When do I take my next dose??

Will methadone and buprenorphine together cause withdrawal? How do I stop precipitated withdrawal? What dose of buprenorphine is best? Do I have to be in withdrawal to start Suboxone?
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JennyB
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When do I take my next dose??

Post by JennyB » Sun Dec 30, 2018 4:06 am

Hi everybody, I finished my induction tonight at 10pm and took the last 4mg at 12am.
Total suboxone for induction came to 12mg
I still have a bit of the hot/cold/goosebumps from withdrawal but I’m riding it out to see if hopefully that will go away. Maybe I should have taken another 2mg? I don’t know!!!
I’m so happy I did this!!!
Side note: I have a physical dependence to short acting opiates (percs, codeine) related to chronic pain. I have been taking these prescribed meds for about 10 years now. Usual daily dose would be oxycodone
100 mg, codeine close to 1,000mg daily. Prior to this I had a huge OxyContin tolerance of 380 mg/day prescribed by a physician too. I kicked that one cold turkey (which I don’t recommend it was 2 months of hell and thank God for my mom who I moved in with so she could take care of me. I used loads of Ativan to help with it) I’m only saying this to get across that my receptors have been totally out of whack for 20 years.

So back to today.....

Question: Since my induction finished at midnight when should I take my next dose? I’m a bit confused. I know how long acting it is but do I wait for w/d symptoms to start up or do I take the full 12 mg in the morning like I should be doing daily or is that too soon? Do I wait until midnight again? I don’t need to be anywhere so if I’m too sleepy that’s fine.
I would ask my Dr this but she’s is not knowledgeable enough and didn’t even tell me I had to withdraw from DOC prior!!! So thankful for this site because I educated myself!!!

What are people’s thoughts on the best plan of action for DAY 2! Also should I still be having the hot/cold/goosflesh feeling or does the suboxone take EVERYTHING away and dose until you reach that goal?
Thanks

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Re: When do I take my next dose??

Post by jennjenn » Sun Dec 30, 2018 4:38 am

Hey JennyB! Welcome & congratulations on starting this treatment.

What dose did your doctor start you on, 12? Or did the doctor just tell ya to take whatever until you got to a certain point or what?

12mg is a good dose honestly. I started out my induction day with 8mg then immediately went to 16mg the next day and each day after (until I tapered later on). The first day, I did immediately feel better from withdrawal and cravings but I do remember still having some minor leg cramps. The next day when I dosed 16mg I was totally good with zero withdrawal. 12mg should cover you fine but if you want to bump it up a couple milligrams (if your doctor is ok with that) just to see if that gets rid of your chills then I wouldn’t see an issue with it.

That’s a pretty good question about dosing at midnight and what time to take it again the next day. I guess if it were me and I’d dosed at midnight, I’d probably wait to take my next dose sometime around the late afternoon or evening. I don’t think you’d have to wait til exactly midnight again but probably not immediately the next morning. You could get a little earlier and earlier each day until you reach your dosing in the morning or whatever time you wake up. That’s just how I’d do it if I were new to the medication and wanted to get away from the midnight dosing. If you decided to dose at midnight every night, that’s ok too, it’s whatever time of day that suits you best.

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Re: When do I take my next dose??

Post by JennyB » Sun Dec 30, 2018 1:27 pm

Thanks JennJenn for the quick reply.
I am feeling pretty good this morning, minor w/d symptoms still with the chills still. I am having craving though. Ugh. I have no DOC so I’ll be fine.
I think I will start my dose late afternoon and if that 12mg still doesn’t kill the chills and cravings then I will bump it up.
I’ll check back in after that and report my progress!
Thanks so much. Couldn’t have done this properly without pw had I not found this site. So grateful.
J

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Re: When do I take my next dose??

Post by jennjenn » Mon Dec 31, 2018 8:19 am

If you’re still having cravings then you may need to go up just a little bit on your dose. One of the main reasons buprenorphine works so well is because it stops the cravings that keep us knocked down, so you definitely need to be on a dose that stops your cravings. Hopefully you’re on the road to getting that lined out. Keep us updated!!
Jennifer

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Re: When do I take my next dose??

Post by JennyB » Mon Dec 31, 2018 1:07 pm

I took my day 2 dose at 6 pm last night and bumped it up to 16mg and my chills and cravings stopped shortly after.
Today is Day 3 and I haven’t taken my dose yet it’s only noon here and I’ve been having the shakes and tears and anxiety and cravings and I’m not sure if this is normal?
Maybe I should take the dose now? Or split it? But if I split the dose then won’t that half dose not be enough to do it’s job?
Struggling today

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Re: When do I take my next dose??

