Norspan (Buprenorphine) interactions

[4thDimension]

Hi dudes, I was wondering if anybody here could help me find answers as to why I am having such intense adverse reactions when taking opiates whilst on my 10 mcg/hr buprenorphine patch.

I use the patch for pain. The other day I took a 20 mg Oxycontin whilst on the patch and I had this horrible panic sensation followed by extreme itching, and hypertension. I also had some codeine, about 3 grams today and the same reactions occurred and it scared the hell out of me.

Anybody have any ideas as to why this is happening?


Oh, I have found these patches to have helped me immensely with my major depression. Very good.


Merry Christmas.

 

[Mr Blonde]

Sounds like a major histamine reaction. 3 grams is a lot of codeine, if you haven't built up to a tolerance of that level WITH codeine, the histamine reaction will be really bad due to the nature of the drug.

No idea with the oxycodone... did you actually get high? The bupe might block it.

 

[4thDimension]

I just read up on that and iit sounds exactly like what happened to me. It felt like my shoulders were on fire, a really shitty high that turned out to be. 22 tablets of 15/500 CWE is a lot for me, twice the usual amount. Just experimenting.
I took 25mg of phenergan straight after, that may have helped.

I feel much better now, just a little peeved that I cannot take any higher dose opiates whilst on my Norspan patch. Can a major histamine release precipitate extreme anxiety and dizziness? The thing is the panic/anxiety stuff happened after I took the Oxycontin while on the patch too. The patch seems to be interacting with the opiates and doing something strange with my neurotransmitters.

Thanks for the advice Mr Blonde.

 

[Christ!]

You probably already know but buprenorphine has a blocking effect with opiates. It does this by binding tightly to certain opiate receptors in your brain, oxycontin or codeine comes along and tries to occupy the 'feel nice' receptor and fails because bupe is sitting on it and won't budge.

This isn't a 100% block though and on lower doses of bup it's totally possible to feel other opiates, although generally they won't work as good.

Surprised the oxy had that effect but codeine especially in large doses is a massive histamine inducer...

Can a major histamine release precipitate extreme anxiety and dizziness?

Yes. Couple that with the oxy and codeine 'kind of' working and kind of not working because of the bup and I can see all sorts of potential for nasty effects...histamine response sounds like it's still strong but other effects like 'euphoria' and 'well being' are probably decreased or even eliminated.

 

[Mr Blonde]

22 tablets of 15/500 CWE is a lot for me

Oh, 330mg, not 3 grams... still, for someone not experienced a lot with codeine it does have a large histamine release compared to other opioids. I imagine at 3 grams it could be very dangerous!

I took 25mg of phenergan straight after, that may have helped.

That was a good idea, any of the first generation, sedating antihistamines will help bring down that reaction as well as reduce nausea. They also cause sedation, which people often like in combination with their opioids.

I feel much better now, just a little peeved that I cannot take any higher dose opiates whilst on my Norspan patch. Can a major histamine release precipitate extreme anxiety and dizziness? The thing is the panic/anxiety stuff happened after I took the Oxycontin while on the patch too. The patch seems to be interacting with the opiates and doing something strange with my neurotransmitters.

Yes, the histamine release can do that. It's the same as when you have a major allergic reaction, basically. As with Christ above, I am surprised the oxycodone caused that reaction as well... I would have thought it just wouldn't work. Have you used oxycodone before? What is your normal dose of it?

 

[4thDimension]

Thanks, I get more pharmacological info here than at university

Cheers for the info Christ. Your birthday is soon, right

Mr Blond, the phenergans are a great potentiator and sedative for an OTC. I can foresee it going to an S4 in the near future.

My usual dose of oxy was 2 x 5mg endone and occasional use of oxycontin 10 or 20 mgs. After some more experimenting I have found anything stronger than a few panadeine forte send me into a hyper anxiety. So it is either stay with the patch or rip it off and free my μ receptors!

the patch has also interfered with other substances i have had, and a friend of mine on the Norspan is having very similar problems too.

 

[Mr Blonde]

Mr Blond, the phenergans are a great potentiator and sedative for an OTC. I can foresee it going to an S4 in the near future.

I know a pharmacist who has a bet with a first year B. Pharm student regarding whether codeine will still be OTC by the time the student is a registered pharmacist!

Promethazine isn't so bad, but there are a lot of pharmacy shoppers getting doxylamine. Some people are addicted to those for sleep. Hopefully they don't go to S4, because there are a lot of legitimate users of these medications out there.