Dose Struggle

What dose of Suboxone do you take? Does your buprenorphine wear off? Do you have opioid withdrawal symptoms?
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bandana
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Dose Struggle

Post by bandana » Fri Jan 04, 2019 7:46 pm

Hi All--
This is my first time posting here. I am looking for some guidance on my dose.
I have been on Suboxone for around 10 months. Over that period, the amount that I need to avoid withdrawal seems to keep going up. I am currently on 24mg/day, and am splitting that dose into 3 or 4 doses per day. For whatever the reason, I can't seem to find the dose that keeps me from feeling withdrawal symptoms consistently. I can go a week or so feeling just fine, but then seemingly out of the blue, I will start feeling terrible during the day. Headaches, restless legs...basically full on withdrawal. Usually, after a couple of days, it goes away and I feel fine again. However, this keeps happening over and over. I never seem to find the right daily dose and/or number of doses that keep me from feeling bad.
Would I be better off taking 12 mg twice a day, rather than 6-8 mg three or four times a day? It seems like no matter what I try, I can't find the steady state, but I'm wondering if that is because I am dosing so many times per day. Any thoughts would be greatly appreciated, because I am sick of feeling so up and down, which I just didn't think would happen with a long acting drug like Suboxone. I expected to reach an equilibrium after a couple of months, but it just hasn't happened.

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Re: Dose Struggle

Post by jennjenn » Sat Jan 05, 2019 8:18 am

Hey bandana welcome!!

Well 24mg is a higher than usual dose, I can’t understand why you’d be having any withdrawal. Suboxone has such a long half-life, it’s supposed to last way into the next day so that your dose isn’t wearing off before the next (as long as you’re over the ceiling level and you’re definitely over it). Has this been happening this whole 10 months since you’ve started or just recently? Does your doctor know you’re struggling with this?

One of the only things I can personally think of is absorption. I’m definitely no doctor so I don’t know about metabolism and stuff like that, but absorption could possibly be something to look at........ maybe. That could explain why sometimes you’re fine and others you’re not. The times you feel ok are the times you’ve achieved good absorption and the times you feel the restless legs and more, that could be during a period that you didn’t get good absorption. Does that make sense? What type of buprenorphine are you prescribed, strips or tablets? Sometimes it’s all in the way you take your medicine.

As far as splitting your dose, I’m not sure since it’s such a higher milligram, but I’d just try anything different than what I had been doing when the symptoms start happening. If you haven’t tried splitting your dose in 12mg at a time then I’d try it. Just remember to hold the medicine still and let it dissolve. Don’t talk while it’s under your tongue. There’s also a way to put the medicine in your cheek next to the gum. If you go to the search function here on the forum and type in better absorption, you’ll find different posts that can help ya with that.

Hopefully others will be along to give you their advice. Good luck!
Jennifer

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Re: Dose Struggle

Post by bandana » Sat Jan 05, 2019 9:02 am

Thank you for your reply.
I am on Suboxone strips 8/2. My understanding is that, with the longer half life, it should be so built up in my system that I never feel any withdrawal, but that is definitely not the case. I have not spoken with my doctor about it, but I will do so at my next visit. The doctor that I was seeing, and who I really liked and trusted, quit abruptly right before my visit 2 months ago, so I have a new doctor that I don't really know very well. I guess I am afraid to say anything, because I am already on such a high dose and I don't want her to think that I am just seeking more. I guess that I need to be a little bit more trusting.
Back to the issue, I will feel fine for a couple of hours after taking a dose, and then I will start feeling poorly again. I told myself that it was mental and that if I just wait it out, the feeling will go away. That has not worked, however, so I think it is real withdrawal.
As far as how I take it, I put it under my tongue and let it just dissolve for 20 minutes or so. I don't worry about swallowing or anything like that, as I don't build up a ton of saliva. I have wondered if maybe I have an issue with absorption, but I don't know how to determine that. I will search the forum for better absorption, though (thanks for the suggestion!). I have also wondered if perhaps the Naloxone could be causing precipitated withdrawals for some reason. Would that be a possibility because I am swallowing saliva?
I really appreciate your reply. It helps a ton to talk to someone who can understand what I am going through.

