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PostPosted: Wed Oct 21, 2015 7:53 am 
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Thank you so much for taking the time to reply. Sometimes I literally feel like I am going to lose my mind, for the most part it isn't my chest, it's just the raging pain and tingles up and down my left arm mostly. Sometimes it's both arms. If I had a EKG and it came back normal, does that rule out having real health issues? I literally changed that dose overnight, bc the arm things started happening and I thought it was bc of the subutex. So I freaked out and came down on dose that much.
My mom lived with anxiety for a long time so maybe it's coming to me bc it's hereditary. I'm not sure.
Some days I don't have the arm pain at all, and some days I do. I have it more then I don't though. That would be awesome if Dr J could weigh in! Much much appreciated! I just need to be told I'm not dying, and I think I could find some relief maybe. Doesn't that sound insane? I think so.. Thanks again for the reply!


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PostPosted: Wed Oct 21, 2015 10:32 am 
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I definitely get heart flutters/palps from taking Subox, no question there's a direct biochemical correlation as far as that med and my body. It happens every time I take it, especially on the higher dose (1mg) I'm taking for depression. I'm not detoxing from opiates, and the only other meds I take are for my thyroid and for anxiety. Both of those, separately or together, can cause heart palps and flutters; however, I've gone 3-5 years since my last heart issues. The same day I went on the 1mg of Subox I had heart flutters all day. Same thing the following day. I've noticed the lower my dose (sub-1mg), the less severe the heart issues. I know there are folks on here (docs included) who claim it's impossible (as in "bupe cannot cause cardiovascular issues"), however, I learned a long time ago every body is different, and any drug that alters brain chemistry, like Subox, can bring on a host of issues not even included in the manufacturer's formal guide to side effects. As we all know, our bodies respond to meds uniquely, and slightly elevated heart rate and all day heart flutters, for me, are a side effect of Suboxone. I'm meeting with my doc tomorrow to ask about lowering my dose, as a result.


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PostPosted: Wed Oct 21, 2015 1:40 pm 
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Meek1988 wrote:
Above post continued...
Also, I don't drink, or take any other med at all. I also don't exactly have the resources to get into therapy.
I just need help :( I live in fear 24-7. Panic attacks come on often when I'm driving. And I've completely ruled out being able to drive on the highway bc the panic attacks are so bad I cannot handle it when on the highway.
Thanks again!! Please help if you can..!


Unfortunately, Meek, all of our help is just going to be suggestions. I'm going to venture to say something here that might not get a great response from you. There are therapists that have a sliding fee scale. My addiction therapist was $60 for one hour, and that was her regular rate. I'm not saying that $60 is nothing, but in the face of your extreme problem it would be worth it. One of the things besides medication that can help enormously with panic attacks is a few sessions of cognitive behavioral therapy. You may only need five or six sessions!

I think that as addicts we always want to hear that there is a pill we can take to make our distressing symptoms go away. Unfortunately there is a cost. We are so much more likely to become addicted to benzos than the rest of the population! We need to find other ways of dealing with panic attacks.

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PostPosted: Wed Oct 21, 2015 2:12 pm 
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Thank you so much for the reply, can Dr J weigh in? That would surely be appreciated! I just need to be told this is NORMAL! Then maybe I will find some relief. Thanks Again!


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PostPosted: Wed Oct 21, 2015 8:51 pm 
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I'm happy to reply, for what it's worth! I replied to the original post on this thread a year ago or so-- so apparently palpitations aren't isolated to just your case!

I agree with the earlier comment that everyone is different. But at the same time, there are certain anatomical and physiological principles that allow for some predictions about the effects of medications. For example, we know that ALL mammals need oxygen to stay alive. All mammals need a way to eliminate carbon dioxide, the primary waste product of their metabolism. All nerve pathways have synapses where neurotransmitters are released, and bind to receptors at post-synaptic neurons. And those receptors are identical from one mammalian species to the next, as well as identical in all humans. In other words, MY opioid receptors are identical to YOUR opioid receptors.

