Bupe Butrans makes me nervous

[Mitchb105]

I’m on a Butrans patch for 8 years now. I use 10 mcg patches every 3 days and I leave them on for 7 days each patch. I find that the patches make me nervous and almost in withdrawals but they are all I am given. For the most part I like the patches but they can occasionally make me uncomfortable. Does anyone else have this problem with Butrans?

 

[DrainBamaged]

If this nervousness is new, I'd first look I to any other medications or supplements you take now. They could be interacting with the bupe. What other non-food things do you ingest?

I've had a lot of side effects from bupe, but never anxiety.

If you are experiencing new side effects from the bupe after 8 years, it's most likely something else causing the issue.

 

[Mitchb105]

Thanks for your reply. It is definitely the Butrans. When I started it 8 years ago it used to make me panic in nervousness but it was all I could get for my chronic pain. I am actually more calm these days than before but I still experience occasional nervousness. I can’t tolerate more Butrans and I can’t even use codeine as it puts me in withdrawals.

 

[DrainBamaged]

You shouldn't be experiencing withdrawals after 8 years on bupe. I think you may be confusing other sources of anxiety, restlessness, depression, or pain.

If you truly have not changed anything in your routine, and taking codeine "puts you into withdrawal", or otherwise makes you uncomfortable, then I would probably go to the doctor. That's extremely abnormal.

Like I said, I have introduced other drugs/supplements into my diet that caused opioids to give me anxiety, but this was abnormal interaction and I eventually figured it out.

I don't know what else to suggest.

Doing bupe for 8 years and then suddenly getting anxiety from it is indicative of some new abnormal interaction or potential neurological issue.

 

[Mitchb105]

I am not suddenly getting anxiety from bupe. 8 years ago I had much more severe anxiety but bupe was all I was allowed for pain so I adjusted to it. I am now much less anxious but I can’t tolerate any more than the dose I have gotten used to. Sometimes I have breakthrough pain but there’s nothing I can use for it. If I use an additional 5mcg patch more than the 10mcg every 3 days then I have severe anxiety. If I use codeine then I have withdrawal symptoms when the codeine wears off. All in all I am pretty okay on my designated dose of Butrans that I have gotten used to.

 

[Pissed_and_messed]

I've had a lot of side effects from bupe, but never anxiety.

I also happen to get occasional bouts of anxiety that are hard to explain, with bupe, tolerance or not.

I guess that it is for the histamine release and gaba suppression of mu-agonists, but with bupe it is worse at least because it makes me so numb and the effect holds over for a long time; there is cognition "ok, I am going to be sort of 'disconnected' for at least 24 hours and maybe more".

When I was doing bupe every day for a short while (very small doses, but THC I passionately use decreases metabolization rate of bupre) and took larger dose occasionally, it often gave me high I considered at least partly disgusting in its character.

Also the kappa receptor agonism might play a part in it, particularly I suspect this because bupre kinda stands out regarding the anxiety, both in good and bad.

I am not sure I could even say that bupre simply makes me always more anxious, there are so many dimensions to it.

 

[Jen X]

I couldn't take buprenorphine because it caused me anxiety so it does happen

 

[TheFunkeeJunkee]

Buperenorphine is known to cause anxiety, restlessness and insomnia in many folks, me included. Also for me it was dose dependent (like you). A 128mg monthly injection gave me insomnia and anxiety for the first 2 weeks while 64mg a month was just right.

It was important for me to develop some healthy tools to manage the anxiety symptoms and pain while I focused on improving my life while on Buperenorphine treatment.

It's unfortunate as a pain patient your only choice is Buperenorphine. I think part of an effective pain management regime is a degree of freedom of choice. Sometimes autonomy alone has huge impacts on people's quality of life and other subjective scores.

It may be the case that you'll need to increase the dose and have a period of adjustment while your drug tolerance to these unpleasent effects increases.

You've been on Buperenorphine for over 8 years now so this may be a silly question but instead of raising the dose have you explored non-pharmacological methods of treating your pain? I know it's sickening to hear but mindfulness gave me the strength and acceptance to manage my pain and anxiety/depression without the regular use of Opioids.

 

[Mitchb105]

I seem to have anxiety off and on with my Butrans 23 mcgs per week. Sometimes I feel anxious but other times I feel good. I am terrified to stop the Butrans and I do have chronic pain which the Butrans sincerely helps. I would like to switch from Butrans to a more typical opioid but I don’t know if I can after being on Butrans for 8 years now. Can anyone advise on how I would be able to switch opioids to one that is easier to tolerate? That said I like the way the Butrans is still working after 8 years without any need to increase dose.

 

[Mitchb105]

6 months later now and I have a new Dr. who continues my Butrans patch(10 mcgs every 3 days for combined total of 23mgs per week). I am as well given Percocet 5mg/325mg for breakthrough pain. I am afraid to use the Percocet as T3’s cause me side effects on top of the Butrans and Tramadol makes me sick for two or three weeks if used. I am sticking to plain Tylenol for pain on top of the Butrans and I am avoiding any other opioid meds to be careful and safe. I still have anxiety from the Butrans but it is not as bad. Sometimes the Butrans makes me feel nice.

 

[Survival0200]

6 months later now and I have a new Dr. who continues my Butrans patch(10 mcgs every 3 days for combined total of 23mgs per week). I am as well given Percocet 5mg/325mg for breakthrough pain.