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Re: Dose Struggle

Post by Amy-Work In Progress » Sat Jan 05, 2019 11:17 am

Hi Bandana, and welcome to the forum!

It is possible that you are a rapid metabolizer of buprenorphine. There are ways to test and see if you are. Your doctor may readjust your dose accordingly. You are right to be concerned that 10 months in, your dose doesn't appear to be correct. It needs your doctor's attention.

Let us know how your next appointment goes!!

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Re: Dose Struggle

Post by Lillyval » Sat Jan 05, 2019 11:43 am

You mentioned nausea, which is sometimes a side effect of too high of a dose. The time from sublingual dosing to maximum blood serum concentration can be up to 3 hours, but I think the average is about 90 minutes. So it’s sounds like you’re feeling poorly just after your dose has peaked, not when you would be experiencing WD. (Most people who experience interdose withdrawal dose in the morning and have WD the next morning before dosing, 24 hours later). Your dose might actually be too HIGH. You might want to try cutting your dose back to 16mg/day (8mg 2x/day). Then maybe keep a log of your symptoms and when they start. You shouldn’t be dosing more than 2x/day unless you are taking it for pain.

Also, you asked about the naloxone. Even if you are one a the few people who are sensitive to the tiny amount that is in Suboxone, it definitely would not put you into WD.

Ideally, you can do what Amy said and get your blood levels measured. Unfortunately, it will probably depend on your insurance whether you can do that or not, because it’s not a routine test.

Good luck. I hope the new doctor is helpful.

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Re: Dose Struggle

Post by Amy-Work In Progress » Sat Jan 05, 2019 7:26 pm

Lilly is exactly right. If these are not actually withdrawal symptoms then they could be side effects of taking too much. Headaches and nausea can definitely be signs of taking to much buprenorphine. If that is the case, you would start feeling better if you went to a dose of 16mg or lower.

I would start to taper down and take a diary of how you feel. We often hear the phrase "less is more" when it comes to buprenorphine. There are people who feel terrible when they are taking too much buprenorphine.

Ok, tell me this. Have you been having cravings for your drug of choice?

The goal when getting on buprenorphine is to find the least amount of the medication that keeps you out of withdrawals and cravings, but that doesn't cause unwanted side effects. For most of us there is a sweet spot right in between. Well, what Lilly and I are saying, I think, is that you might have gone right past the sweet spot into unwanted side effects from too large a dose.

Some doctors have the tendency to dose too much in the beginning. So, the signs I know of for this situation when you are dosing too heavily are: nausea, headaches, no cravings, feeling sleepy all of the time, and possibly lacking motivation.

Typically when your dose is too LOW, you will being experiencing physical cravings as much as you experience withdrawal symptoms. The best way to find out is to drop 4mg, see how you're feeling after a few days. If you are feeling much worse, you might not be dosing enough. If you feel the same or a little bit better and still have no cravings, try another drop to 16mg. Keep a diary so you track your symptoms. And check in here at the forum.

Amy
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Re: Dose Struggle

Post by jeandianne » Sat Jan 05, 2019 10:50 pm

You don't say much about yourself but seem focused on your dose. As previous posters have told you , maybe your dose might be too high. Many medications and medical conditions besides withdrawal can cause restless legs.
If you are having such a rough time, I hope that you are working on improving your life. relaxation exercise and having a support system are important.
I have been on suboxone for 12 years now. My highest dose was 20 mg a day, and I was feeling lousy. I switched doctors and was immediately lowered to 12 mg a day then quickly to 8 mg. a day. That was the sweet spot for me, I felt great. My doctor continued to decrease my dose over the years and now I am on 1.5 mg a day. I never could have imagined.
Many on the site have found that less is more. This drug is odd. It has a long half life and usually people don't experience withdrawal until several days off the drug or on a drastically reduced dose. I hope that you can keep an open mind and find what works for you.

