Psycho-Babble Medication Thread 71430

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Re: Temgesic » Neal

Posted by Elizabeth on July 23, 2001, at 16:32:08

In reply to Elizabeth - Re Temgesic, posted by Neal on July 22, 2001, at 20:06:31

> Elizabeth - Can you give me some idea of the dose range for AD use of Temgesic taken sublingually? Also should I take it once/twice/three times daily?

I don't know much about it. It probably should be taken 3 times a day. I'm not sure about the therapeutic dose range; it depends, among other things, on what you're using it for. For some people, 0.2 mg SL is adequate.

-elizabeth

 

Re: Elizabeth - Re Temgesic » Neal

Posted by shelliR on July 23, 2001, at 20:51:53

In reply to Elizabeth - Re Temgesic, posted by Neal on July 22, 2001, at 20:06:31

> Elizabeth - Can you give me some idea of the dose range for AD use of Temgesic taken sublingually? Also should I take it once/twice/three times daily?
> Thanks for any advice.
>
> -Neal

Neil, I'm curious, because I also have taken an opiate for depression. In both instances it took time (up to 1 hour) for my depression to lift after swallowing the pill. I know you are taking it sublingually, so it is probably faster. And then at a certain time of day depending on the specific opiate, I knew it was no longer effective. Like on vicidin, it worked for about four or five hours and now on oxycontin (pdoc proscribed), although it is "supposed" to last 12 hours, I start to crash at around 8-9 hours.

So I'm confused at why you don't have a sense of how often to take it. Opiates are short acting. Don't you start to feel depressed again after a certain number of hours? If it is lasting you the whole day, are you sure that it is the Temgesic that is acting as an antidepressant? What other meds are you on?

Shelli

 

Re: Temgesic;Elizabeth;ShelliR

Posted by Neal on July 23, 2001, at 23:43:37

In reply to Re: Temgesic » Neal, posted by Elizabeth on July 23, 2001, at 16:32:08

I am taking it experimentally, to see if it helps me. The tabs are .2mg. I can just barely feel the effect of one tab. 2 tabs at one time feel good but a tiny bit spacey. I gathered from your previous posts that there is very little addiction potential to the bup?

 

Re: Temgesic; Addendum

Posted by Neal on July 24, 2001, at 1:20:09

In reply to Re: Temgesic;Elizabeth;ShelliR, posted by Neal on July 23, 2001, at 23:43:37

I found this government report about buprenorphine to be informative and interesting, even though it is about bup's use in heroin addiction mainly, and using very large doses.
___________________________________

General Information
What is Buprenorphine?
Buprenorphine is a derivative of the morphine alkaloid, thebaine, and is a partial opioid
agonist at the m opioid receptors in the nervous system. It is also a k (kappa) opioid receptor
antagonist. It has low intrinsic agonist activity, only partially activating m opioid receptors, thus
producing a milder, less euphoric and less sedating effect than full opioid agonists such as
heroin, morphine and methadone. Nevertheless, its activity is usually sufficient to diminish
cravings for heroin, and prevent or alleviate opioid withdrawal in dependent heroin users.
Buprenorphine also has a high affinity for m opioid receptors, binding more tightly to these
receptors than full opioid agonists. It therefore reduces the impact of additional heroin (or
other opioid) use, by preventing heroin from occupying these receptors. By its dual effects of
producing opioid responses while blocking the effects of additional heroin use, buprenorphine
reduces the self-administration of heroin.
What form does it come in?
The buprenorphine product registered in Australia for treating opioid dependence is Subutex®,
a sublingual tablet preparation of buprenorphine hydrochloride in 0.4, 2, and 8 mg strengths.
Buprenorphine is also registered in Australia for the management of short term (not more than
one week) relief of moderate to severe pain, including post –operative and terminaland chronic
pain pain as Temgesic® sublingual tablets and ampoules for intramuscular or subcutaneous
injection. Sublingual buprenorphine tablets have approximately 30-35% of the bioavailability of
intravenous buprenorphine preparations 1 . Buprenorphine undergoes extensive first pass
metabolism when taken orally.
How is it metabolised?
Peak plasma concentrations are achieved 1 - 2 hours after sublingual administration.
Buprenorphine has a distribution half-life of 2 - 5 hours. It is principally metabolised by two
hepatic pathways: conjugation with glucuronic acid and N-de-alkylation. The metabolites
areexcreted in the biliary system, with enterohepatic cycling of buprenorphine and its
metabolites. Most of the drug is excreted in the faeces and urine.

