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PostPosted: Tue Feb 10, 2015 9:57 pm 
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As you all know Dr. Junig and others have spoken about the ceiling effect of Suboxone (buprenorphine). They state that the ceiling (the dose at which increased dosage does not increase effect) is 4mg.

As I understand this the 4mg ceiling assumes all 4mg are absorbed by the route of administration. As we know this is not the case.

If a person (as in studies) was given 4mg intravenously they would feel no different if given they were given 6mg, 8mg, 10mg, 12mg. However, sublingual administration varies wildly from 30% (normal dosing) up to 50% in an alcohol solution.

This means putting 4mg under your tongue is not the ceiling. It’s most likely 30% of the ceiling considering most people don’t put alcohol under their tongue with the dose.

Just to simplify the math lets say its 33% instead of 30%. Given that adjustment it would take 12mg to reach the ceiling dose.

But buprenorphine has a long half life so it doesn’t just disappear from your body after you take it. It hangs around. Along with its high affinity for the mu receptor it also has a very high blood protein binding (this is why although the sublingual administration puts it right into your blood it takes 30-60min to feel the benefits).

So lets do a little more simplified math:
Lets assume once daily dosing and a 24hr half life (in reality its longer, but everyones experience varies). Here is an example of how this 24hr half life would work:

Each dose separated by 24hrs assuming 24hr half life:

1st dose: 8mg
2nd dose: 8mg + the 4mg left over from the first = 12mg
3rd dose: 8mg + the 6mg (4 + 2) left over from the previous 2 doses = 14mg
4th dose: 8mg + plus half the last 3 doses total (7mg) = 15
5th dose: 8mg + plus half the last doses (7.5mg) = 15.5

Eventually you get to double your daily dose. (Anyone whose taken Calculus will recognize this as an infinite series) So if your taking 8mg a day you build ever and ever closer to 16mg in your body assuming 24hr half life.

Now take the 30% and you actually get 2.4mg out of 8mg and you build up to 4.8mg which is above the ceiling of 4mg.

Now, there are weird properties of buprenorphine. People taking it for pain split their dose and take it every 6 hours. For some reason the pain relieving properties wear off after 6 hours even though the withdrawal and craving benefits last much longer. Its another one of the weird properties of this drug. Others being a semi-agonist with a ceiling effect.

Hope this helps with anyone confused about the ceiling and anyone psyching themselves into taking more not realizing how much they have really built up in their body.


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PostPosted: Sat Feb 14, 2015 12:44 am 
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Ok Mrmatt so if I'm having a hard time finding what's right for me and this is day 5 and I have chronic pain what would you Try to dose for tomorrow ? I'm prescribed 8mg strips 2 times a day! Never userd "H" just norcos perks Roxys and oxys ! Thanks for breaking that down so ppl like me can understand it !! I'm greatful! Have a blessed day:)

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PostPosted: Sat Feb 14, 2015 12:45 am 
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Ok Mrmatt so if I'm having a hard time finding what's right for me and this is day 5 and I have chronic pain what would you Try to dose for tomorrow ? I'm prescribed 8mg strips 2 times a day! Never userd "H" just norcos perks Roxys and oxys ! Thanks for breaking that down so ppl like me can understand it !! I'm greatful! Have a blessed day:)

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:) Jade


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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