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PostPosted: Tue May 04, 2010 12:24 pm 
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[align=center]Hi, I'm Kim I'm new on here but I've been taking Suboxone for almost 3 months. I know I need to discuss this with my dr but she's out of state right now and I think my medicine is starting to wear off quicker. It might just be me but I used to be able to take my last dose in the evening and be good to go untill late the next afternoon, now it seems like it's wearing off as soon as I wake up. I wake up feeling achy and tired, like I didn't even sleep and start developing a headache first thing. I take 1 n 1/2 8 mg of sub a day, 12 mgs all together. I'm just wondering if the sub is like every other drug in which over time you develop a resistance to it over time and may need more to get the full effects of the meds. Thanks for taking the time to read this =)[/align]


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PostPosted: Tue May 04, 2010 12:33 pm 
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So do you split up the dose and dose once in the morning and once in the afternoon/evening? Or just one dose in the evening? I'd personally switch dosing to the morning if i were you, but talk to your dr first.


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PostPosted: Tue May 04, 2010 12:38 pm 
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Hi Kim and welcome,

Suboxone is not like other opiates with regard to the tolerance you're describing. In fact, suboxone has a mean half-life of about 37 hours. Most people dose once daily, but some even dose every other day. Are you saying you think your having some kind of withdrawals when you get around the 24-hour mark? Everyone is different and everyone metabolized medications differently. I would discuss this with your doctor when s/he gets back to town. Depending on how much flexibility your doctor gives you on when you dose, maybe you'll want to consider taking it in the morning. Just a thought.

I'm sorry I don't have something more concrete to offer you. Again welcome to the forum, we're glad to have you here.

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PostPosted: Tue May 04, 2010 1:30 pm 
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Hey Kim...glad to have you on the forum. I agree with what the others have said, but I had 2 additional things to add.

First, make sure that what you are feeling is related to withdrawal. Are you sure you aren't just having sleep problems and that is why you are feeling bad in the morning? Have you had problems with insomnia in the past? O (and I know this sounds weird) have you gotten a new mattress or pillow lately....I got a new pillow a while ago and realized that it was hurting my neck when I was asleep. I wasn't sleeping well and was waking up all soar....a long shot, but a possibility. I've noticed that I tend to attribute a lot of my problems to addiction issues (withdrawal, cravings, suboxone side effects), so I like to rule everything out first.

Second, Hatmaker is right....most people dose once a day, and this is important for a lot of reasons. Most importantly, it helps us break addict habits...feel bad, take a pill. Having said that, I actually dose twice a day. I felt like my dose wan't holding me through the night. I would dose in the morning, be fine all day, go to sleep, and wake up about 2 hours later, and be sick at night. I tried dosing at night and slept great, but felt sick in the afternoon. So, after talking to my doctor, I dose twice a day (2mg at each dose). But (and this is important) I am really strictly with my dosing schedule. My doses are ALWAYS 12 hours apart...no sooner no matter what!!! This has helped out a lot.

Just wanted to throw that out. Best of luck....keep us updated :) !

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PostPosted: Tue May 04, 2010 2:55 pm 
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Subs actually has a half-life of up to 72hrs, so unless you are taking for pain mgt, it's likely a mental issue. Suggest you try adjusting the nightime dose a tad higher... or else keep morning dose next to bed and try taking prior to getting up.


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PostPosted: Tue May 04, 2010 6:02 pm 
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anni52 wrote:
Subs actually has a half-life of up to 72hrs, so unless you are taking for pain mgt, it's likely a mental issue. Suggest you try adjusting the nightime dose a tad higher... or else keep morning dose next to bed and try taking prior to getting up.


Not to nit-pick, but the average half-life of buprenorphine is actually 36 (not 72) hours and, according to SAMHSA, the maximum half-life is 60 hours and the minimum half-life is 24 hours. Plus, it's my understanding that the dosage doesn't really effect the half-life since both 2mg and 36mg (and all doses in between) have an average half-life of 36 hours.

I think it is also really important to remember that all people react differently to various medications.

