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PostPosted: Fri Jan 23, 2015 11:02 am 
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I know, like all drugs, metabolism will play a part in how long the effects of a drug work, so as a preface... I have an incredibly fast metabolism. I'm very involved in fitness and bodybuilding. I strength train 4 days a week and eat 7 meals throughout the day. Over the years, this has drastically ramped up my already high metabolism.

I should also note that I had been off of opiates for over a month before starting Suboxone. And I've also been on Benzo's for about 6 years.

On day 1, I took .5mg and within an hour or two, all of my cravings and anxiety just vanished. It was the was most level I think I've ever felt. About 8 hours later, I started getting really tired and could, in a subtle way, feel the Sub wearing down. Cravings and anxiety started to creep in a bit but definitely not as bad as normal and I got really tired, much moreso than normal. I did, however, only need to take half my valium dose at night, which was great.

On day 2, I took that same .5mg dose but this time, I got so tired about 3 hours after taking it and over the course of the following few hours I had to take a couple of quick 20-30 minute naps, I just got hit hard with tired spells. Then they just... went away and I was fine. Around 10 hours after this dose, I could feel the Sub wearing off again just like the first day. Same effects... Some cravings returning, anxiety returning and got really, really tired again.

I would initially speculate that I got tired because my dose was too high, even though that seems impossible at 1/2 a mg, but why would I not get tired until it wore off one day and the next day, get really tired shortly after taking it? Could the random tiredness just be acclimating to Buprenorphine and may not be related to the dose? And is tiredness when it wears off a common effect?

I really do not want to dose my Sub twice a day but my doc did give me the option if I want to. I actually have up to 2mg that I can experiment with to find my optimal dose but I really think I can get by without having to go over 1mg. Aside from these tired spells, .5mg feels like a great dose for me but it just doesn't quite last long enough. If I were to take 1mg instead, would that only increase the effects of the Suboxone for the same amount of time or would it also increase the duration of it? I would rather take a higher dose and only take it once a day but if it will not last longer than I guess my only option would be take the .5mg twice a day?


I know it is far too early to know how my dosing will end up but if I could grab some wisdom from you guys/ladies who have been on it for a long time and been around this forum for some time, that would be great! I know these doses are very low and my doc has no other patients on doses this low but I'm elated they're working.

Any advice would be greatly appreciated.


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PostPosted: Fri Jan 23, 2015 4:06 pm 
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Hi HC,

I'm happy to hear that you made your decision and are having good results with the Buprenorphine. :D

The feeling of being tired from the bupe is actually pretty common in the beginning of treatment. It effects people differently, and can come at dosing time or later in the day depending on each persons tolerance to opiates. Taking into account that you haven't taken any opiates in a month I would say your tolerance is very low or non-existent at this point. Since your dose is so small, I really think this side effect will go away within a couple of weeks.

The fact that your dose seems to be wearing off in the evenings isn't surprising either. Suboxone is intended to stay at a level dose in your system for a 24 hour period. However, this is assuming that the patient is taking doses at or above the ceiling level. You are well below that at .5mgs so it makes sense that you feel the effects wearing off at night. My suggestion would be to split your dose and take it twice per day. I know you said you didn't want to dose multiple times, but if you want to stay at a low dose I'm afraid it's the only way to not have that sensation of the medicine wearing off at night. You could definitely try increasing to 1mg, once per day and see if it works. But, that dose is still well under the ceiling and it still may not last the full 24 hours. You might even be able to get by with .25mg taken twice per day and have the same effects. It's really hard to know exactly what will work for you without a little bit of trial and error.

It may just come down to you deciding which thing is more important to you personally. Staying on a very low dose, or dosing only once per day?

I think you should keep in mind that your case is a bit different than the average person being prescribed Suboxone. Since you are not taking it only for addiction it gives you a little leeway into customizing your routine without it effecting your recovery negatively. Normally we would stress the importance of only once per day dosing, but I don't feel that applies to your case so much. It's similar to what we tell people who are using bupe for pain control as well as addiction. The pain relieving effects of Suboxone only lasts a few hours. As long as you plan your dose and take the same amount at the same time each day you aren't feeding into the addictive behavior.

Good luck HC. I'm sure you will get some more opinions soon.

Q

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PostPosted: Sun Jan 25, 2015 9:16 am 
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qhorsegal2,

You've given such helpful advice to me, it's very much appreciated.

