Posted by Peter S. on October 24, 2008, at 17:01:06
In reply to Re: Started Buprenorphine! » Peter S., posted by okydoky on October 23, 2008, at 17:46:07
Thanks for all that info! I took a couple of days off and restarted at .5mg. Less nausea now. Now I'm just dealing with the inability to urinate, which is another common side effect. Left message with my p-doc- I wonder if this will go away, or I need to take flo-max or something like it.
Definite anti-depressant effects are showing! I should be clear that it feels nothing like an opiate type eurphoria. Will keep posting on my status.
> I dont know if this will help but here are a few things I found:
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> http://www.nauseaandvomiting.co.uk/NAVRES001-4-opioid.htm#_edn4
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> http://www.mywhatever.com/cifwriter/library/70/4937.html
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> Taken from the proceeding link:
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> Because opioid-related nausea is so common, it will be discussed separately. Opioids result in nausea through two major mechanisms: inhibition of gut motility and stimulation of the CTZ. Stimulation of the CTZ relates more to increases in blood opioid levels than it does to absolute opioid levels. Thus, initiating opioid therapy or raising the opioid dose is likely to result in nausea. However, if a new steady-state blood level is maintained, nausea usually subsides within two to three days. During this time aggressive treatment of nausea usually allows patients to tolerate opioid therapy. This is particularly important if the oral route is used for administration. Patients may enter a vicious cycle of nausea interrupting oral opioid administration, resulting in fluctuating blood opioid levels and perpetual nausea (in addition to unnecessary pain). In severe cases a nonoral route of administration should be used, at least until nausea is under control, in order to escape this cycle. As stimulation of the CTZ is primarily mediated through D2 receptors, dopamine blockade is critical to drug therapy. Anticholinergic and antihistaminic agents are less effective for this form of nausea, although they may help with relatively minor stimulation of the vestibular apparatus by opioids. Anticholinergic and antihistaminic agents may increase undesired sedation associated with initiation or upward titration of opioids and may also exacerbate poor gut motility, adding to these serious side affects of opioids. Anticholinergic and antihistaminic agents dry the mouth, a common and troubling side effect in the seriously and terminally ill patient (also worsened in patients taking opioids). Thus, a strong argument can be made for maximizing dopamine blocking effects and minimizing anticholinergic and antihistaminic effects in choosing an antiemetic for opioids. Having said this, it is remarkable that no controlled trials (of which I am aware) have compared prochlorperazine (Compazine - relatively antidopaminergic) to promethazine (Phenergan - a weak antidopaminergic drug and strong antihistamine) in the treatment of opioid-related nausea. Given the prevalence with which both agents are used to treat opioid-related nausea, this is testimony to the fact that what often drives research is not solving common, practical problems, but pharmaceutical dollars and research ambitions.
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> Here are a few excerpts from different sites. My computer turned off so I dont have the sites anymore:
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> Piperazines antihistamines are not the best for reducing nausea.
> Ethanolamines Antihistamines (Diphenhydramine/Benadryl, Dimenhydrinate/Dramamine) or Promethazine work much better in my opinion
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> try an antihistamine like cyclizine or cinnarizine (used as travel sickness tablets, but cyclizine is also specifically used for opiate nausea in drugs likd diconal -dipipanone/cyclizine - and cyclomorph - morphine/cyclazine)
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> Considering it has been a week, I sure hope that the nausea has subsided by now! I just felt that I would list a few over the counter and prescription anti nausea medications (and the suggested dose) and any other medication that may help for symptoms of opioid/opiate nausea while on the subject:
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> Anti-emetic and Anti-histamines
> 50mg Dimenhydrinate (Dramamine)
> 25-50mg Hydroxyzine (Atarax)
> 25-50mg Diphenhydramine (Benedryl)
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> Anti-acid medications
> 10mg Metoclopramide (Reglan)
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> Phenothiazine derivatives
> 25mg Phenergan (Promethazine)
> 10mg Torecan (Thiethylperazine)
> 5mg Prochlorperazine (Compazine)
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> Somewhere I did read that Diphenhydramine should be used at 100mg but it is not clear to me if it would hinder the analgesic affect of the opiate?
> I was told to use Prilosec which worked well but I needed to find another solution because I could not tolerate it for other reasons, hence I was looking and saw your post. I really hope this helps you but hopefully you have gotten beyond the problem.
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> oky
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poster:Peter S.
thread:831927
URL: http://www.dr-bob.org/babble/20081016/msgs/859130.html