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PostPosted: Sun Nov 21, 2010 3:52 pm 
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Today I found the following letter to Reckitt-Benckiser from the FDA which approves the Suboxone sublingual film.

http://buprenorphine.samhsa.gov/Approva ... neFilm.pdf

It's nine pages, but a very interesting read! It mentions how they received approval of the film on the condition that they do a study of how it affects QT intervals (among other) - which could represent cardiac arrhythmia. Could someone medically-trained please explain this better than I can?

This is the first I've heard about suboxone in any form having a correlation to any kind of heart arrhythmia. Is this just something they have to rule out or is this a possible risk? I have tachycardia and take metoprolol and I know others who also take beta blockers, too. I'm hoping Dr. Junig could read this and tell us what he thinks and if this is just normal procedure or an actual concern. Regardless, I wanted to share it with you all. Thoughts?

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PostPosted: Mon Aug 01, 2011 10:30 pm 
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I have been having problems with tachycardia and it has now turned into AFIB. I have had several attacks that put me in the hospital and now on daily meds. I am still having problems increasing to almost daily. I almost went to the hospital tonight as I had a pretty severe one. i usually can take an extra heart med, lay down and then in about an hour I feel some what better. I'm just wondering. The heart docs don't know anything about Sub, heck not hardly any regular docs know about sub.

I've tried getting off sub and did shortly to have an cath. The cath was normal, but I continue to be plagued with this horrible AFib attacks out of nowhere.
I am down to 2 mg sub daily but I really am trying to get off and i am having trouble. I am supposed to be cutting my film in half and so far haven't been able to. IDK, I just want ff and I am worried now that the sub may have something to do with my problem of afib.Anybody know?????


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PostPosted: Tue Aug 02, 2011 12:53 am 
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hatmaker510 wrote:
Today I found the following letter to Reckitt-Benckiser from the FDA which approves the Suboxone sublingual film.

http://buprenorphine.samhsa.gov/Approva ... neFilm.pdf

It's nine pages, but a very interesting read! It mentions how they received approval of the film on the condition that they do a study of how it affects QT intervals (among other) - which could represent cardiac arrhythmia. Could someone medically-trained please explain this better than I can?

This is the first I've heard about suboxone in any form having a correlation to any kind of heart arrhythmia. Is this just something they have to rule out or is this a possible risk? I have tachycardia and take metoprolol and I know others who also take beta blockers, too. I'm hoping Dr. Junig could read this and tell us what he thinks and if this is just normal procedure or an actual concern. Regardless, I wanted to share it with you all. Thoughts?


Highly doubt it is causing your problem. Found this on American Health Journal

"OT Interval Changes Caused By Other Opioids"

The adverse events of methadone followed a history similar to that of levoacetylmethadol, a structural derivative of methadone. Levoacetylmethadol was approved in 1993 for the treatment of opioid dependence. It was developed and studied as an alternative to methadone because it was longer acting than methadone and required less-frequent administration. Originally, it was found to be as safe as methadone.[59] In 2001, reports of adverse cardiac effects associated with high doses of levoacetylmethadol began to surface, and levoacetylmethadol production was subsequently curtailed.[60] Some researchers still believe that levoacetylmethadolis safe when administered in accordance with guidelines (e.g., routine ECG monitoring, proper dose selection) and that it should be reconsidered as an option for treatment.[61]

Aside from levoacetylmethadol and methadone, no other opioid or opioid-related compounds have been associated with adverse effects on Q-T intervals when used at therapeutic levels. Katchman and associates[62] found that codeine, buprenorphine, and fentanyl can block potassium ion channels, but these drugs reach lower plasma concentrations than levoacetylmethadol and methadone. Therefore, codeine, buprenorphine, and fentanyl may be less likely to cause noticeable Q-T interval prolongation. Propoxyphene, which is structurally similar to methadone, has been noted to prolong Q-T intervals in acute overdose cases, but this effect seems to be related to interactions with sodium channels.[63]

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 Post subject: heart issues
PostPosted: Tue Aug 02, 2011 1:00 am 
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toothygrin wrote:
I have been having problems with tachycardia and it has now turned into AFIB. I have had several attacks that put me in the hospital and now on daily meds. I am still having problems increasing to almost daily. I almost went to the hospital tonight as I had a pretty severe one. i usually can take an extra heart med, lay down and then in about an hour I feel some what better. I'm just wondering. The heart docs don't know anything about Sub, heck not hardly any regular docs know about sub.