Post by razor55 » Mon Dec 31, 2018 3:43 pm

Hello Jenny, your doing fine at this point. Ive just read your first posting and you were on alot of opiates before starting treatment. Its day 3 for ya and your third day without all thoses meds . It ll take some time,not long but a little time to get balanced on Suboxone. Try not to worry to much at this point on how you feel. Just know your new medication is going to work for you. I started at 2 mgs at first then to 16mgs for a short time. As Jenn said you want that sence of wellness or well being. A normalicy wo have not had in a llong time. Hang in there, give it some time... Razor 60... and this will be a great New year clean and sobor

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Re: When do I take my next dose??

Post by JennyB » Mon Dec 31, 2018 8:01 pm

Thanks I feel better razor55. It’s just the flood of emotions that scared me. I am going to work on getting my dose time for the morning....because I started late at night it’ll take a few days to get the dose timing right which is morning for me.
Thank you soooo much for your advice,
Jenny

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Quick question for newbie

Post by JennyB » Tue Jan 01, 2019 4:27 pm

This should probably go under the topic of dosing but I thought it was best to continue with the thread I started.
So this is day 4 of suboxone and I’m taking 16mg once a day. I started induction very late at night and I’m working on taking my dose earlier in the day so it becomes a morning “as soon as I wake up” thing. Today I dosed at noon. However, when I woke up I felt major withdrawal which was so strange. I panicked and immediately took the suboxone and the symptoms eventually went away. Since day 1 I’ve always had chills that won’t seem to go away. Wearing hoodies and heat pads. Wish that would stop. But 16mg seems like a big dose so maybe I shouldn’t take anymore? Ugh. Don’t know what to do. Anyone have advice?
Also, How long do I stay at 16mg? From what I’ve read do we go down in dose until withdrawal symptoms start and then you maintain at that dose?
Also some people split their dose for 2x a day. Is that the more common way?
Help!!

Thanks and Happy New Year

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Re: When do I take my next dose??

Post by Dee19 » Wed Jan 02, 2019 5:46 am

Good Morning Jenny B! I was on here saw your post. I wanted to congratulate you. I'm sure other more experienced people will respond soon. It sounds to my inexperienced mind that you are doing well. Had you tapered down your pain meds before beginning the suboxone? They say you should be in withdrawal before starting it. My sister in law was taking more than 10 30mg oxysomethings a day. I believe she started out at a higher dose 24 to 32. This was about 6 years ago and back then I believe the thought was more is better. I am not a doctor, not on Suboxone. Just thinking that if you are waking up in withdrawal perhaps you should take it first thing in the morning? Or take half of it first thing and half later in the day?
I hope you are doing ok

To be honest I thought that doctors did the induction in the office giving patients a dose waiting an hour giving another dose, continuing until the patient was comfortable. Then that would be your starting dose.

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Re: When do I take my next dose??

Post by Dee19 » Wed Jan 02, 2019 5:51 am

I wanted to add that the most important thing right now is that you are on a dose that doesn't allow withdrawal or cravings. Suboxone has a long half life.

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Re: When do I take my next dose??

Post by docm2 » Wed Jan 02, 2019 9:06 am

Many people split their dose. So If you are taking 16 mg a day, one film in the morning and one in the evening is fine. I am quite aware the recommendations are for once a day, but if it works, it works. Once a person is seriously into their taper they are dosing twice a day anyway.
You had a pretty high tolerance so it may take a week a two for the cravings to subside as you get use to the Buprenorphine.
Were you taking oxycodone and codeine tablets or did they have acetaminophen. If T3's or Percocet I would be very concerned about the huge amount of acetaminophen and get your liver checked.
That level of codeine is very uncommon in the US. Are you in Europe by chance? PAX

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Re: When do I take my next dose??

Post by JennyB » Wed Jan 02, 2019 3:02 pm

Hi docm2
I am in Canada where the T3s and T4s are prescribed in abundance. Physicians are starting to prescribe tramadol now more frequently because codeine just sucks. We don’t have Vicodin here so I guess that’s why the T3s. It’s the most commonly prescribed oral analgesic. All of my prescriptions have been for chronic pain, most recently fibromyalgia. My tolerance is soooo high it’s scary. I think it’s from those years of huge OxyContin doses (380mg/day prescribed!!) and I’ve been taking less potent but still opiates since. My receptors are whacked right out.
My liver enzymes are all surprisingly fine. Thanks for the heads up.
My suboxone is not in strips, it’s the brand name in sublingual tabs.
My withdrawal symptoms have subsided! No more hoodies and scarves and blankets lol.
I think I just needed a few days on this to adjust and now that it’s Day 5 I’m feeling pretty good.
Lots of emotional roller coasters though....normal I believe so I’ll just ride it out.
docm2 what did you mean when you said “once a person is seriously into their taper they are dosing twice a day anyway”????
All I need to know is should I stay on this daily dose of 16mg for a while or should I start going down a bit now?? I’m confused when to do that
Thanks!