Buprenorphine has an elimination half-life of 24 - 37 hours. It is long-acting, relative to the
dose administered. Peak clinical effects occur 1 - 4 hours after sublingual administration, with
continued effects for up to 12 hours at low doses (2 mg), but as long as 48 - 72 hours at higher
doses (16 or 32 mg). The extended duration of action of buprenorphine is thought to relate to
three factors:
· its very high affinity for opioid m receptors (once bound to these receptors it is
dislodged only slowly);
· its high lipophilicity (low levels of buprenorphine are released slowly from fat
stores, particularly with chronic dosing).
· Reabsorption of buprenorphine after intestinal hydrolysis of the conjugated
metabolite.
The prolonged duration of effect at high doses enables alternate-day, and even 3-
days-a-week dispensing regimes.
TABLE 1
ONSET AND DURATION OF RESPONSE TO BUPRENORPHINE
Onset of effects 30 - 60 minutes
Peak clinical effects 1 - 4 hours
Duration of effects 8 - 12 hours at low dose (e.g. < 4 mg)
24 - 72 hours at high dose (e.g. >16 mg)
_________________________________

Buprenorphine also exhibits antagonist effects at the k opioid receptor. The role of these
receptors in humans is still poorly understood, but excess endogenous k agonist activity
appears to be implicated in both affective and psychotic conditions. Buprenorphine’s
antagonist effects at the k receptor are thought to produce anti-depressant and anti-psychotic
effects in some people. However, as further research is needed into these effects,
buprenorphine is not currently indicated for these conditions.
__________________________________

Withdrawal syndrome from buprenorphine
Its partial agonist properties, along with its slow dissociation from opioid receptors, are thought
to explain why opioid withdrawal syndrome is milder with the cessation of buprenorphine
treatment, than with heroin, morphine or methadone. Typically, the withdrawal syndrome
following the abrupt cessation of long-term buprenorphine treatment emerges within 3 – 5
days of the last dose, and mild withdrawal features continue for up to several weeks.

 

Re: Temgesic » Neal

Posted by Elizabeth on July 26, 2001, at 23:48:54

In reply to Re: Temgesic;Elizabeth;ShelliR, posted by Neal on July 23, 2001, at 23:43:37

> I am taking it experimentally, to see if it helps me. The tabs are .2mg. I can just barely feel the effect of one tab. 2 tabs at one time feel good but a tiny bit spacey.

The spacey feeling should go away with time. My problem initially was nausea (that went away too; promethazine 25 mg is good for blocking it in the meantime).

> I gathered from your previous posts that there is very little addiction potential to the bup?

Right, to the best of my knowledge.

-elizabeth

 

Re: Temgesic » Elizabeth

Posted by Neal on July 27, 2001, at 23:43:33

In reply to Re: Temgesic » Neal, posted by Elizabeth on July 26, 2001, at 23:48:54

Well, the study I cited in a previous post on this thread said going off bup was "milder than heroin or methadone", but that really isn't saying a whole lot. Of course the dose used for depression is miniscule compared with the dose for addicts.

 

Re: Temgesic » Neal

Posted by Elizabeth on July 31, 2001, at 18:29:33

In reply to Re: Temgesic » Elizabeth, posted by Neal on July 27, 2001, at 23:43:33

> Well, the study I cited in a previous post on this thread said going off bup was "milder than heroin or methadone", but that really isn't saying a whole lot. Of course the dose used for depression is miniscule compared with the dose for addicts.

There's a lot less of the flu-like feelings -- shivers, nausea, hot/cold flashes, etc. There can be significant rebound depression, though.

-elizabeth

 

Re: Temgesic » Elizabeth

Posted by Neal on August 1, 2001, at 1:35:07

In reply to Re: Temgesic » Neal, posted by Elizabeth on July 31, 2001, at 18:29:33

Did I read on another thread that you intend to go off bup? I was curious as to why.

