Bupe Buprenorphine + pseudoephedrine

[kazon]

Hello y'all.

I'm currently being maintained on 32mg/day (dosed twice daily) generic Buprenorphine (monotherapy, my diagnosis is "depedence" rather than "addiction", so to save money, I get the Subutex generics rather than Suboxone...) for dependence caused by treatment with high-dose loperamide for neurogenic chronic diarrhea. Note that I've been on this dosage for months, so I'm not really in the induction phase.

Luckily, I have a great doctor, so I get to try out how the buprenorphine can best help me, including dissolving and plugging it, but that's a different story altogether 8(

Usually, I only get a small and short drug-like effect when I dose, and this is as such fine. I have a full-time job (developing software) so I like to 'be sharp'.

Now, during the summer-time, I have horrible grass, oak etc. allergies. So I eat acrivastine (non-sedating histamine) 16mg + 120mg pseudoephedrine tablets three times daily.

I've noticed that this increases the drug effect of the buprenorphine vastly. My pupils, whilst on the buprenorphine, are normal size–but when throwing in the pseudoephedrine, they constrict massively, I get itchy, buzzed and even nod out somewhat. I used to study medicine (have a bachelor of medicine degree, never qualified to be an MD) so I'm quite familiar with the concept of enzyme inhibition/induction

But pseudoephedrine doesn't really affect the enzymes that the buprenorphine is metabolised by. Even IF PE was a CYP inhibitor, buprenorphine is metabolised to norbuprenorphine by a whole array of CYP's—including many that the PE doesn't touch. Also, the effect also happens if I take the allergy tablets hours after dosing the buprenorphine.

So, is there any knowledge of a direct, opioid-effect bosting effect from Pseudoephedrine on Buprenorphine? Can't find anything in the literature, but if anyone knows, it's gonna be you guys. Hope you can help.

 

[Fire&Water]

Not sure how the ephedrine potentiates the bupe, but it sounds like your "great doctor"
has his/her self a great unsuspecting guinea pig.

 

[kazon]

Not sure how the ephedrine potentiates the bupe, but it sounds like your "great doctor"
has his/her self a great unsuspecting guinea pig.

The antihist+pseudoephedrine is prescribed by my primary care physician. The buprenorphine is prescribed by a different doctor (who my primary phys. referred me to); a doctor who -only- works with buprenorphine (10+ years) for both addiction, pain management, etc. So every dosing interval from 0.2mg to 56mg per day. But yes, this is a unique case–due to the loperamide aspect of it. I encouraged him to write a case report to get more experience out there, so guinea pigging is A-OK

Of course, the two MD's can see each other's prescriptions, so no doctor shopping aspect of it. I know that benzos and other sedatives (like old antihistamines) as well as enzyme inhibitors can potentiate a lot of opioids. But this antihistamine is non-sedating, and pseudoephedrine should really act by dilating the pupil instead of constricting it. If Acrivastine was a sedating antihistamine, that'd dilate the pupils too through the anticholinergic action.

So why the (intense) buzz—reminding me of oxycodone I've had prescribed after surgery a while ago—, pinpoint pupils and itchy skin?

 

[Jabberwocky]

you have a great Dr. and you studied medicine yourself but yet you are taking 32MG of bupe per day!? maybe neither one of you should have gotten that PhD.

thats an awful high dose which I am sure you have grown accustom to since you have been using it for quite some time now. you may want to ready a bit more into that and potentially ween yourself off a bit; making it easier in the long haul once you decide to distance yourself from that medication. I was a heavy, heavy, heavy heroin addict and still only take 16/MG/day bupe; the 16/day is at my worst, but there are days where I can easily get by with 4-8/MG.

unfortunately, I have nothing to say w/ regard to the question be asked; I have no experience there, sorry.

 

[d1ahp]

There's no potentiation between those two, only synergy.

 

[Usa51]

32 mg is crazy

 

[siq]

32mg?? Umm you're wasting a good 24mg at least bud. Do a little research, it'll benefit you.