I should make my way back to my original thread and put an update there, detailing what ultimately led to my decision to go back on Sub. But for now, in this thread...

I definitely hope the tiredness goes away with time. Today wasn't all that bad except for about 9 hours after my dose... BAM! Passed out on my girlfriends lap. Unstoppable nap. I have a feeling there may still be plenty of days where the tiredness kicks in randomly before it goes away though. I guess it's just one day at a time. And you're definitely right, my tolerance at the moment is definitely low. Although no other opiate has produced this kind of tiredness with me, I have no doubt that the low tolerance alone could be the cause of this issue, especially considering the strength of Buperenorphine.

You mention the dose "wearing off" and this is where it gets kind of interesting. I wish I knew what others felt (or didn't feel) on Suboxone. I've read many accounts where people say they feel "nothing" on Suboxone but I cannot relate to that. By no means would I consider it a high, but I do feel a mood lift from it. I would say about 30 minutes after I dose, is when it "kicks in", as in my cravings start to go away, my mood increases and my anxiety begins to vanish. For the next two hours, all of this, very subtly, progresses and then remains in that state for about another 5-6 hours. I would say about 7-8 hours after my dose, I start to feel it wear off, which to me is my mood dropping a bit, minor cravings coming back and minimal anxiety returning. It's like my mind recognizes this is an opiate but unlike any opiate it has ever processed before, if that makes any sense.

I feel as if it's a catch 22 because I feel the desire to re-dose, which is something I am trying to completely eradicate but I also think that the desire to re-dose is rational considering how much better I feel when the Suboxone is active and I do have a rapid metabolism, to say the least. Unlike other opiates though, even with having more than I need sitting in my cupboard, it takes zero restraint for me to not re-dose until I truly decide I want to. I've also been able, in 4 days, to go from 20mg Valium/day down to 7.5, which is phenomenal. And I know if I re-dosed my Sub, I would not even need that 7.5. Only taking 1 medication/drug a day would certainly be a first for me in about 8 years.

Does any of this make sense? Perhaps I'm just giving myself a hard time about Bupe making me feel... good, if you will, compared to my normal depressive, moody and non-stop opiate craving self.

Tomorrow I may make an attempt at your idea and try dosing .25mg twice and if that does not work, just go with .5mg twice a day. The addict in me, despite Buperenorphine's unique properties, speculates whether or not 1mg would make feel substantially "better" (when .5mg seems just fine right now) and then I would end up dosing 1mg twice a day because I enjoyed the feeling more. I hope this does not come off wrong, I feel like it would make way more sense if I were actually speaking these words but alas... that is not possible.

Hopefully this post wasn't too far off-topic, I just like to type out everything that is on my mind when I get on this forum, even if there aren't responses lol. It's been very therapeutic and helpful having this community and hopefully, in time, I can help others as much as they've helped me.


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PostPosted: Sun Jan 25, 2015 9:55 am 
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I do understand what you are saying but i just got this thought while reading your post...Perhaps this "good" feeling is how "normal" people feel. People that haven't had to live with a depression...Do you know what i mean? Maybe the small sub dose just puts your body/brain in balance so when it wears off you want that "normal" feeling again.

I also was able to reduce my xanax to bedtime only and at a much smaller dose. I only use xanax during the day now if i get a panic attack.


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PostPosted: Mon Feb 09, 2015 10:13 am 
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Well now that I officially have open threads in the Mood, Dosing and Side Effects forums, I can switch to them as necessary lol.

I found out REAL quick that two .25mg doses are almost unbearable because of how short lived it is. And now that I'm almost 3 weeks into this, I'm even finding that .5mg begins wearing off around 6 hours for me. I know that may sound odd but I honestly think the combination of being so far below the ceiling level of Bupe and my rapid metabolism make this quite believable.

Because .25 seems to last only a few hours and .5 seems to last about 6, I'm inclined to make my next jump a whole mg when I wake up and see if the duration follows suit and lasts longer than .5 does. I'm done being hard on myself over possibly using "too much", which are two words I've found myself terrified of since I began Suboxone. The reality is, even at .5mg doses, I still find myself having cravings for my doc which causes a lot of anxiety, and that is far more terrifying than being on a higher dose of Bupe then I initially expected to be on. Mentally, it's very odd feeling at times to be titrating up in my dose, which is the complete opposite of most people! I'm becoming comfortable with it though.

All in all, I'm happy with Bupe. It isn't magically fixing everything in life for me, it's making me work for it!