 

buprenorphine » Neal

Posted by Elizabeth on August 1, 2001, at 14:00:19

In reply to Re: Temgesic » Elizabeth, posted by Neal on August 1, 2001, at 1:35:07

> Did I read on another thread that you intend to go off bup? I was curious as to why.

Side effects, of course. But it depends on how well the desipramine ends up working.

-elizabeth

 

Re: buprenorphine » Elizabeth

Posted by Neal on August 1, 2001, at 22:53:44

In reply to buprenorphine » Neal, posted by Elizabeth on August 1, 2001, at 14:00:19


> Side effects, of course. But it depends on how well the desipramine ends up working.
>
> -elizabeth

-What were they, if I may ask?

 

Re: buprenorphine » Neal

Posted by Elizabeth on August 2, 2001, at 8:41:10

In reply to Re: buprenorphine » Elizabeth, posted by Neal on August 1, 2001, at 22:53:44

> > Side effects, of course. But it depends on how well the desipramine ends up working.
>
> -What were they, if I may ask?

Dry mouth, constipation, and itching are the main ones.

-elizabeth

 

Re: buprenorphine » Elizabeth

Posted by jojo on August 3, 2001, at 1:48:36

In reply to buprenorphine » Neal, posted by Elizabeth on August 1, 2001, at 14:00:19

> > Did I read on another thread that you intend to go off bup? I was curious as to why.
>
> Side effects, of course. But it depends on how well the desipramine ends up working.
>
> -elizabeth

Elizabeth- Would you tell me what side effects?

jojo

 

Re: buprenorphine » jojo

Posted by Elizabeth on August 3, 2001, at 17:25:47

In reply to Re: buprenorphine » Elizabeth, posted by jojo on August 3, 2001, at 1:48:36

> Elizabeth- Would you tell me what side effects?

Dry mouth, constipation, urinary hesitancy, pruritis (itching), irregular menstrual cycles, psychomotor agitation (jitters)...a lot of things. Most of them can be dealt with by taking other drugs (bethanechol, Benadryl or ChlorTrimeton, Xanax or Klonopin, propranolol, Metamucil, etc.), but I'd really rather not just keep piling things on.

There's also the fact that if I ever was injured and required opioids for pain relief, I'd probably have some tolerance and would need higher doses than the usual ones. (I should probably get one of those emergency medical bracelets and/or carry a wallet card that says what meds I'm on.) Plus I don't like that it's not available in a pill and has to be taking three times a day; that makes it very inconvenient to use.

IMO, opioids are harder to tolerate than just about any other class of antidepressants.

-elizabeth

 

Re: buprenorphine » Elizabeth

Posted by jojo on August 3, 2001, at 20:57:16

In reply to Re: buprenorphine » jojo, posted by Elizabeth on August 3, 2001, at 17:25:47

> > Elizabeth- Would you tell me what side effects?
>
> Dry mouth, constipation, urinary hesitancy, pruritis (itching), irregular menstrual cycles, psychomotor agitation (jitters)...a lot of things. Most of them can be dealt with by taking other drugs (bethanechol, Benadryl or ChlorTrimeton, Xanax or Klonopin, propranolol, Metamucil, etc.), but I'd really rather not just keep piling things on.
>
> There's also the fact that if I ever was injured and required opioids for pain relief, I'd probably have some tolerance and would need higher doses than the usual ones. (I should probably get one of those emergency medical bracelets and/or carry a wallet card that says what meds I'm on.) Plus I don't like that it's not available in a pill and has to be taking three times a day; that makes it very inconvenient to use.
>
> IMO, opioids are harder to tolerate than just about any other class of antidepressants.
>
> -elizabeth

Now I understand why you questioned if I were taking the drug properly. I have a very high tolerance for most drugs. I won't go into details, but my Psychiatrist has had to talk many times to the Pharmacists from my medical insurance company about why I was being prescribed 30 mg/day of Ambien when I had a bout with insomnia last year.
I've had the dry mouth and constipation, but that has mostly faded. As far as jitters go, I've stopped 35 mg./day of Dexedrine, but do take 16.2 mg./day of Yohimbine, which acts as an AD and is a psychomotor as well as sexual stimulant. I think that I handle the drug well. Now, in the next few weeks, I have to find out if it's handling me well as an antidepressant.

jojo


 

Re: buprenorphine » jojo

Posted by shelliR on August 3, 2001, at 22:50:21

In reply to Re: buprenorphine » Elizabeth, posted by jojo on August 3, 2001, at 20:57:16

jojo,

Was it your idea to go on buprenorphine or your pdocs? If yours, did he/she have any problem with it? And do you have any problem getting it from the pharmacy?

