've been in a vicious cycle of opiate use/abuse/tolerance and so on. And that whole deal sucks no matter who you are or what your story is!
So congrats on taking this step and for working on your health in general. Keep that up. Educate yourself all you can about this subject and continue to visit here often. You will learn a bunch as I have!


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 Post subject: Welcome...
PostPosted: Wed Jan 06, 2010 12:57 am 
Hiya Mitch, welcome, I just wanted to encourage and support you in your decision to switch to Suboxone. This medication has absolutely saved my life. For some reason it is an opioid that doesn't seem to carry the negative consequences associated with other narcotics. I think you will look back and be very glad you decided to take it.

But a couple things: This doctor sounds careless at best. I mean, you could have gone into a nasty withdrawal by taking it too soon, or taken too much, or anything because he really didn't tell you squat. Having someone read the manufacturer's literature is not sufficient patient consultation. Ultimately, it sounds like you need to find a pain specialist that knows addiction medicine and prescribes Suboxone. They are out there, there are actually a few in my city (Richmond VA). BUT before you leave this doc make sure you have a good little supply of Sub pills, because to run out of your Suboxone is a seriously bad thing. The withdrawal is fairly severe and you want to make sure you don't have to do it until you are ready and you have weaned down over several years.

As far as the doctor giving you doses in his office, that's not always the case. Suboxone has a very good safety profile with a very low risk of overdose. At my first appointment with my Sub doctor, he wrote me a prescription for 90 8mg pills and said to take up to 3 a day as needed and then come back in a month. I took 3 for a week, then settled on 2. So you don't really need the doctor to decide your dose. Hoped this helps!
JD


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 Post subject:
PostPosted: Wed Jan 06, 2010 2:40 am 
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Thanks for the support, sincerely. I feel like Ive been taking the Oxy more for my addiction than any other reason lately, there have been many times I would wake up in the middle of the night sweating and my skin crawling so I'd take a dose of Oxy or Norco or both. I hate the sweating and restlessness. I'm sick of planning everything around my medications. I hope I will be okay with the 1 x 8MG until tomorrow afternoon.


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 Post subject: Suboxone's half-life
PostPosted: Wed Jan 06, 2010 8:13 am 
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Hi again, Mitch,

I noticed you expressed hope that one 8 mg pill will hold you for 24 hours.

Please be aware that Suboxone's half-life is on average 37 hours. Many, many people dose once every 24 hours.

Just FYI.

Keep in touch.


Melissa


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 Post subject: Welcome
PostPosted: Wed Jan 06, 2010 12:05 pm 
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Hi Mitch,
Just wanted to chime in with my $0.02!
Welcome to the forum. I hope you find it as usefull as I do / did when I was just starting my treatment with Suboxone.
I wanted to share my experience with you so you can compare it to your own seeing as you didn't get much giudence from your Dr.?? I was on 300 - 350mgs. of Oxycodone @ the start of 2008. I had the addiction for many years and it progressed to that point. I knew I had to do something before I ended up in the city morgue! I came clean with my Dr. and he was great. He sent me to a Subox Doc. and 2 days later (after being OFF ALL pills for 24 - 36 hrs.) I was in that Dr.s office for my induction. He started me of with 2mgs every hour for a total of 12-14mgs. that day. They watched me and monitored me during this time. I felt very comfortable with the whole process. That was 11 months ago! Fast Forward to today... I am on 16mgs. a day . I take them both (2x8mgs.) in the morning and they last till the next day with no problems. I also see a therapist 2 times a month and my Subox doc every 2wks. for my script! I think next summer I will start my taper? But that's down the road for me... I didn't mean to ramble just wanted to give something to compare yourself to.. I wish you the best in your recovery... You have taken a big step in the right direction by asking for help... The rest will come in time! Keep us posted on your progress and Best of Luck!!
God Bless
TW


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 Post subject:
PostPosted: Wed Jan 06, 2010 12:58 pm 
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Hey Mitch!

Also, welcome! I hope you are doing well today. I'm curious how your induction and progress is going?

setmefree mentioned something that was actually a little harder for me than I thought! As you mentioned, you planned your life around your pills. So did I! Stressful.

Well, when I was prescribed my sub - I read information, watched video's, went to the pharm co's website - watched the induction method - and was ready for an in-office induction.

Well, it was not that way! I received better and more information than you did - for sure, but I was given 12mg's a day - and to start with 4mg that afternoon (being as I was already in mild/moderate wd).

Because I've been around doc's a bit - my goal was to get on suboxone and figure out how to stop the dependency on full opiates. I, honestly, was just glad to have a script and to get things out in the open with the doc and my wife. That was very hard for me.