I still maintain the validity of the title of this thread though lol.


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PostPosted: Tue Feb 10, 2015 10:26 am 
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I realized I completely forgot to ask the main question that I wanted to in my last post...

After increasing to two .5mg doses, I've found not much of a difference, except for my second dose lasts maybe 1-2 hours longer. Even at these doses though, I still get cravings in between my two doses (they are spaced 8 hours apart) and towards the end of the night.

If I up the doses to 1mg, I fear the same thing may happen, which leads me to wonder if the "ceilings" thread is true or not. Perhaps I will not be able to find a true balance and consistency unless my receptors are fully saturated? I definitely "feel" my doses too... I feel them kick in, I feel them peak, and I slowly feel them wear off. I see how Bupe acts more as an agonist under the ceiling level but I'm unsure as to whether or not I should keep increasing the dose(s) until I find a dose that remains stable and I stop "feeling" the Bupe or whether I should just call it a wrap and be happy with where I'm at.

If anybody has any thoughts, they are of course greatly appreciated!!


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PostPosted: Tue Feb 10, 2015 6:33 pm 
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Hey Happy,

It's tough to answer this question. For addicts on maintenance treatment we suggest that they find the lowest dose possible that will hold their cravings and cover the physical WD's. Basically, they need to be at or above the ceiling level to stay fully saturated and avoid feeling the bupe kick in and wear off each day. If you are dosing below the ceiling level, you aren't going to experience that stable, level feeling you are looking for.

That being said, I don't want you to think that you will wind up taking doses that are very high before you get to that point. We have many members here (myself included), who feel completely stable on doses of 2mg or less. I'm not saying that 2mg is providing full saturation, but that for me it feels comfortable and I don't have bad cravings.

Based on the things I've seen here over the years, a dose of 2mg is really about as low as most of us can go without feeling some type of WD set in. If I were you, I wouldn't feel a bit of guilt about increasing to 2mg and camping there for awhile to see if it works. Hopefully you will feel good there and not have to worry about increasing any further.

I hope I answered your question...LOL. I kind of feel like I just went around in circles with my answer. Above all I just want you to quit feeling guilty about taking more than you initially planned on taking. If you are going to do it, you need to give yourself permission to get the best results possible. If that means taking a bit more than you thought you would need, so be it.

Let us know how it goes okay?

Q

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PostPosted: Sun Feb 15, 2015 9:18 am 
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Hey Q,

Thanks for the advice!

I've done exactly as you said and stopped feeling guilty over taking a larger dose then I initially intended to. I was just so dead set on the point blank lowest dose possible, now all I care about the lowest-but-most-effective dose possible!!

I moved my .5 twice a day dose to just 1mg in the morning for a few days and now I'm at a tricky point where I'm having to decide whether I want to dose 1mg twice a day or try a full 2mg first thing in the morning. My doc actually thinks I'll need 2mg twice a day but is obviously fine with a lower dose if it works.

I truly want one dose a day to work, I feel the most comfortable dosing bupe once a day but I also wake up in the morning with a little bit of wd. Not bad wd but not enjoyable lol. Each time I raise the dose, it seems to last just a little bit longer though, so I'm wondering if I stick to one dose and raise it enough, if it will eventually last long enough to be perfect for once daily dosing.

So I guess what I'm asking is if I'm under the ceiling AND I metabolize things at a rapid rate, do you think it would be possible to find a once daily dose that will potentially not have me feeling wd/cravings in the morning if I am getting that issue at 1mg once a day now? I'm OK with dosing twice if I absolutely have to, just really trying to avoid it.


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PostPosted: Sun Feb 15, 2015 5:09 pm 
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Yes, it's absolutely possible for you to be fine for longer than 24 hours on one dose per day. Even with a high metabolism you should be able to find a dose that will hold your WD's for at least 24 hours. This is really how Suboxone is supposed to work. You just have to find the dose that gets you close enough to the ceiling. As I said before, I don't think you will get to that point if you are dosing below 2mg daily.

Honestly, this last post from you leads me to believe your head is in the right place. Once daily dosing is best, but you have to get that dose high enough so that you aren't feeling a high right after dosing and a low before it's time for the next one. Eliminating that cycle is one of the keys to recovery.

I see progress, Happy! If you are feeling pretty good most of the day on 1mg then I don't think it's going to take much more to get you where you want to be. Just keep adjusting up a little at a time until you find the magic number. You'll know when you get there.