:)

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PostPosted: Tue May 04, 2010 6:52 pm 
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I would like to point out that if you are on a lower dose such as ene579 then it becomes a much bigger deal on how long it is lasting because she isn't at such a high dose that the half life is keeping her above the threshhold necessarily. When you are up to 12mg, you shouldn't be getting any withdrawals. With that being said, when I dropped from 16mg to 12mg I could really feel the difference and wasn't feeling well. I LATER learned that I wasn't getting maximum absorption anyways and was taking it incorrectly. So first off, make sure you are taking it right. Second, I would suggest taking the higher dose in the evening and see if you wake feeling better or not. (Really feeling better because our minds play tricks on us). I found that dosing once per day has really taught me not to attribute any and every feeling I had to the suboxone. I learned that a lot of what was making me uncomfortable was just life and had nothing to do with my dose. It was anxiety I wasn't managing properly. You can try dosing once per day and explore ways to deal with the anxiety. You should not be developing any tolerance to the medication. That doesn't really make sense.

Welcome to the forum also! Good luck!

Cherie


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PostPosted: Tue May 04, 2010 6:57 pm 
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Thanks for the clarification Cherie....I totally forgot about the threshold thing at different doses....this really is a complicated drug!! :)

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PostPosted: Tue May 04, 2010 7:58 pm 
You've gotten good replies already. The half-life is in fact, ~36 hours as the others stated according to any reliable data that I have read. We're not suggesting that you aren't truly feeling what you say you are feeling, rather that scientifically speaking, true withdrawal isn't very likely. However, if you ask 10 bupe patients if they experience what you are describing at some point in their therapy with the medication despite the "facts" that say otherwise, I bet that 8 or 9 would agree that they had feelings of w/d before they 'should' have. I know I have.....lots of times.
As Elizabeth suggested, I think we tend to immediately think "it's the Suboxone" when we have any sort of symptom which reminds us of w/d. Most of the time, when those symptoms come, if we will distract ourselves with something or go exercise, the symptoms vanish without taking another dose of Sub. As I have decreased my dose I have started doing something different when I start to feel like I'm having withdrawals.....I check my pupil size. If a person is in withdrawal from opiates, the pupil should be dilated (big) even in regular room lighting. If one is sufficiently 'loaded' with opiates (Sub included,) the pupils will be more constricted (small or even tiny.) At least that is how I understand it. If I'm wrong, someone can correct me, but I don't think I am. Anyway, so here lately, if I feel like I'm in w/d, I check my pupils. And guess what.....even on only 1.5-2mg/day of bupe.....my pupils are still pretty constricted. That being the case, I think to myself...."Well, even if I am in a bit of w/d, it ain't much. So, suck it up and deal with it!!" I'm at that point, though, where I'm not as quick to panic if I do feel some symptoms. At the 3 month point where Kim is right now, I probably would have found it intolerable.
I don't want to belittle your symptoms, but at the same time, I think we (myself included) sometimes expect too much from these orange pills. We have screwed ourselves up by taking full agonist opiates. We have damaged our brains, literally and figuratively. We have messed up our perception of pain and discomfort, and our ways of coping and dealing with life's stressors. It's going to take time and more help than any medication can give us to get this damage repaired. Bupe is helping me do that, but it isn't doing it for me. So I think we have to be careful with attributing everything negative to the medication or our dose.
Having said all that, I do want to add that I agree with the others regarding the fact that everyone is different and absorption issues play a big role.
Hang in there Kim and do talk to your doctor when he/she gets back in town. Hopefully you can get to the bottom of the problem. I'm not a doctor or any kind of expert. Just someone like you who's trying to figure all this out and get better. Welcome and I hope you'll be back!


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PostPosted: Tue May 04, 2010 8:30 pm 
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Great comments. Most of the w/d early on is 'psychological,' and I would bet that if I gave a placebo and told the person to take it at the end of the day (thinking it was bupe), it would eliminate the w/d completely. One of the things I stress the most is that if a person doses ONCE, in the morning, he/she will almost always experience cravings and w/d at the end of the day. If he realizes these are psychological and uses distraction, they will be completely gone by the end of a week; if on the other hand he insists on taking more buprenorphine, that second dose will be harder and harder to get rid of as time goes on. The process of eliminating that second dose is called 'extinguishment' in regard to conditioning (learning) studies. In animals that are trained to push a lever for food, the lever-pushing behavior is 'extinguished' by stopping the reward (the food). With opiate dependence, if you stop dosing at the end of the day, the cravings will eventually go away.