 

[kazon]

32mg?? Umm you're wasting a good 24mg at least bud. Do a little research, it'll benefit you.

32 mg is crazy

I've read all the "less is more" stuff. That doesn't change the fact that 8mg was ineffective. I titrated from 2mg to 12mg over 7 days, and, suffering from withdrawal, was titrated upwards. Everyone's different, and there's as large a difference between 16->32mg as there is for 2mg->8mg for me.

I've agreed with the doctor to go down 2mg each 14 days until we find the optimal dosage. Since it's treatment for the symptoms of a disease (pain+diarrhea) the goal is not to taper out and be "clean", but rather get to a level that is maintainable. Since I luckily don't suffer from any side effects from the buprenorphine, this is vastly preferable to me rather than the alternatives (depot morphine, or methadone) which were tried but were simply too psychoactive for me.

Finally, did you know that the dosing guide-lines (including the ceiling effect thing) were carried out using ethanolic solutions? Since the B/A of Bup.HCl is much higher in alcoholic solution than the sublingual tablets, that means that a ceiling effect at 24 or 32mg using the solution doesn't translate to a ceiling for the sublingual tablets, since the absorbed amount of drugs is much smaller. I've read through both forums and the scientific literature—along with my doctor—so please, don't patronise. I'm thankful for the concern, though

 

[Zerwas]

What was your habit like before the Bupe-Maintenance? I ask because I agree with anyone saying that 32mg is way too much.

Even most people who were using really high doses of H or Fentanyl daily get along with 8-16mg or they get Methadone due to being used to the sedation which Buprenorphine does not provide to that extent.
So what doses of which opis (except the Lope) did you take that you got prescribed such an overkill amount (that roughly equals about 1g of Morphine)?

 

[kazon]

What was your habit like before the Bupe-Maintenance? I ask because I agree with anyone saying that 32mg is way too much.

Even most people who were using really high doses of H or Fentanyl daily get along with 8-16mg or they get Methadone due to being used to the sedation which Buprenorphine does not provide to that extent.
So what doses of which opis (except the Lope) did you take that you got prescribed such an overkill amount (that roughly equals about 1g of Morphine)?

Nothing but loperamide to control my problem. It ended up at around 120-160mg per day, being escalated over ~5 years in conjuction with my physician to treat this disease. Other treatments were tried, but loperamide was the one which was more effective and had the least side-effects. Eventually, it caused long QT-syndrome because of the dosage (like methadone) so the decision was made to try to control it, and the associated dependence, with buprenorphine, so I was referred to another physician with experience in treating both addiction, as well as other diseases, with buprenorphine.

The only aside was a week of SR oxycodone ~3 years back due to back surgery. 20mg twice daily.

The buprenorphine was chosen in preference to trying out methadone due to the fact, that I travel a lot for work. Methadone is more difficult to travel with. Also the fact that it would exacerbate the long QT syndrome (which has disappeared on buprenorphine) and that it's as sedating as it is.

 

[Usa51]

I was on 200mg day give or take for a long time and 4 mg was good enough to me to Get thru day guess everyone different

 

[kazon]

I was on 200mg day give or take for a long time and 4 mg was good enough to me to Get thru day guess everyone different

200mg of loperamide? Or..?

 

[kazon]

I know it's kinda lame, but just to illustrate the difference, here is tracings of photos taken under the same lighting conditions (closed room, no windows, same light source)... The difference is that big!

 

[gousfbulls]

I'm super-interested in this thread and I have no idea why. I even created an account on here so that I could profess my state of perplexity (In both the science/bio talk and also kazon).

You mind me asking what disease you have the unfortunate blessing of having? Curious to know what a level of Bup that high is helping you with. (Well, I know what it's helping, but like, what's your condition?). Not expecting an answer, just thought I'd try.

 

[ShiningStar]

Bupe and effedrin. safe?