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Re: When do I take my next dose??

Post by docm2 » Wed Jan 02, 2019 6:38 pm

[quote]should I stay on this daily dose of 16mg for a while or should I start going down a bit now?? I’m confused when to do that [/quote]

If this is the dose that is working stay on it. Once the 'sweet spot' is found; whether it is 8, 12, or 16 mg a day, once a day or split dose, I encourage people to stay there for several months. A year above the 'ceiling effect.' If you are comfortable at 16 mg a day I hope you can stay there for several months, reducing when you are ready. Separates a person from addictive behavior and allows time to heal, whether it is health, heart, relationships, employment. I think of this time as a transformative time or change, not just being on Suboxone.
By seriously into their taper I mean at 6 mg a day or less.
When you mentioned the high doses of codeine I suspected Europe but should of thought as Canada as well. The USA is the oxy king of the world, I may have the exact #'s off but we are something like 5% of world population consuming 95% of oxycodone.

Glad you have it sorted and you are doing well.

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Re: When do I take my next dose??

Post by JennyB » Thu Jan 03, 2019 3:37 pm

Hi docm2,
Just wondering what the “Ceiling effect” is that you have mentioned and others have mentioned throughout the forum. Can you explain this to me or guide me to a thread that explains it?
Thanks for all of your help. I am so happy and feel pretty darn good.
JennyB

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Re: When do I take my next dose??

Post by Amy-Work In Progress » Fri Jan 04, 2019 8:25 pm

JennyB, this is a link to Dr. Junig's blog post on ceiling limits:

http://suboxonetalkzone.com/ceilings/

I hope this helps!

Amy
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Re: When do I take my next dose??

Post by rule62 » Fri Jan 04, 2019 11:36 pm

Congratulations JennyB, we love a good success story. You found exactly what this forum is about. Helping those first getting on Suboxone and helping them find their life again. It appears you are on the road to living a good life.

The majority of us are very grateful that Suboxone was invented in time to treat our addictions. Without it, I don't know what would have happened to me. Others will say similar things. We are very pleased to have you with us and how well you followed directions to achieve maximum results.

Don't you feel so much better now? You made my day today knowing it's working for you.
Don't take yourself so damn seriously

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Re: When do I take my next dose??

Post by JennyB » Sat Jan 05, 2019 12:21 am

I can’t express enough how happy I am to have found this forum. It has changed my life for if it weren’t for the caring people here, I would not have learned how to do this properly and safely and make it successful!
Even though I’m not even a week in I’m feeling pretty good and my physician gave me a 1 month prescription for suboxone 16mg/day taken twice a day at 8mg. She was very impressed when I showed her the forum and the help I received and wasn’t offended that I searched for help. She said she will keep this forum in mind to direct her future patients that would benefit from suboxone.
This is going to allow me to really do a deep dive and focus on my recovery and my road to wellness instead of the panic of pills and the fear and shame that goes with an opiate addiction.

Thanks for everyone’s support.
Jxo

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Re: When do I take my next dose??

Post by Amy-Work In Progress » Sat Jan 05, 2019 10:39 am

Happy Saturday, JennyB!

I want to reiterate what you've heard from others so far.

Once you are on a dose that keeps you out of withdrawals 24/7 and without physical cravings 24/7, stick with that dose! Your dose should really keep you from having any with withdrawal symptoms at all, not just for most of the day until the next morning. That's what docm2 meant about staying above the ceiling limit. (I hope my link was helpful for you!) Staying above the ceiling limit means that you have a steady amount of buprenorphine in your blood plasma. If the amount of buprenorphine dips down enough for you to have withdrawal symptoms, your dose may be too low. 16mg is a good dose for a lot of people, but if you need 20mg or 24mg, that's what you should be taking. You may, for example, metabolize buprenorphine faster than most of the people taking the medication. Does all of that make sense?

I also want to reiterate that this is NOT the time to be worried about tapering down. When you've found your correct dose, and it very well may be that 16mg is your correct dose, it's time to stop focusing on how you feel. You want to get to the point that you are just taking your buprenorphine as casually as you would a birth control pill or blood pressure pill. Because when you aren't focusing on how you are feeling, you can focus on changing your life for the better.

It's so important to understand if there are any reasons that taking your pills became attractive to you (beyond pain relief). What did they make feel better, if anything, in your emotional life? Did they dull the pain of losing someone important to you? Did they make any personal relationships or situations feel better or less intense? We haven't heard a lot of your story, but I did read that a flood of emotions has hit you since you started buprenorphine and left the other opioids behind. When we become unused to feeling our feelings, it can be overwhelming when they all come back. Dealing with them again takes some practice and skill building. If you are unable to access the discomfort on your own, or if you feel like you're being overwhelmed by the returning feelings, finding a therapist to help you is a great idea. That's exactly what I did when I started my recovery.