Q

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PostPosted: Mon Feb 16, 2015 9:21 pm 
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That's great to hear. You've clearly been around this board for a long time and seen a lot, not to mention your first hand experience(s). I greatly appreciate my doc's opinions but nothing beats first hand experience.

Thanks Q, I actually really do feel like this past week I've come to realizations about Bupe that have completely changed my perception of it for the better. That description is perfect... "but you have to get that dose high enough so that you aren't feeling a high right after dosing and a low before it's time for the next one" ...Bingo! That's exactly what I'm aiming for. In complete honesty, I've spent so many days, several hours after I take my dose, thinking thoughts like "Should I consider this a high? Maybe it's more of a mood lift? I can't tell...". Have there been times where I've felt high? Absolutely, but even during those times, I never get intense cravings when it starts to wear off because it is so gentle, it just goes into a calming mood lift, as opposed to a big high with a massive peak and then a huuuuge drop down to nothing like regular opiates. It's forgiving.

I suppose my biggest concern with raising my once daily dose (which I've been back to once a day for 4 days straight now) is that I'll legitimately get a stronger initial high but the therapeutic aspects still will not last me 24 hours but within a few days, I'll mentally feel like I need that higher dose. Hours 2-3 are when I can feel the Bupe the strongest and I actually prefer when that wears off and it has a more gentle, background feeling to it, so that's why I'm worried about upping the dose and that strong feeling getting even stronger. I know it needs to happen though because cravings start to kick in about 4 hours before I go to bed and I definitely am in minor wd every morning. Guess I just feel caught in a big catch 22 at this point.

Hopefully this makes sense.


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PostPosted: Tue Feb 17, 2015 4:16 pm 
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Happy - My findings are that .5 doses and below tend to come with shorter half lives or metabolize quicker. I'm currently at a 0.04 dose (Haven't dosed yet today) and I feel pretty crap right now. But truthfully, even at higher doses (closer to .5) I'll still feel like its wearing out earlier than the commonly assumed half life actually is. this could be the dose, or metabolism, or both.

See if your doc would be okay with you dosing twice a day, once in the morning, once at night at half of your dose. However, you may not feel much of anything taking .25 2 times a day (I didn't).

evolved.


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PostPosted: Wed Feb 18, 2015 9:20 pm 
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Hey evolved, I appreciate your response but it looks like it was in response to the first post I wrote in this thread and my last post is a much more accurate description of where I am at in my little Suboxone journey.

Q... So yesterday I upped my once daily dose from 1mg to 1.5mg, considering I was feeling the effects wear off 4-5 hours before I went to bed and waking up in minor wd, and the result? Way too strong! :( I actually felt very high (not in a pleasurable way though, not that I'm seeking a pleasurable high or any type at all) and uncomfortable for quite awhile. I'd say it took about 4-5 hours after my dose before the Sub fell into that subtly calming, background feeling that I am searching for.

To make matters worse, I still found myself waking up this morning in slight wd. I'm kind of dumbfounded here... It's like I'm either going to have to take way too high of a dose in order to get 24 hour relief or I'm going to have to take too small of a dose to avoid getting an uncomfortable high but at least be able to feel level for the majority of the day but the up and down of that each day also forces me to "feel" my Bupe much more.

I've reread that several times and it sounds kind of confusing but hopefully it makes sense. I'm truly trying so hard to make this work but some days it's tough because I do not know how I am going to properly dose my Subs :|


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PostPosted: Mon Feb 23, 2015 5:23 pm 
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Hi Happy,

I'm sorry that I didn't see that last post until today. So have you figured out a solution yet? The beginning of treatment with bupe is difficult for some people, especially those with a lower tolerance to opiates. Even though you have been on some form of opiate for years, it seems your tolerance is pretty low still. It seems to me that you are probably going to have to either decide to dose twice per day, or just tough out that high feeling for a couple weeks until your body adjusts to the bupe. I know it seems counterproductive to drive your tolerance up, but it may be the only way to get you to that steady place you are wanting to be. Like I said before, if you take a dose long enough your body will adjust to it, and in a couple weeks you won't feel that high anymore.

I can't tell you what is the right choice. But, I think if it were me I would just stick with either .5mg or .75mg twice per day for a week and see if you wind up adjusting to it. What is your doctor recommending? You may have to deal with some discomfort for a couple weeks in order to get there, but you eventually will.

Q

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