From what I understand, buprenorphine should make taking oxycodone ineffective. Correct me if I'm wrong. Some doctors don't just know that much about pharmacology?

 

[paranoid android]

From what I understand, buprenorphine should make taking oxycodone ineffective. Correct me if I'm wrong. Some doctors don't just know that much about pharmacology?

Yup my friend had a doctor give her bupe patches when she was on dilaudid and it caused instant wd. Id imagine oxy would be the same

 

[Mitchb105]

You are correct that some Drs don’t know much about pharmacology however at the dose of buprenorphine on a Butrans patch( even the highest dose patch 20 mcgs) opioids like oxy, codeine, hydromorph etc are still effective at the lower dose Bupe level of the patch. Doses at the higher Subutex or Suboxone doses will block additional opioids. That said it is my experience that additional opioids although effective while on Butrans patch can have unpleasant side effects in my case which is why I don’t use them while on the Butrans patch. The opioids are effective however while on low dose Bupe like Butrans 20mcgs which is comparable to sublingual Bupe 1.5 mgs.

 

[Mitchb105]

Yup my friend had a doctor give her bupe patches when she was on dilaudid and it caused instant wd. Id imagine oxy would be the same

Apparently you can use a full mu opioid if already on Butrans but if you’re on a full mu opioid you can go straight into withdrawal if you use Butrans or any dose bupe. The literature explains why and all that said I still have side effects from using even one T3 while on Butrans. Its not full blown opioid withdrawal however. Just some anxiety and sweating. The effect is uncomfortable but not typical withdrawal. Occasionally the patches may wear off a little early and then I may experience withdrawal.

 

[DeathIndustrial88]

If your bupe dose is low enough, full agonists will work on top of it.

Taking full agonists on top of bupe will not result in withdrawal. You have to be actively dependent on full agonists AND THEN take bupe, to cause withdrawals.

The tiny amount in butrans patches is not enough to block full agonists. That's why doctors will prescribe full agonists for "breakthrough pain".

That patches probably are leaving OP in slight withdrawal at various times through out the day, because the lower bupe doses aren't going to last 24hrs like the higher doses.

 

[4DQSAR]

As others have pointed out, buprenorphine is recognized as producing anxiety.

I think someone actuslly worked out why (or at least had a theory with evidence) and it turned out that buprnorphine has affinity for some receptor-types totally unrleated to it's opioid activity.

I think it's worth mentioning if it's getting worse. I ended up saying 'well, it stops the pain but I haven't slept for a week' to my GP who ignored me. Four days later, tonic clonic seizures and hospital reading my medical records and asking why acute insomnia was ignored. So got oxycodone in place... and I GUESS it's better. I mean no dose increase in 9 years...

 

[Mitchb105]

I am experiencing on and off insomnia on Butrans but I usually get enough sleep. I get good pain relief from 20 mcg dose per week and I get 30 Percocet every month for breakthrough pain but I don’t use it. I figure since the Butrans is working I don’t want to chance possible reactions with it. They are good to have “just in case”. I can’t stand the after effects of Tramadol and codeine is oh well codeine.

 

[4DQSAR]

I am experiencing on and off insomnia on Butrans but I usually get enough sleep. I get good pain relief from 20 mcg dose per week and I get 30 Percocet every month for breakthrough pain but I don’t use it. I figure since the Butrans is working I don’t want to chance possible reactions with it. They are good to have “just in case”. I can’t stand the after effects of Tramadol and codeine is oh well codeine.

Of course sufficient buprenorphine will blockade all the others, but the doses used for PAIN don't equate to doses that entirely occupy the MOR receptors.

It's interesting to know that burpenorphine long-term has it's issues. In the UK at least, it's become quite a popular option but I ALSO know that if a patient goes back to their GP complaining of insomnia... that's now recognized.

But then it appears to produce far less tolerance and dependence - so your call. I don't know many happy endings with the words 'and finally the patient was given <name of potent MOR agoniat> and it all turned out just great.

In short - it HAS it's place. But I suggest it's place is in detoxiciaction, not analgesia.

BTW did you know it was discovered by a team who were seeking a cheaper alternative to codine for use in paracetamol and codeine tablets? Lack or oral bioavaiability killed it, but ALL of the Bentley compounds were discovered using a MacFarlan Smith funding.

Kenneth Bentley was quite the guy. Etorphine discovered when entire team discovered unconscious - a glass stirring rod used in the synthesis was reused to stir tea, IN THE LAB!!! Crazy people.

 

[Mitchb105]

What I like about the Butrans is that it is still extremely effective at the same dose as 8 years ago. I am still getting good analgesia and I am not craving full mu opioids like I used to.

 

[thurston]

If your bupe dose is low enough, full agonists will work on top of it.

Taking full agonists on top of bupe will not result in withdrawal. You have to be actively dependent on full agonists AND THEN take bupe, to cause withdrawals.

The tiny amount in butrans patches is not enough to block full agonists. That's why doctors will prescribe full agonists for "breakthrough pain".

That patches probably are leaving OP in slight withdrawal at various times through out the day, because the lower bupe doses aren't going to last 24hrs like the higher doses.

I agree with the slight WD. I try to keep myself on as low a dose as possible of my DOC for pain and I sometimes feel like I'm keeping myself in mild wd which makes the pain worse kinda.