As for half-life, it IS dose dependent, but doses of 8, 16, or 24 mg are all very high, at a point where the metabolic pathways are overwhelmed. Buprenorphine is used to treat pain in MUCH lower doses, on the order of 10-20 MICROgrams. 8 mg of bupe is 8000 micrograms! At microgram doses, the half-life is much, much lower-- around 6-8 hours (I can't remember the exact number in Goodman and Gilman, but it is somewhere in that range-- maybe even shorter). The dramatic drop in halflife at lower doses is why I recommend dosing twice, three, or even four times per day in the latter stages of a buprenorphine taper.

I saw the term 'high dose buprenorphine' or HDB in a paper recently, and I think that is a good term that we should learn to use. We know, for example, that bupe in microgram doses has little if any toxicity, but HDB is a relatively new phenomenon, and therefore it is a good idea to separate HDB from the thirty years of experience that we have with low dose buprenorphine.


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PostPosted: Wed May 05, 2010 10:36 am 
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Thanks for the replies everyone. I kinda do think it's in my head in the way that I start feeling bad n i'm like pointing fingers on the pill cause before when i felt bad i pulled out the plate n in a few minutes felt just fine again, now that i don't do that i think i'm feeling worse than i really am. but with the tolerance thing, thanks so much, because that's not something ive ever thought of asking my dr about or hearing other people talk about. i think it is the way i take it because my dr told me to take a hole one in the after noon and a half in the evening, but i called the director of the program i'm in and he said to start back the way i did before, take a half when i wake up half mid afternoon and half at bedtime, that way i don't short myself through the night. again, ya'll are very helpful, i'm really glad i found this site, thank you!


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PostPosted: Wed May 05, 2010 12:23 pm 
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Setmefree wrote: "The half-life is in fact, ~36 hours"


Taken from SuboxDoc Blog

When people are approaching surgery I recommend that they lower their dose of Suboxone as much as possible– to 4-8 mg if possible. Because of the very long half-life (72 hours), this should be done at least a week before the surgery.


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PostPosted: Wed May 05, 2010 5:16 pm 
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anni52 wrote:
Setmefree wrote: "The half-life is in fact, ~36 hours"


Taken from SuboxDoc Blog

When people are approaching surgery I recommend that they lower their dose of Suboxone as much as possible– to 4-8 mg if possible. Because of the very long half-life (72 hours), this should be done at least a week before the surgery.


Anni,

1. Webster’s definition of “half-life” is: : the time required for half the amount of a substance (as a drug, radioactive tracer, or pesticide) in or introduced into a living system or ecosystem to be eliminated or disintegrated by natural processes

2. Having gone back and re-read the blog post that you sited, I believe that Dr. Junig was talking about the amount of time it takes for buprenorphine to COMPETELY be removed from your body (so that you would be bupe free for surgery), not the half-life. I don’t want to put words in his mouth, and God knows he understands this better than I do, but this is my reading of the information.

3. Dr. Junig has made other references to the half-life of buprenorphine….for example:


Taken from SuboxDoc Blog:

“The actual half-life is 36 hours, but that is a good thing, not a bad thing! That allows a person to take a single dose of Suboxone per day in the morning, allowing the obsession with opiates to fade away. “

4. The information that I sited in my earlier post is from SAMHSA (The Substance Abuse and Mental Health Services Administration): “Buprenorphine is highly bound to plasma proteins. It is metabolized by the liver via the cytochrome P4503A4 enzyme system into norbuprenorphine and other metabolites. The half-life of buprenorphine is 24–60 hours.”

5. I think if you scroll up and read Dr. Junig’s response to this topic from last night, you will see some additional discussion of the half-life of buprenorphine.

