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 Post subject: Sick in the morning
PostPosted: Wed Jun 22, 2016 6:10 pm 
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Hello:

I have been on suboxone for about 6 months now. I was on it about 3 or 4 years ago, I got off, did ok for a little while but ended up addicted to oxycodone again.

So for the first 4 months, the suboxone has worked great. I stabilized my marriage, my job, and got back to my hobbies.

The past month or so, I have been having some major issues, however.

I wake up in the morning, and I feel absolutely awful. Feel dizzy, vertigo, headaches. Also I am very constipated. But the dizziness and headaches are ruining my life. I had to call into work, I could barely get out of bed.

These aren't withdrawl type feelings, it feels more like too much of a dose.

So i reduced my dose down from about 8-12 mg down to about 2-4 mg a day, only taking enough to feel ok. I typically take 1-2 MG before bed.

I don't really want to have to quit suboxone-I don't know how I can stay off Oxycodone, and a month or so of withdrawals are too much to take in my life right now.

I know my doctor wants me to take 16MG a day, but I feel like it is too much for me.

Is it possible I am not taking enough suboxone and that is why i am sick in the morning?

Should I not take a dose before bed or try to take a dose earlier before bed?

I am worried every morning I wake up and feel like absolute hell.

I'll take any advice I can right now-I am desperate.


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 Post subject: Re: Sick in the morning
PostPosted: Wed Jun 22, 2016 8:25 pm 
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I have a number of patients who feel best on 2-8 mg per day. If you are not having withdrawal (which would get worse and worse as you get closer to your next dose, and would be associated with dilated pupils), then a lower dose may be the best dose for you.

About 25% of a dose is absorbed in the mouth; the other 75% gets swallowed. Swallowed buprenorphine is converted to norbuprenorphine at the liver. Norbuprenorphine is an opioid agonist, and does NOT have a ceiling effect. Norbuprenorphine causes constipation, which in turn contributes to nausea.

Norbuprenorphine does not cross the blood brain barrier, and so it doesn't get much attention. It does not contribute to the risk of overdose, for example. But there is a part of the brain called the 'chemoreceptor trigger zone'... it is in an region called the 'area postrema' of the brainstem. That part of the brain recognizes toxins and promotes vomiting, and is the area where syrup of ipecac has its effects. I've never seen studies about this issue, but I've wondered if norbuprenorphine causes nausea and vomiting in some people through actions at the area postrema-- where the blood brain barrier is more permeable than other parts of the brain.

I would hope your doc will tolerate this discussion?


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 Post subject: Re: Sick in the morning
PostPosted: Wed Jun 22, 2016 8:37 pm 
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Thanks for the reply, I really appreciate it. I'll take your advice to heart. Maybe I can reduce some of what I am swallowing so it doesn't convert into Norbuprenorphine.

I am thinking of trying a couple of things:

1. Spit out what I would normally swallow.
2. Try a higher dose before bed.
3. Try a lower dose before bed.

I don't remember this being a problem when i was one the Suboxone before, and it hasn't been a problem until just recently.

I will talk to my doctor about this. He prefers me on twice daily dosing, 8MG in the morning, 8 MG at night, but it seems awfully high to me. For months, I was able to maintain at less than 6MG a day.

But I'll try a few different things. Not ready to give up the suboxone just yet, it worked wonders in my life for months before the morning sickness, and no matter how much resolve I have shown in withdrawal after withdrawal (only 1 sub withdrawal but many 'codone withdrawals), I always end up weak and relapsing.

Thanks again for sharing your advice and wisdom, much appreciated.


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 Post subject: Re: Sick in the morning
PostPosted: Thu Jun 23, 2016 1:59 pm 
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Hi Hess, Welcome! I have heard a number of people say that they get up a few hours earlier, dose, and go back to bed. By the time they are getting up to start their day, they feel fine. Its worth a try! I can tell you, it works for me! Have a good day!


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 Post subject: Re: Sick in the morning
PostPosted: Thu Jun 23, 2016 10:45 pm 
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Thanks Michelle! I was thinking about trying that! I'll give that a shot as well.

I did spit instead of swallow (um, that sounded wrong), and I think that helped.

Appreciate the advice!


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 Post subject: Re: Sick in the morning
PostPosted: Thu Jun 23, 2016 11:32 pm 
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Quote:
I did spit instead of swallow (um, that sounded wrong),


thanks, now I have to clean my tea off the key board.


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 Post subject: Re: Sick in the morning
PostPosted: Sun Aug 14, 2016 7:15 pm 
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suboxdoc wrote:
About 25% of a dose is absorbed in the mouth; the other 75% gets swallowed. Swallowed buprenorphine is converted to norbuprenorphine at the liver. Norbuprenorphine is an opioid agonist, and does NOT have a ceiling effect. Norbuprenorphine causes constipation, which in turn contributes to nausea.

Norbuprenorphine does not cross the blood brain barrier, and so it doesn't get much attention. It does not contribute to the risk of overdose, for example. But there is a part of the brain called the 'chemoreceptor trigger zone'... it is in an region called the 'area postrema' of the brainstem. That part of the brain recognizes toxins and promotes vomiting, and is the area where syrup of ipecac has its effects. I've never seen studies about this issue, but I've wondered if norbuprenorphine causes nausea and vomiting in some people through actions at the area postrema-- where the blood brain barrier is more permeable than other parts of the brain.


Thank you for this information. I have had severe issues with constipation since being on Subutex. I recently had a bout of not having a BM for 13 days. I had to go to the hospital and they did some sort of enema given by a doctor in the radiology department. I am going to try not swallowing after I dose. If it helps even a little.... I would be in heaven. You also mentioned nausea.... I had no idea that this was why I dry heave at least 2 times a day. I get this feeling constantly and it's worse after I dose. I had no idea that it could be a side effect. Thanks....


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 Post subject: Re: Sick in the morning
PostPosted: Thu Sep 29, 2016 10:01 am 
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Thank you for this information. I have had severe issues with constipation since being on Subutex. I recently had a bout of not having a BM for 13 days. I had to go to the hospital and they did some sort of enema given by a doctor in the radiology department. I am going to try not swallowing after I dose. If it helps even a little.... I would be in heaven. You also mentioned nausea.... I had no idea that this was why I dry heave at least 2 times a day. I get this feeling constantly and it's worse after I dose. I had no idea that it could be a side effect. Thanks....[/quote][/quote]

Hi BeLinda,
I hope all ur side effects have subsided sense ur last post.
I have the same side effects, on sub 3mg once daily....on sub for 21 days. I was hoping it was the Nox in the sub that was doing it, plan was to ask/beg My Dr to switch me 2 pure Subutext.....sigh
Would love to know how u are doing and what u did if ur symptoms are better.
Hope to hear from u soon
Take care


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