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Re: Dose Struggle

Post by jennjenn » Sun Jan 06, 2019 6:55 am

Bandana mentions withdrawal type symptoms of restless leg, those types of symptoms wouldn’t come from too high of a dose but the headache symptom definitely would be. Also, bandana you mentioned that you’ve had to keep going up on your dose during the course of 10 months, how long have you been taking 24mg? Everything does sound like your dose is too high except for the restless leg. The restless leg part has me stumped.
Jennifer

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Re: Dose Struggle

Post by Lillyval » Sun Jan 06, 2019 11:29 am

I was thinking the same thing, Jenn. One of the symptoms of too high of a dose is agitation. I’m wondering if extreme agitation could be similar to RLS?

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Re: Dose Struggle

Post by bandana » Tue Jan 08, 2019 8:36 am

Thank you all for your replies.
I have started to try to reduce my dose and take it fewer times per day. I am feeling a bit better, but still not where I think I should be. I am now taking 8mg in the morning, and can make it until around 1:30 or 2:00, before I start to feel withdrawal symptoms. At that point, I take around 6mg, but that doesn't seem to be able to quite get me through the day. I have to take around 4mg more at 7:00. I am hopeful that I will be able to continue to reduce both the dose and the number of times I take it. I will keep working at it.
Regarding the restless legs, I have RLS, which is how I ended up on Suboxone in the first place. I went through all of the drugs that they use to treat RLS, and they all eventually fail and cause what's called augmentation. Augmentation means that the drug actually starts to make your RLS symptoms worse. When that happens, they have to switch you to another drug. The last drug they put me on was tramadol, and I was on the maximum dose of that for 7 years. That too eventually failed and caused augmentation, so it was either go on Suboxone or methadone. Methadone is the last course of treatment for RLS and the only drug that does not cause augmentation eventually. I have heard horrible things about methadone, so I thought suboxone would be the better option.
So, I take Suboxone for two reasons: I am physically dependent on opioids and I have RLS. I do not have any cravings for any other drugs. I simply don't want to withdrawal and don't want to have RLS symptoms. I do think there probably is a mental component to my problem. I was used to having to take Tramadol 5 times a day, because it is relatively short acting, and I think I have struggled mentally with the idea of only having to take something maybe twice per day. I think and worry about it not working, and that probably contributes to feeling poorly. I also think you all are probably correct that I was taking too much, rather than too little, and I will need to work hard at reducing that amount and overcoming the mental hurdle that seems to be in my way.
I greatly appreciate all of your feedback. It really helps to have people in the know tell me their experiences and gives me hope that I can get back to feeling somewhat normal again. I don't have a doctor appointment for another 3 weeks, but I will talk to my doctor about it when I see her again.

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Re: Dose Struggle

Post by SubstantialTarantula » Wed Jan 09, 2019 1:08 am

bandana wrote:Hi All--
This is my first time posting here. I am looking for some guidance on my dose.
I have been on Suboxone for around 10 months. Over that period, the amount that I need to avoid withdrawal seems to keep going up. I am currently on 24mg/day, and am splitting that dose into 3 or 4 doses per day. For whatever the reason, I can't seem to find the dose that keeps me from feeling withdrawal symptoms consistently. I can go a week or so feeling just fine, but then seemingly out of the blue, I will start feeling terrible during the day. Headaches, restless legs...basically full on withdrawal. Usually, after a couple of days, it goes away and I feel fine again. However, this keeps happening over and over. I never seem to find the right daily dose and/or number of doses that keep me from feeling bad.
Would I be better off taking 12 mg twice a day, rather than 6-8 mg three or four times a day? It seems like no matter what I try, I can't find the steady state, but I'm wondering if that is because I am dosing so many times per day. Any thoughts would be greatly appreciated, because I am sick of feeling so up and down, which I just didn't think would happen with a long acting drug like Suboxone. I expected to reach an equilibrium after a couple of months, but it just hasn't happened.
I bet your genetics make you an "ultra-rapid metabolizer" of buprenorphine. Ask for a cheek swab to analyze your DNA. Sometimes certain drugs just don't work for people.
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Re: Dose Struggle