I'm asking because right now I am taking OxyContin for my depression but I need to add an AD because it is losing it's effectivenss at the dose I started with. So I was also considering buprenorphine instead of the oxy if I do not get the effect I want from parnate.
I've never discussed this with my pdoc, although the oxycontin was his idea; (I had been self-medicating with vicodin).

Thanks,

Shelli

 

Re: buprenorphine » Elizabeth

Posted by Neal on August 4, 2001, at 13:31:41

In reply to Re: buprenorphine » jojo, posted by Elizabeth on August 3, 2001, at 17:25:47

Elizabeth,
You might consider Temgesic. I am currently taking just one .2mg pill a day and I can feel it working. You might want to take more than one a day, but it's easier than the intra-nasal method.

 

Re: buprenorphine

Posted by jojo on August 4, 2001, at 16:24:42

In reply to Re: buprenorphine » Elizabeth, posted by Neal on August 4, 2001, at 13:31:41

> Elizabeth,
> You might consider Temgesic. I am currently taking just one .2mg pill a day and I can feel it working. You might want to take more than one a day, but it's easier than the intra-nasal method.

I'm telling you guy's, a metered nasal spray dispenser
makes it no problem at all. If you plan on taking
3.0 ml that day in 1 ml increments, 7 sprays 3
times per day. Put your 3 vials in the dispenser
using a syringe, in the morning. Calibrate it
yourself, so that you trust the dose you're getting.

jojo

 

Re: buprenorphine » jojo

Posted by Elizabeth on August 4, 2001, at 21:47:28

In reply to Re: buprenorphine » Elizabeth, posted by jojo on August 3, 2001, at 20:57:16

> Now I understand why you questioned if I were taking the drug properly. I have a very high tolerance for most drugs.

Do you mean acquired or intrinsic tolerance?

I seem to have a high intrinsic tolerance for some of the effects of opioids and for benzodiazepines. I have no idea why this would be the case. (Well, I have some ideas, but they're pretty vague. < g >)

> I won't go into details, but my Psychiatrist has had to talk many times to the Pharmacists from my medical insurance company about why I was being prescribed 30 mg/day of Ambien when I had a bout with insomnia last year.

I know what you mean. Pharmacists are constantly giving me a hard time whenever I present them with my script (for 20 mg of Ambien nightly). It's like they think they know better than the doctor what I "should" be taking. A lot of times they just try to give me a bottle of only 30 tabs because they don't seem to understand that 60 is a one-month supply for me. (I don't get it: they make the labels, can't they read what the instructions are?)

> I've had the dry mouth and constipation, but that has mostly faded.

That's good news.

> As far as jitters go, I've stopped 35 mg./day of Dexedrine, but do take 16.2 mg./day of Yohimbine, which acts as an AD and is a psychomotor as well as sexual stimulant.

I'm not sure I'd call yohimbine a "sexual stimulant," but it has vascular effects that can counteract impotence. Buprenorphine isn't likely to cause jitters; I seem to have an unusual response to it.

> I think that I handle the drug well. Now, in the next few weeks, I have to find out if it's handling me well as an antidepressant.

Good luck to you! :-)

-elizabeth

 

Re: buprenorphine » Neal

Posted by Elizabeth on August 4, 2001, at 21:51:22

In reply to Re: buprenorphine » Elizabeth, posted by Neal on August 4, 2001, at 13:31:41

> Elizabeth,
> You might consider Temgesic. I am currently taking just one .2mg pill a day and I can feel it working. You might want to take more than one a day, but it's easier than the intra-nasal method.

No thanks. I'm not interested in going to the effort and expense of ordering drugs from overseas.

I talked to my pdoc and he seems to be open to the idea of showing me how to give myself IM injections (I gather it's not that hard anyway) in case I need to take a dose when I'm somewhere I can't lie down. I think that would be more reliable than the intranasal and sublingual routes.