Sorry for the ramblings, the idea I wanted to share was multiple times a day dose. The script said 4mg's 3x a day. I did exactly that for a while, then noticed the noon dose was hard to do at work. So, I went 8mg - am, then 4mg - pm (dinner'sh). I wanted to get to 8mg, and started cutting down my afternoon dose to see what would happen. I found no wd's (except a runny nose - which may have been a cold anyway) - but there was something about even a 'fragment of a pill' in the night which my brain desired. Amazing. One day, I was distracted somewhere away from my house at night and when I came home I realized I hadn't taken my little night piece of sub. So... I thought - here goes - skip it. Well... the next day was nothing. I knew all about the 37 hour half life, etc.... some of our behaviors are mental. For me at least. So now I'm once a day and it's easier/convenient, etc.

CAVEAT!! There is no 'exact' best way to take sub as to times per day dose - (that is - one size fits all). Obvious, for people like me with no pain reason now (knee surgery was a decade ago!), breaking habits is important. Others here are in Chronic pain, and find that smaller doses throughout the day seem to help them a little better. I think someone said 'it's like topping off the tank' or close. With your leg, and your pain - please dose in the way you get the best relief.

WAY TO GO! and please post back how things are!


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 Post subject: realization...
PostPosted: Wed Jan 06, 2010 2:32 pm 
This thread had reinforced in my mind what an important tool buprenorphine treatment really is to addicts everywhere who've found themselves slaves to the pain pills. I never thought I could have a productive life again.


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PostPosted: Wed Jan 06, 2010 2:40 pm 
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I tossed & turned all night, my stomach still hasn't recovered, my legs were achy and I've had a dull headache off and on since yesterday. I finally slept a little-bit this morning.

I was starting to get 'hot flashes' (will they ever subside?) and feel the need so I took another dose at 9am (this morn) and I'm feeling better now. Ill probably be more active today so hopefully Ill sleep better tonight. I have some old Soma that I was tempted to take - to help me sleep but I'm not sure that's a good idea at this point (?)

I have to say that I was really concerned about how I was going to react to this whole thing, I actually put it off a couple of times (I wanted to get through the holidays) which turned out to be a good thing because it gave me the opportunity to do a little more research. So far its working great - the support here has been a blessing too. Ill keep updating, hopefully my trip will help someone else who's lost their compass.


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PostPosted: Wed Jan 06, 2010 3:01 pm 
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If I have learned anything throughout my past months here, it's that there is more than one "right" way to take Suboxone. Some people are on lower doses, some on higher; some dose once a day, others twice and even a few three times each day. The trick is in finding the dose and frequency that works the best for you. To do that you'll have to endure a few more of these types of days to get stabilized. However, if you find by say this weekend the same things are going on, it may well be that you are not on a high enough dose. The symptoms that you describe coupled with the fact that after taking your next dose, they seem to subside, MAY mean your dose is a bit low. However, that could very well correct itself in the next couple of days as your blood levels come up. You'll just have to try to be patient and sort of tough it out. My point is, if you get to Monday and are still having these problems, a call to your doctor (or a visit) is probably in order so he can adjust your dose - or perhaps add a second 4 mg or 8 mg dose at night.

Hang in there. You are very likely to get stabilized here shortly.


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 Post subject: You are on your way!!
PostPosted: Wed Jan 06, 2010 4:07 pm 
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Hi Mitch,
If I could add something... You are well on your way in recovery! I say that because your head is in the right place. It seams to me that you are very intrested & active in your recovery.... Thats a big part. I don't know if you are getting any counseling along with your medication but, from my stand point it is also a very valuable part of recovery...The last thing is... Be open with your Dr. as far as the meds. go. Let him know if you think your current dose is not doing the trick! If you can't talk openly with your Dr. maybe it's time for a new one...
I wish you continued success & keep up the hard work!

God Bless
TW


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 Post subject:
PostPosted: Thu Jan 07, 2010 9:49 pm 
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I think I am going to try an AM/PM dose, in the evening I get hot flashes, runny nose and I'm grouchy. I'm disappointed, I wanted to get this over with asap but I have to be realistic and accept that its going to take a few months or longer. Does 8MG AM and 8MG PM sound like too much?


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 Post subject: Not at all.
PostPosted: Thu Jan 07, 2010 10:16 pm 
No. That dose is absolutely fine. The only thing is that taking it more than once per day really makes no difference other than in your head, but if it works for you, go for it!!
JD


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 Post subject:
PostPosted: Thu Jan 07, 2010 10:45 pm 
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"The only thing is that taking it more than once per day really makes no difference other than in your head"

Careful there JD. That may be the case for you, but it is not the case for everyone. In fact, there is a reason that the manufacturer recommends twice daily dosing - following scientific trials and FDA approval. Some folks may require or do better with twice daily dosing - especially in the first couple of months after starting Suboxone, and in some cases with lower doses.


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 Post subject: OK, cool
PostPosted: Thu Jan 07, 2010 10:53 pm 
I stand corrected! I really didn't know that. But at least that will be one less piece of misinformation I'm spouting...LOL.
JD


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