Post by jennjenn » Wed Jan 09, 2019 9:50 am

So you do have RLS and have been treating it (or doctor has been treating you) with opiates and what led you to suboxone in the first place is you didn’t want to go through physical withdrawal and to help your RLS that was being treated with opiates like Tramadol...... ok nowwww I understand a little more and it’s making more sense to me now. Sorry it took me so long to get it IF I’m even getting it now because I still could be wrong :)

Well if I had to guess (if I’m understanding it correctly now) I’d think that buprenorphine just isn’t helping your rls any longer. I don’t know, this is a pretty unique situation for me that I haven’t really heard of before so hopefully someone else will have better advice for ya. I know rls is HORRIBLE. It’s just awful. I’ve had it from withdrawal plenty of times and it was my worst feared withdrawal symptom. I would even try sleeping in the floor at night to stop it. I hope you can get better relief and something figured out, my mom has it from time to time and she just tries to suffer through it because she’s anti medication on everything pretty much.
Jennifer

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Re: Dose Struggle

Post by BlueLight » Wed Jan 09, 2019 9:51 pm

RLS is awful. I wouldn’t wish it on an enemy. It sounds like Suboxone isn’t going to work for you. I’m not a doctor but it sounds like a daily methadone and gabapentin cocktail is up next. I’d call and get into your doctor b4 3 weeks from now. Your doc can script methadone just like any other opioid given it’s not for addiction issues. If you had to go to a clinic every day, that would be a different matter entirely.

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Re: Dose Struggle

Post by SisterMorphine » Fri Jan 11, 2019 7:23 pm

BlueLight wrote:It sounds like Suboxone isn’t going to work for you.
BlueLight
that is a bold statement. many other suggestions have been given for bandana to try.

bandana
i definitely agree on getting down to 2 doses a day. maybe you could taper your extra doses inbetween.
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Re: Dose Struggle

Post by JennyB » Sun Jan 13, 2019 11:58 am

Hi Bandana,
I too have uncontrolled RLS and since my diagnosis of fibromyalgia I was put on a high dose of Gabapentin for pain. This has completely gotten rid of my RLS especially at night.
Maybe give it a try?
Another product that works is a natural product called “Hylands Restful Legs” . You can get it at CVS, Walgreens, etc. This is a miracle “drug” for many people I know and it did help me prior to the gabapentin.
Good luck
JennyB

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Re: Dose Struggle

Post by jennjenn » Tue Jan 15, 2019 12:56 pm

Gabapentin does help restless leg and arms because it’s definitely helped mine before bk in active addiction. If I was ever in withdrawal and could find any gabapentin, I’d get it because it always stopped the rls. It’s very good for that, I’d forgotten about it.
Jennifer

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Re: Dose Struggle

Post by bandana » Sat Feb 02, 2019 9:05 am

Sorry. Moved this conversation to another topic

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Re: Dose Struggle

Post by lilibet » Wed Feb 13, 2019 2:21 pm

Hello, new to this site and going thru my own subox induction at the moment after 10 years of opiate use for chronic pain...but I saw this discussion about RLS and wanted to mention that my mom suffered for decades with it, until I bought her a bottle of magnesium spray. She sprayed it on the bottoms of her feet and rubbed it in then went to bed...she called me the next morning and was literally stunned - she had slept 8 hours solid for the first time in over 20 years. Simple magnesium spray had done what no medications or relaxation techniques, sleep positions or other recommendations had been able to do. Ever! Not sure if that has been tried by OP or not, but in the event it has not been tried it could also help *fingers crossed*

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