I've tried getting off sub and did shortly to have an cath. The cath was normal, but I continue to be plagued with this horrible AFib attacks out of nowhere.
I am down to 2 mg sub daily but I really am trying to get off and i am having trouble. I am supposed to be cutting my film in half and so far haven't been able to. IDK, I just want ff and I am worried now that the sub may have something to do with my problem of afib.Anybody know?????


I have heart issues as well (well before starting the sub by the way) I am on atenolol beta blocker that slows the heart rhythm. The prolonged QT interval would be seen on your EKG so you can ask about that. Have you ever had Tachycardia before? Any workups like Holter monitor, Echocardiogram, Cardiac Cath?) Many things can cause tachycardia I am sure you have been warned about caffeine) A heart study with cardia catheterization is safe and is a good thing to do if you have chronic issues with the tachycardia to try and isolate the cause (ever heard of WPS syndrome?) Usually those with AFib can be managed well on meds too. I would suggest a very good cardiac specialist (an electrophysiologist would be your best bet!) Best wishes.

Diane

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PostPosted: Tue Aug 02, 2011 1:10 am 
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http://en.wikipedia.org/wiki/QT_interval (Explains QT Interval)

Hard to see where multiple and in-depth studies have been done to support "real" information on suboxone treatment and its effect on QT interval-seems minimal at best so i really wouldn't worry about it. This was from 2002 and I am not sure about more recent studies but here it is and it should be a little reassuring. Your doctor can also look up what recent studies have been done on this issue with the JAMA (Journals) Most doctors get these journals and can look them up online in their databases


https://ora.ra.cwru.edu/showcase/showca ... st&id=1824 (2002 study)




Now studies do exist about a drug interaction affecting QT interval/heart issues when methadone is combined with suboxone: (not that I know why anyone would do such a thing) but here is the link for that info:

http://www.surveyorhealth.com/meds/comb ... 57343-2634


Hope you are feeling better!

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PostPosted: Tue Aug 02, 2011 8:43 am 
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I actually never meant that it was causing my tachycardia, and I apologize if it came off sounding that way. I was just relaying my own personal experience with tachycardia and palpitations and how it's treated in me. That's all.

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PostPosted: Wed Aug 03, 2011 2:52 am 
I have a cardiac defibrillator for Long Q-T Syndrome.

Suboxone, even though has not been studied as extensively as Methadone, has not been shown to cause prolongation of the Q-T interval. Methadone is totally contraindicated for patients who have been diagnosed with Long Q-T Sydrome, as the drug itself CAN cause the QT interval to become longer. What this means is a very very small percentage of patients may have complications, in the form of a lethal arrhythmia, from Methadone. Every one on Methadone should have an EKG to measure the interval before/after starting Methadone. I discussed this with my cardiologist who is an electrophysiologist.....

This does not seem to be a problem with Suboxone. Many people experience minor palpitations and tachycardia during withdrawal due to the irritation of the sympathetic nervous system. Many people are placed on clonidine and beta blockers and monitered by their doctors for the withdrawal period. AFIB does not appear to be related to Suboxone use.

Any one with a symptomatic*, irregular heart beat should be seen by a doctor and evaluated with EKG or holter moniter to determine which type of arrhythmia it is, echocardiogram, to look for functional abnormalities (esp those with AFIB) and a thyroid and electrolyte profile, especially potassium, sodium and magnesium. I know, it all costs a ton of $.

Hope none of you are having these types of problems. I'm not a doctor, but have many years experience with this syndrome.

*dizziness, fainting, prolonged racing heart, tachycardia at rest, family history.


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 Post subject: AFib
PostPosted: Mon Aug 08, 2011 6:15 pm 
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Sorry i am just now getting back for a reply.

Quote:
The prolonged QT interval would be seen on your EKG so you can ask about that. Have you ever had Tachycardia before? Any workups like Holter monitor, Echocardiogram, Cardiac Cath?) Many things can cause tachycardia I am sure you have been warned about caffeine) A heart study with cardia catheterization is safe and is a good thing to do if you have chronic issues with the tachycardia to try and isolate the cause (ever heard of WPS syndrome?) Usually those with AFib can be managed well on meds too. I would suggest a very good cardiac specialist (an electrophysiologist would be your best bet!) Best wishes.