I think it is really important to check the accuracy of facts, and to look at the context of your citations, especially if you are going to use the information to tell someone how to take their medication.

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PostPosted: Thu May 06, 2010 10:32 am 
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Again the doc says "half-life" of 72 hrs. You can interpret that anyway you like. But the fact remains thats what he said.

My initial post stated that subs has a half-life up to 72hrs which I believe is essentially correct according to the suboxdoc and others. Especially people who are detoxing and say they don't feel any wd's till 3 days later. You can find those postings all over the internet.

That being said, I don't think anyone [including suboxdoc] really knows what the half-life is for an individual or group. He says in one blog it's 72 hrs and you claim somewhere else he says 36. I'm sure there are multiple variables including dosage, absorption etc. However, you would think he could be more consistant with his opinion.

This really isn't a big enough deal to spend our time debating. I personally don't care one way or the other unless it affects me or someone I care about or I'm in contact with.


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PostPosted: Thu May 06, 2010 12:35 pm 
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I just wanted to add something to what Elizabeth had mentioned about making sure what you are feeling is from the sub. I spent many months thinking my dose was wearing off in the afternoon cause I would feel horrible when In fact it's cause I am diabetic and my blood sugars were out of control and I wasn't testing them and keeping them controlled. Now, Im not saying you are diabetic, obviously. but Im just saying that if it isn't mental it most def. could be something else going on. Hopefully not, but just wanted to give you my experience. Take care!


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PostPosted: Thu May 06, 2010 11:39 pm 
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Also guys when talking about halflives (in this case buprenorphine) it is important to remember that the amount of drug is cut in half every halflife. So if you for example are taking 16 mg of sub daily and the half life is 36 hrs, once that time has elapsed then you are down to 8 mg in the body and after another 36 down to 4 mg then 2mg then 1mg and so on. A duration of a halflife DOES NOT mean the amount of substance is out of your system in merely two halflives. It is super common to assume that that is how it works and it simply isnt true. Sorry i sort of suck at explaining things so hopefully that makes sense to everybody....


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PostPosted: Sat May 08, 2010 12:29 am 
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MyNameIsKim wrote:
[align=center]Hi, I'm Kim I'm new on here but I've been taking Suboxone for almost 3 months. I know I need to discuss this with my dr but she's out of state right now and I think my medicine is starting to wear off quicker. It might just be me but I used to be able to take my last dose in the evening and be good to go untill late the next afternoon, now it seems like it's wearing off as soon as I wake up. I wake up feeling achy and tired, like I didn't even sleep and start developing a headache first thing. I take 1 n 1/2 8 mg of sub a day, 12 mgs all together. I'm just wondering if the sub is like every other drug in which over time you develop a resistance to it over time and may need more to get the full effects of the meds. Thanks for taking the time to read this =)[/align]



I have experienced similar problems throughout my course of treatment, which began in July 07. You are on too high of a dose IMO. It also helps to dose once a day. For me, I personally started to feel good when I dosed 2mg a day. 1mg is even better if I am fully stabilized. Because my endocrine system seems to feel healthy.

The truth is you do become tolerant to Suboxone's effects and the ideal dose will inevitably be the lowest dose possible that keeps you out of withdrawal. For me all Subs gave me at high doses, was lethargy, depression, craving for more suboxone, made sex less enjoyable, and just plain made life less enjoyable.

If your going to be a successful Sub patient, you need to have and keep the "lowest dose is best mentality." You are on this med for the long run, and you will eventually adjust to the effects of every "spike" or every "drop" you make. I discovered the only way to find peace is to just comply with the program and just dose small and once a day. If you can stay consistent, you will eventually start to feel "normal" again. The only problem I have is dropping below 0.5mg, which is the lowest I got to.

I personally struggle with tapering and spiking. What happens, I get real low and then I'll wake up and decide to melt 2mg to enjoy a short-lived buzz. I am at 2mg right now, and I have been at it for months. The main point is don't take more than 2mg if you want to feel good on sub. It isn't hard to taper to 2mg btw. Going from 4mg to 2mg is more delicate though than other larger drops.


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