Likewise, the processes that cause cardiac arrhythmias are the same in all mammals, and in all humans. The heart consists of cells that have certain characteristics. Cardiac tissue slowly releases certain ions that cause individual cells to 'depolarize' at certain frequencies. Depolarization causes the muscle fibers to contract-- so in other words, cardiac muscle tissue will contract at specific intervals in all humans.

Some molecules will increase the rate of those contractions. Adrenaline and dopamine, for example, will increase the rate of contractions. Acetylcholine decreases the rate of firing. These effects are the same in ALL mammals.

So when I think about what is causing heart contractions, I have to come up with something that makes sense. Yes-- all people are different in SOME ways. But when it comes to physiology, some things make sense-- and some things don't.

To get extra beats, the heart must become more excitable. That implies that the sympathetic nervous system is being activated, and adrenaline is being released. So we have to figure out how a drug that has effects at mu opioid receptors can cause activation of the sympathetic nervous system. I say that because I have never heard of any direct effects of buprenorphine, or other opioids, on cardiac tissue.

As I have written before, the only way I can imagine buprenorphine activating the sympathetic nervous system is when a person is in withdrawal. During withdrawal, epinephrine and other sympathetic mediators are released in the brain and at the heart, causing general excitation in the brain, increase in heart rate, and an increase in blood pressure. The excitation in the brain causes us to feel anxious.

In meek's case-- perhaps the very low dose is causing you to go into mild withdrawal as the dose drops below the ceiling threshold(?), and maybe that is causing the release of epinephrine, making your heart more excitable and more likely to fire premature beats. I can't think of any other way to get from opioid receptors to cardiac tissue.

Realize that palpitations are almost always 'benign'. The exception would be in cases of ventricular arrhythmia, that occurs during a heart attack or in people with congenital heart problems. But if you have had an EKG and there were no abnormalities, it would be extremely unusual for you to have something dangerous going on. The extra beats cause some discomfort, because the heart fills with more blood than usual during the interval after an early beat.... and that extra amount of blood pushes against the esophagus and trachea after a contraction, giving an odd sensation in the chest. But there is no risk of anything bad happening. Those extra beats don't damage anything, or lead to anything dangerous.

My recommendation is that you increase your dose slightly, to prevent dropping into blood levels that trigger the mild withdrawal.

Hopefully this makes sense... I wanted to explain everything to help you understand that there ARE explanations for the things that happen in the body--- and there ARE certain things that can be predicted. In this case, the prediction is pretty clear-- that you are uncomfortable, but NOT in danger of heart problems.


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PostPosted: Wed Oct 21, 2015 9:02 pm 
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Good points. Just to note, the FDA cites heart palps *irregular heart beats" as a common side effect of Suboxone sublingual.

http://www.fda.gov/downloads/Drugs/Drug ... 225677.pdf

So, for anyone who experiences heart flutters, etc., know that Suboxone can and does cause them.


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PostPosted: Thu Oct 22, 2015 4:03 am 
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Hi meek, how often do you experience, the tingling and pain? Is there any pattern regarding time of day, environment, standing, lying down?
I agree it may be worth increasing your dose, do you have any concerns in doing this?
Something to consider...
Take care,


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PostPosted: Thu Oct 22, 2015 10:57 am 
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Tomhunter, understand that the sheet you posted is the Reckitt-Benckiser copy of the side effects negotiated with the FDA for marketing purposes-- NOT scholarly data about buprenorphine.

When any pharmaceutical company seeks approval to market a drug, they submit studies to the FDA that include all symptoms reported by people in the study. If one of the 80-100 people in the study has heart palpitations during the clinical trial, that side effect will be listed.

For example, during studies for Bunavail, some patients in the early studies reported symptoms of withdrawal, and some patients reported 'drug addiction'-- and now their list of 'side effects' to the drug will forever include 'withdrawal' and 'drug addiction'.