Yes, I have had it ALL. Holter, 21 day event moniter, Echo, Cath, Been on two different meds. Now since I just had another episode TODAY, they have upped the medication. I am to see a electrophysiologist tomorrow. may have to wear a 21 day event moniter again. Looking at ablation.


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PostPosted: Mon Aug 08, 2011 11:44 pm 
Tooth Lady, I am glad all of the testing has been done and I know it sucks to have the afib. It is scary to have intermittant afib and of course the possible complications that can occur. I am sure you have read all about the complications including heart failure if the rate remains too fast >140 for prolonged periods or possible emboli (blood clot) formation that can go to the lungs or brain. I have never found any relation to suboxone.

Afib is world wide, even Paul McCartney, Ellen Degeneres, George Bush Sr. and others, have it. If medication cannot control the rhythm/rate the next step is the ablation to rid your heart of the chaotic loop of abnormal electrical messages that are sent to the top portion of the heart (the atria), and to restore a normal rhythm. Ablation has been used for over 15 years. In some cases a pacemaker will be inserted if the heart rate is too slow after an ablation. Your electrophysiologist will discuss all of the options with you.

I wish you well and if you ever have any questions, please PM me. I have an extensive cardiac history,
Love Robin


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PostPosted: Mon Nov 28, 2011 9:13 am 
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Studies into Butrans has linked buprenorphine with QT prolongation.


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PostPosted: Mon Nov 28, 2011 11:13 am 
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oh my god'. i get tachycardia/ most of the time when i lay down in bed' it take about 2 hours some times to slow down to normal :(


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PostPosted: Mon Nov 28, 2011 10:52 pm 
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As long as your doc is aware johnboy.


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PostPosted: Wed Nov 30, 2011 3:03 am 
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I am a Cardiac Nurse and I've NEVER heard of ANY opiate including buprenorphine causing prolongation of QT. It's usually caused by cardiac meds to treat certain conditions. Some meds that slow the heart can increase the QT interval. If the QT interval gets long enough, your heart can go into Torsades de Pointes which is French for "twisting of the points". This is a cardiac EMERGENCY. But in my years I've never seen this due to opiate abuse no matter how much. As far as those of you talking about Afib or NSVT (tachycardia), there are treatments for both of these. Afib usually is controlled with medication to help slow the heart and meds to thin the blood to prevent clots. Tachycardia also responds to medications such as beta blockers, calcium channel blockers etc. Also there are some techniques that one can do to get the heart to slow down which include vasovagal technique. This causes the parasympathetic nervous system to kick in and slow the heart rate. This can be done by bearing down like you are having a bowel movement for a period of time. For tachycardia that doesn't respond, you may need to go into the hospital and either have a medication called adenosine that literally stops the heart for a few seconds and causes your nature pacemaker to keep back in or have a synchronized shock to the heart that kicks the heart back into a normal regular rhythm. As far as Afib, if meds don't work you might need an ablation. A doc makes an incision usually in the groin and a catheter with a tip that can cauterize the affected areas of the heart that are misfiring is used and hopes are these affected areas die and no longer cause a problem. So if anyone has heart issues, please take them seriously and go into the ER. Don't ever think it's normal and it's related to suboxone or other opiate. Always take the safe road.


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PostPosted: Wed Nov 30, 2011 7:25 am 
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Two medications that did it for me were ... Amisulpride (atypical antipsychotic that's no longer prescribed exactly for this reason) ... and Seroquel (when I had an accidental overdose).

Both were really scary. I remember with the Seroquel one, it floored me and I passed out. Then I woke up instantly, my heart literally stopped for a few seconds. Then it went bang bang bang bang bang .. incredibly quickly, for a couple of hours. I got driven to ER by my partner who felt my heart and was worried, and they told me it was a possible cause.

The really weird thing is. I like to think I got a good grasp on reality. But just before it happened, when I woke up, I swear to this day I saw a shadow of death running across the bedroom wall. And I don't even believe in that stuff.


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PostPosted: Wed Nov 30, 2011 8:20 am 
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tear'. i have been treated for this, but it seems they did not no what they can do about it/
but there is one good thing . i have high B/P'. but wile i have been treated with suboxone.
my B/P dropped from, 160/110 to around 130/80.


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