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PostPosted: Fri Sep 18, 2015 8:43 pm 
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Hello everyone my name is Tim, I have been on a suboxone maintenance program for about 2 years now. My current dose is 4-6mg per day in doses of 2mg.

The issue i'm having is that for about the past year or so i've been having extreme exhaustion when I take my suboxone. It'seems especially noticeable when I sit or lay down within 5 to 10 minutes I feel total fatigue overwhelm me and I cannot hold my eyes open. This is especially troublesome while DRIVING. I have a 4 year old son and nodding at the wheel really scares me. (Isn't this the reason I got off of oxy? Lol.) It may be helpful to note that for the first year suboxone didn't make me sleepy at all, in fact it made me feel energized for several hours. I felt like doing things and I was a lot more talkative and social. But it's just getting worse and worse now. Also, up until recently my first 2mg of the day would give me a very slight bump of energy and bit of euphoria while the fatigue gradually sets on throughout the day. What's more weird is it always occurs around 4 to 6 pm daily.

Does anyone know if this could have anything to do with irregular dosing? Taking 4mg some days and 6mg others?

Sorry for the wall of text!

Thanks in advance.


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PostPosted: Fri Sep 18, 2015 11:18 pm 
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People sometimes automatically attribute things to buprenorphine, when in fact buprenorphine may not be related. I don't know about your case-- but you say at first that you get tired after taking Suboxone, but then you say the tiredness always occurs from 4-6 PM. Buprenorphine is absorbed over 1-2 hours-- so are you saying that you typically dose at 2 or 3 PM? If so, take it in the morning, and see if that improves things. People have a steady level of buprenorphine in the bloodstream, but there is a small bump up in blood levels for 3-4 hours after a dose.

Also realize that almost all adults have significant drowsiness in the afternoon. That drowsiness is 'hard wired' in the brain; we have a high 'sleep debt' at that time, but the wake centers in the brainstem haven't started firing yet. That is why we can typically nap at 3 PM, but not at 6 PM-- after the wake centers have started firing.

Finally... I have many patients who complain about excessive sleepiness, usually in the afternoon. Some of those patients are taking buprenorphine products, and some have no history of addiction and do not take buprenorphine. It is a common complaint. The best treatment is to exercise in the first half of the day; it increases your general metabolism, and usually reduces drowsiness for the rest of the day, assuming you are getting enough sleep.

I'm not saying it can't be the buprenorphine-- just that it might not be. Most people develop full or near-full tolerance at mu receptors, because of the ceiling effect causing a very level effect at the brain... and many of the 'side effects' that I hear about don't fit real well with the actual onset time of the drug.


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PostPosted: Mon Sep 28, 2015 1:56 pm 
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I feel the same way I've been on 8mg twice daily and I get very tired after my first dose so you are not alone. I've been on subs for 2 going on 3 months. It was not as bad when I first started.. any help would be great


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PostPosted: Mon Sep 28, 2015 2:57 pm 
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Hey sempiternal,

Sometimes after awhile on bupe people say they can become tired.
Suboxdoc did explain reason for this but ive found that many folks seemly
end up taking to much bupe.
16 mgs is a good dose. Try cutting back off of 16. You may find you ll feel better on less.

Just my opinion. .
Razor......


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PostPosted: Sat Dec 26, 2015 8:41 am 
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I know this is an older post but I just wanted to say yes, I've been on it for just over 2 years now and the first year to year and a half, I would feel energised a couple of hours after dosing but now I feel exhausted. I stopped taking my morning dose before work as I couldn't concentrate and my nighttime dose just made me nod out. Im on 32mg and not in the best place right now so taking 8mg every few hours (I only have the 8's no 2's) just to fall asleep. I miss the energy it used to give me :(


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PostPosted: Sat Dec 26, 2015 10:21 pm 
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French, if you are in a bad place this may not be the time to tinker around... but realize that all buprenorphine formulations are indicated for use once per day. I usually recommend patients take divided doses twice per day, just because most people feel more comfortable taking it that way--- not sure if that is chemical or psychological, but I've learned not to fight it.