I don't know the circumstances that led to 'palpitations' being placed in the RB package insert. Maybe some of the people had palpitations-- or maybe some of the people in the study used cocaine one day. Maybe a couple people in the study had histories of cardiac arrhythmia. But whatever the case, the paper you listed is a legal document that is settled between the company's attorneys and the FDA-- based on the side effects reported in the original studies of small numbers of people.

I don't have access to a lit search right now, but wikipedia references a study about buprenorphine: Common adverse drug reactions associated with the use of buprenorphine are similar to those of other opioids and include: nausea and vomiting, drowsiness, dizziness, headache, memory loss, cognitive and neural inhibition, perspiration, itchiness, dry mouth, miosis, orthostatic hypotension, male ejaculatory difficulty, decreased libido, and urinary retention. Constipation and CNS effects are seen less frequently than with morphine.[57]

I will do a literature search in the next few days if I get some free time, and see if anyone has found a connection between bupenorphine and PVCs.

Apparently tomhunter gets palpitations after bupenorphine. I've treated over 1000 patients with buprenorphine over the years, and never heard a single complaint. So if they are related, I would consider it to be an unusual thing.

Realize also, though, that palpitations and panic attacks are two completely different things. I've had palpitations on and off throughout my life; I'll have them for 6 months, then they will go away, then they come back for six months. They are benign-- and in most cases early atrial beats, not ventricular beats. Caffeine aggravates them and sometimes causes them.

During panic, there is a surge of adrenaline that will cause palpitations from early beats. If you are having panic attacks, the proper treatment would be an SSRI-- which almost always eliminates them. You could also use a beta blocker-- although and SSRI would get to the anxiety, and not just treat the symptoms of anxiety.


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PostPosted: Thu Oct 22, 2015 11:10 am 
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Sounds good.

You'd think they'd not list it as "common" in the document, if it was, say 1% of the total patients studied, even for legal purposes (or, especially for legal purposes), and that the term "common" would have to be defined, rather than colloquial.

Perhaps it is the naxalone? But, in reading all the anecdotal reporting on this and other forums, it does seem to be an established side effect. Now, of course, there are myriad variables, to be sure: people with pre-existing or withdrawal-induced anxiety probably making up a significant portion of the reports (esp w those folks who have never dealt with palps, flutters, etc.). Drug combos, as well, I am sure create some of these effects - and if Subox has any effect on thyroid function, Lord knows that could cause some of these instances (having had mine removed following a thyroidectomy in 2003, both hyper- and hypothyroidism can certainly cause arrythmias).

I'll see if I can find any peer-reviewed journal articles, double-blind/placebo studies, or other more scientific reporting on this connection.

I do know there's a direct correlation in my case - for me, Subox is a heart palp inducer. I see my doc in an hour, so I'll ask him. He's a Johns Hopkins guy with 20+ years as a Subox prescriber (though, again, primarily as an opiate recovery tool). I'll post here when I get home.


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PostPosted: Thu Oct 22, 2015 1:03 pm 
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Thank you so much for your reply! I appreciate it more then you know.
It seems to come on at all different times of the day. I can't seem to get out of my head, if that makes sense?! It is always Mainly my left arm, and left hand that it happens to. Just all up and down pains and numbness.


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PostPosted: Thu Oct 22, 2015 11:36 pm 
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I can really relate to what your saying. I thought subutex was causing a lot of problems for me too. I was having severe joint and bone pain when waking up and when going to bed. Its feels like I'm 90 years old and I'm 26. I'm still having the pain, it comes and goes. I know its not anything else but the subutex. I know this because I've never had these problems before EVER until starting methadone and now with the sub. So I too am trying to ween myself off. A lot of it could be anxiety, or maybe just feeling things for the first time in awhile. I've tried increasing my dose and decreasing, right now I'm at 2mg. I know what your saying and I can relate.