I was taking Codesan syrup today 10deciliters 2times, because of smoking cough was killing me. I am heroin addict but clean 3weeks now. I used subutex to get off 4mg 2days and 2mg the 3rd day. Since i moved high up north and from midland to sea climate, cigarettes that never made me cough before (20years smoking) are tearing up my lungs and bronchs now. And change of climate gets the freezing cold in my bones and even when im inside it seems to travel from skin to bones down to the rest of my organs like electric shock..:D So my question is: I need a buzz, i need to relax and stop thinking of going other side of sea. I have that Codesan syrup, bupe, xanax and clonazepam. Is it safe to take bupe with codesan>effedrine, or better to take clonazepam or xanax on top. Does effedrine and bupe mix really make you nod out? Thank if anyone answers. Right now im off bupe and 0.8mg make me feel good, so how much should i take?

 

[Znegative]

I would not mix the benzos with the buprenorphine if you're off buprenorphine and don't have any real tolerance. The reports of buprenorphine overdoses always include the use of a benzodiazepine.

 

[DeathIndustrial88]

I don't know if OP is still around or cares but I have this same thing.

Bupe on it's own, with tolerance to it, doesn't do a whole lot. But when I take a sudafed or a bronkaid, it can change the experience into a very noddy one (albeit not as euphoric still as the real deal). There must be some sort of synergy here that some how causes sedation/noddy-type effect.

 

[DeathIndustrial88]

I know this is an old thread but it’s been bumped before and is relevant. I am on bupe maintenance and have recently discovered that taking 12.5mg - 25mg ephedrine with my bupe creates an almost full agonist like experience. It reminds me a lot of the combination of tramadol and buprenorphine; which got me thinking, most attribute the tram + bupe synergy to the norepinephrine releasing effect of tramadol increasing subjective euphoria because, at least on paper, bupe should (and does) block the opioidergic effects of tramadol, yet most who’ve taken the combination would agree there is a special synergy there and it does feel more akin to a full agonist.

To extrapolate to ephedrine + bupe, we know much of ephedrine’s effects are peripheral or norepinephrine-based and therefore imho it sort of makes sense that these two combinations (bupe + tram and bupe + eph) would resemble one another in creating a pseudo full agonist effect.

I for one have been taking ephedrine with my bupe consistently and finding it to consistently provide this effect; sure it has diminished as is expected but it’s still legitimate imo. Just wanted to share this.

I've been on bupe for 8 years almost & have noticed this too.


Taking ephedrine changes the bupe experience BIG time. And I'd like to know why as well.

For me personally, I'd still say that bupe + ephedrine has nothing on tramadol or full agonists... but it gets close.
I can literally be feeling nothing from bupe & then I take some ephedrine & suddenly I can't keep my eyes open. It has literally put me down for the count. I would say there's minimal euphoria increase, but it definitely increases sedation & gives the bupe a bit of a rounder feeling.

My guess is the weak dopamine release from ephedrine (yes ephedrine causes dopamine release too, however small) potentiates the buprenorphine ever so slightly. Similar to how when I use to use meth & then take bupe. Suddenly the bupe would feel closer to a real full agonists thanks to the meth in my system.

I actually ended up taking ephedrine daily for like 2 years because of this very thing. Which brings me to my concerns about what kind of cardiovascular damage I could be doing by taking ephedrine too often.

The norepinephrine thing sounds plausible too. Maybe it's the combo of dopamine & norepinephrine release. It's been theorized that these pathways also play a role in pain perception, so when you alter them on top of a partial agonist, it's possible you're creating, like you said, a "psuedo-full agonist" effect.

I was buying Bronkaid every other month for this reason for like 2 years. I worry about heart attack / stroke with long term daily ephedrine use though.

I'd still prefer the tram + bupe combo though. lol Tramadol has it's full agonist metabolite going for it, so that part of the experience would be hard to recreate with anything other than another full agonist opioid.