But there is just no chemical reason to take it every few hours. My concern in patients who do that is that they are back in a cycle of focusing on how they feel, in response to the act of dosing---- similar to when they were using. Again, maybe that's just where you have to be for now. But keep in mind that it takes a few hours for the absorption process, so if you dose every few hours, you are taking doses (and thinking you need doses) even when your blood levels of buprenorphine are at their highest.

The process to reduce dosing frequency is to use distraction, as soon as a craving appears. If you think about it, you will always make the same choice (at least most people do). So as SOON as you notice you are thinking of another dose, do a task that takes 15-30 minutes. Set out to clean the bathroom. Wash a couple windows. Do the dishes. Read an interesting article online or in the paper. Anything to take your mind away from the need for another dose for a few minutes.

Also, try to avoid having extra doses of buprenorphine handy. If you work, take a dose in the morning and then go to work without any medication, taking your next dose 12 hours later, when you are back at home.

Most people will also tell you that 32 mg is a very large dose, and you would probably feel exactly the same taking 8 mg, or maybe 16 at the most.

Taking 32 mg of buprenorphine is much safer than using heroin or other agonists. but when things get more stable, you will have less sedation, less fatigue, and fewer hot flashes on a lower dose... plus you will better accomplish what bupe is intended to do, which is to break the cycle of using, feeling something, then feeling the need to use again.

Good luck-- I hope things settle down.


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PostPosted: Sun Dec 27, 2015 10:43 am 
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Hi French,
I have been on Suboxone about six weeks now. Well zubsolv to be exact, I take one 5.7 mg tablet a day. That is equivalent to one 8 mg tablet or strip. I am a long time heroin user. I have two young children and I work like yourself. When I first was induced with 8 mg tablets, he instructed me to take one in the morning and one twelve hours later. After about four or five days he told me to go down to one tablet a day. Two or three days after being on 16 mg a day I felt very sedated, like a zombie. And not in the great, euphoric way heroin made me feel. After I cut my dosage down, I felt better in a couple days. I really feel that less is more with this drug. I'm really surprised how many people are on such high dosages. Of course consult your doctor first.


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PostPosted: Sun Dec 27, 2015 10:52 am 
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I am glad this post was brought up. I truly think over time like "years" our body gets bup, in our system and we don't need as much to feel "NORMAL"

So if you are starting to get tired after your dose then more than likely it is time to decrease your dose.

I personally was once on 12mg starting out and I have slowly tapered to 2mg because I just didn't need as much to go about my day.

and to be honest I feel the same from 12mg to 2mg over time my body just naturally needed less.


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PostPosted: Sun Dec 27, 2015 11:48 pm 
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That happens over time. IMO it's due to the ceiling effect. I have experienced exactly what you described. Lower your dose and keep it consistent. My advice would be to get off it asap. I was on it for 12 years and did some potential permanent damage to my body, and I'm only 32. Suboxone should never be taken for longer then needed. Just enough time for you to battle your demons, then kick. Any questions please don't hesitate to ask.

We're all in it together,

James


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PostPosted: Mon Dec 28, 2015 12:49 am 
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James, do you have any proof that suboxone has caused any permanent damage to you or anyone else. I understand that this is your opinion, but if you make such a claim on this forum you need to have proof. All long term opiate use can disrupt the endocrine system and cause low testosterone in males (and maybe females). This is a side effect that some will have and it is a problem that can be addressed by medication. It's a disservice to tell everyone that they should stop suboxone as soon as possible when opiate addiction is a disorder that results in the death of so many addicts. There are many factors to consider. One need not panic over low testosterone because it is fixable. Addiction is a much tougher fix with no known cure.

Amy

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PostPosted: Tue Dec 29, 2015 1:54 am 
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James,

FYI, when you post a statement that is only true for you just put in IMO so people know it is just your experience or opinion. No bashing please.

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