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PostPosted: Fri Oct 23, 2015 3:06 am 
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Tomhunter, if something started on methadone and continued on suboxone I don't know how you come to the conclusion that sub is the culprit. That just seems odd to me.

Meek, my husband has the exact same problem of pain and tingling up and down his left arm. He had an MRI (I think) of his neck and he has problems with the vertebrae of his neck which is causing compression of nerves that originate in his cervical spine. His arm sometimes falls asleep when he is sleeping. You might want to get the nerves in your neck checked out!

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PostPosted: Fri Oct 23, 2015 7:58 am 
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Not sure where methadone comes into it? I simply stated Subox can cause palps and to dismiss the idea as impossible is irresponsible and not medically sound reasoning, even with caveats about not providing actual medical advice here (which, of course, would be inherently dangerous on a number of levels). The FDA has stated it, I've had it happen to me, a number of Subozone users on these forums have experienced it (though the causality is of course debatable esp with pre-existing anxiety), my psychiatrist (yesterday) told me it was rare but does happen in some patients, and my cardiologist's office also did some homework for me and told me they'd not seen it as they dont have anyone on Subox, but the other cardiologist in her office had seen it. It's surprising, in light of all this, the resistance to the idea Subox can cause heart-specific issues in even a very small portion of the population. Rare is the doctor that will say anything is impossible when it comes to biochemistry. I think useing the phrase "it's highly unlikely your symptoms stem from bupe..." would have been more appropriate and more accurate. I do agree, wholeheartedly, however, that it seems cardiovascular or pulmonary complications (such as arrythmias, tachycardia, bradychardia, or any kind of heart palpitation) brought on or exacerbated by the two major drugs that comprise Soboxone are experienced by a very small percentage of patients who are prescribed Suboxone. I think these forums are a wonderful resource, and the mods (and the doc) seem to be genuinely interested in helping the millions of folks dealing with opiate issues. With great power comes great repsonsibility, though, and it's clear there are hundreds of people here who hang on every word an actual MD (if subox doc is actually an MD - apologies, I haven't checked to see if that's just a screenname or an actual medical credential) offers so clarity and accuracy are that much more critical here, esp with so many folks just hanging on by their fingertips.


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PostPosted: Fri Oct 23, 2015 8:02 pm 
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Thank you to everyone for your replies. It helps tremendously knowing I am not alone, and that what is happening to me is some what normal.. So glad I found a place to find some answers, and some relief.
I do not want to up my dose because that's the opposite of what I am trying to do here, ya kno? I hope to be completely done with Sub by the end of the year! Dosing down and down each week.
I am trying very hard to keep focused, and not let my mind take over that I am "dying"
Sounds crazy, huh? With the whole arm numbness, it truly freaked me the heck out.
Thanks again everyone! You ALL helped me so much! I will keep up with posting my progress!
Thanks again!


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PostPosted: Fri Oct 23, 2015 8:04 pm 
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:D :D :D :D :D


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PostPosted: Sun Oct 25, 2015 12:12 pm 
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OK, so I've pored over as many threads as I can, and I've taken in about a hundred years' research and anecdotal evidence as a doctor probably does in their lifetime - which is a good thing :)

and it's clear there are hundreds of people here who hang on every word an actual MD (if subox doc is actually an MD - apologies

Tom, your first statement doesn't match your second. Dr. Junig is one of the more prolific writers. His blog comes up very high on search engines and is linked on the tool bar above. He has posted presentations he has given at national addiction conferences. Perhaps you are like your namesake, unless you can put your hand on him you will doubt.