Please understand that I'm not wanting to make assumptions about why it is necessary for you to start on buprenorphine. Perhaps you just need to be on a medication that stops the increasing need for larger doses of short acting opioids. However, if there is any emotional/psychological component to your need to switch to buprenorphine, it's important that you examine it closely.

As for tapering your dose, that is a discussion for another day at least a year in the future. The buprenorphine is serving an important purpose right now. Let it work! My daily dose was 16mg, so I stayed on that dose for a couple of years before I thought of tapering. When I did slowly taper, I had no problem working my way down to 6mg, and very little difficulty getting down to 2mg. I have bounced back up to 6mg which is a good dose for me right now. My point is that steady and slow works well. Patience is definitely a virtue when it comes to tapering. For now, you don't need to be thinking about that though.

It is so wonderful to hear that we have been helpful to you and that your doctor is impressed with the website. Our Dr. Junig, who goes by suboxdoc here created The Talkzone to blog about important issues surrounding buprenorphine. The link is at the top of the page, just click the tab that says Talk Zone. Dr. Junig is both a recovered opioid addict and a board certified psychiatrist. He is a very smart man, as well as compassionate person.

Keep on asking questions and telling us more about your self! You are very welcome here!

Amy
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Re: When do I take my next dose??

Post by JennyB » Sun Jan 06, 2019 2:04 am

Amy,
Your post is exactly “me”. There is definitely a psychological/emotional component to my long standing relationship with opiates. It started with and continues to be chronic pain related however the pills were doing nothing for my pain. Just making it worse actually. I have contact a psychologist and will be seeing her once a week. It will be a good thing. I will definitely share my story in a future post because it’s so important that maybe someone else will be able to relate and make that big decision to choose suboxone and recovery.
I’m at 16mg split into 2 doses a day. I was at 18mg when I went to see my physician however for prescribing and how the pills come she thought I would be fine at 16mg. I put up a little fight and didn’t win and wish I would have been a little more assertive because even though it’s only 2 mg, I’ve been having chills/goosebumps all the time. I’m trying not to think of it and just stay positive but it’s there. She said it will go away and I’ll be fine. It’s been 3 days and it’s still there though. I’m hoping it will go away! It just pisses me off that I went through all the trouble of doing this and educating myself from this forum because she just gave me the drug and said take it and the first time I did I went into pw because I had no clue what I was doing and then took enough Percocet to eventually overcome the pw....which was LOTS. That’s just my rant. If it doesn’t go away in a couple more days then I’ll go back and ask for an 2 mg tab for each day. I’m not scared to do that. This is my recovery and I’m my own advocate. I’m also a Registered Nurse so I’m not afraid of Dr’s lol. (I’m off work on disability for fibromyalgia right now. Now that I’ve said I’m an RN I’m also proud to say I have NEVER been high at work and have never done anything illegal to obtain my DOC. I am no better than people who have done things for their DOC, this is just what happened to me. They have always written a prescription, always ran out way too early and just manipulated my way into getting new ones. Sad. But done!!
I am totally taking your advice Amy and just concentrating on feeling well and worrying about today and tomorrow not 2 months from now. The more I read the more I learn how important it is to stay on a dose above the ceiling for a while!
Thanks Amy...and everyone else.
JennyB

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Re: When do I take my next dose??

Post by Amy-Work In Progress » Sun Jan 06, 2019 11:20 am

There are definitely some similarities in our stories, Jenny. I was finishing up prerequisites for a BA to BS in Nursing program when I admitted my addiction and decided that I shouldn't pursue a career in nursing. And I was also receiving a large monthly prescription, but running out early. I was lying about the amount of pain I was in to get this prescription, though, so I wasn't in as much legitimate pain as you were. The pain I did have responded to ibuprofen and immitrex. The opioids I was receiving were strictly to get high.

I have a link for you from Dr. J's Talk Zone on optimizing absorption of your dose. If you can get a bit more absorption from your dose, the additional 2mg shouldn't matter. I do understand why you are upset with your doctor for changing your regimen, but I think that you should be able to work through that problem with better absorption.

http://suboxonetalkzone.com/optimizing- ... bsorption/

I have always said the same things as you about not being better than others. I ratted myself out back in 2011 because I couldn't stand being a crappy mom to my 13 year old son. The fact that I was able to ask for help prior to getting into legal or financial trouble has nothing to do with being a "better" addict than any other addict. I am no better or worse than anyone who has broken laws, neglected kids, pawned family heirlooms, etc. What I am is fortunate that I grew up in an intact home filled with love and positive regard, and was treated with kindness and respect (for the most part).

I think you have a really good attitude about the future and where you are headed, Jenny! We will continue to provide you with the best advice we have. :D

Amy
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