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PostPosted: Sun Oct 25, 2015 12:36 pm 
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I doubt all doctors, as everyone should. Doctors have the most informed opinions on medical issues, most often, but relying wholly on any doctor without doing your own homework is inherently foolish. As this forum demonstrates, in hundreds of posts, there are untold numbers of folks with MD after their names who have overprescribed opiates, not listened to their patients, been uninformed on medication side effects, and numerous other shortcomings. Listen to your doc, yes, but balance that information with what you learn on your own, doing your own research. God knows, there are also plenty of docs in the pockets of Big Pharma, who intentionally hook patients on long-term drugs (benzos and opiates being two of the most well documented) - so, motivation is also something you have to consider as a patient. Not all doctors adhere to their oath, as we all know, and don't mind doing harm to their patients, if only indirectly and passively. Hell, my GP misdignosed a lump in my neck for 5 years, and, because I trusted him, I never questioned it. Only after moving across the country and finding a new GP was that "benign" lump diagnosed as cancer. Many people will - as I did - blindly follow the diagnoses of their doctors, and the treatment plan. Do that at your own peril. I see Dr J is all over this forum - for all I know, he founded it - but he's also human, and not perfect, despite having been published. Im a PhD and Ive been published numerous times on subjects in my field, and I am the first to say, take my research and conclusions and compare that to the other available literature, your own research, then decide if my conclusions are valid. Any responsible academic or scientist would say the same thing.


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PostPosted: Mon Oct 26, 2015 1:24 pm 
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Yes, Dr. Junig founded this forum. He created this forum to disseminate evidence based information about suboxone and to help suboxone patients around the world. He doesn't receive kickbacks from any pharmaceutical company. You should have seen his opinion piece on how Rechitt Benkheiser was trying to quash any generic formations by making a lame case to the FDA that the films were the only formulation that was safe to be in homes with children! Fortunately the FDA were wise to the fact the RB was just trying to keep suboxone profits to themselves. You see, they still had the patent on the films while the suboxone tablets they had first created were not under patent any longer. If RB wants proof that blister packs can be effective in keeping medication out of small hands, they only have to watch my daily struggle to open my Zubsolv if I don't have a pair of scissors handy!

Dr. Junig did not have to create a forum at his own personal cost if he were not motivated by altruism. The fact that he has served hundreds of opiate addict patients means that his points are quite valid. He sees trends that we as addicts aren't privy to. Asking the opinions of the addicts around you is not as illuminating as noticing trends among hundreds of patients. While Dr. Junig may not be correct exactly 100% of the time, he is coming from a place of being an addict himself and feeling empathy toward opiate addicts. That, itself, speaks very highly about him in my opinion.

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PostPosted: Mon Oct 26, 2015 1:36 pm 
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Well stated, and I do see your point. Suboxone does need its advocates, as it certainly has its detractors.

Having been to rehabs (in-patient and outpatient), doctors, researched online, asked psychiatrists, etc... it's amazing to me how focused the whole system seems to be on keeping people hooked on opiates and so seemingly oblivious to titration/weaning, etc. - and so often unwilling to believe you when you tell them how bad withdrawals can be. I've detoxed from alcohol (5 or 6 years ago), opiates (four weeks ago, roughly), and Ativan (a benzo, maybe 4 years ago). While #1 and #2 are physically brutal, nothing on the planet compares to trying to wean off benzos. I've been on prescribed valium for three years (20mg, down to 15 now), and while I'd not like to go through alcohol or opiate withdrawals ever again, benzo w/d is the only one I truly fear. It's freaking insane, literally.

Anyway, I did see something interesting on the forums yesterday, as I've had a headache non-stop for 10 days since I started this. Some folks opined that swallowing the sublingual saliva after the dissolving process is complete might be the culprit. Interesting idea.


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PostPosted: Mon Oct 26, 2015 7:29 pm 
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If one has a sensitivity to naloxone then spitting the saliva out can help with headaches. I hope yours go away soon! I get migraines with annoying regularity, but I've had them for far longer than I've taken suboxone. Since mine seem to be hormonally triggered I am hoping for early menopause! Some days I have half a mind to cut off my head and find a new one on ebay. ;)

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