-elizabeth

 

Re: buprenorphine

Posted by jojo on August 7, 2001, at 9:59:07

In reply to Re: buprenorphine » Elizabeth, posted by Neal on August 4, 2001, at 13:31:41

> Elizabeth,
> You might consider Temgesic. I am currently taking just one .2mg pill a day and I can feel it working. You might want to take more than one a day, but it's easier than the intra-nasal method.

Neal-

Do you find the action of Temgesic more like a "euphoriant"* (you feel the "lift" soon after taking it, but it wears off in less than a day or two) or an "antidepressant"* (if you miss a day it is not immediately noticeable)?

· My definitions.

jojo

 

Re: buprenorphine-Vicodin » shelliR

Posted by Wendy B. on August 7, 2001, at 18:40:14

In reply to Re: buprenorphine » jojo, posted by shelliR on August 3, 2001, at 22:50:21

> jojo,
>
> Was it your idea to go on buprenorphine or your pdocs? If yours, did he/she have any problem with it? And do you have any problem getting it from the pharmacy?
>
> I'm asking because right now I am taking OxyContin for my depression but I need to add an AD because it is losing it's effectivenss at the dose I started with. So I was also considering buprenorphine instead of the oxy if I do not get the effect I want from parnate.
> I've never discussed this with my pdoc, although the oxycontin was his idea; (I had been self-medicating with vicodin).
>
> Thanks,
>
> Shelli

Shelli,
I've been reading this thread with interest. I have a question if you don't mind answering it: where were you getting the Vicodin for self-medicating?

Best,
Wendy

 

Re: buprenorphine-Vicodin » Wendy B.

Posted by shelliR on August 7, 2001, at 19:29:05

In reply to Re: buprenorphine-Vicodin » shelliR, posted by Wendy B. on August 7, 2001, at 18:40:14


>
> Shelli,
> I've been reading this thread with interest. I have a question if you don't mind answering it: where were you getting the Vicodin for self-medicating?
>
> Best,
> Wendy

I got some from my current gyn for my premenstrual symptoms, including bad nausea for about eight days of the month. (It's ironic; in many people codeine/codone causes bad nausea) Before that I had quite a stash from a psychiatrist who I saw a few times, while I was looking around for a pdoc I really liked. He gave me a large amount with I think two refills. They were also given to me for pms, and I took such a low dose (1/2 of a 7.5/750 once a day) that they lasted for a long time.

I do want to emphasize that both my pdoc and my therapist knew, and it was one of the reasons I terminated with my pdoc--she was bent out of shape about it, and I would have had to lie to her. That would not have felt comfortable to me. It is much more comfortable for me having my pdoc prescribe it, but finding someone to prescribe opiates is not an easy task.

Shelli

 

Re: buprenorphine-Vicodin » Wendy B.

Posted by jojo on August 7, 2001, at 23:26:50

In reply to Re: buprenorphine-Vicodin » shelliR, posted by Wendy B. on August 7, 2001, at 18:40:14

> > jojo,
> >
> > Was it your idea to go on buprenorphine or your pdocs? If yours, did he/she have any problem with it? And do you have any problem getting it from the pharmacy?
> >
> > I'm asking because right now I am taking OxyContin for my depression but I need to add an AD because it is losing it's effectivenss at the dose I started with. So I was also considering buprenorphine instead of the oxy if I do not get the effect I want from parnate.
> > I've never discussed this with my pdoc, although the oxycontin was his idea; (I had been self-medicating with vicodin).
> >
> > Thanks,
> >
> > Shelli
>

Actually, it was the Post by Elizabeth,
quoting the Editorial in Biological Psychiatry
(I hope I have those facts right).

I recently posted a note to someone whose
Pdoc was quitting practice, relaying how I happened to find my
Psychiatrist. In regard to buprenorphine, I gave her the Journal article, we discussed whether I
would continue taking Celexa with it, but as the main goal was to recover
from the antisexual effects of the SSRIs (if that was indeed the cause of my
anorgasmia -haven't decided yet) we decided to drop the Celexa.

She had no problem with it, nor did the local pharmacy {Wal-Mart} (haven't tried my
mail-in insurance pharmacy yet. Wal-Mart did have to order it, but it was in the next morning.


jojo
>
>
> Shelli,
> I've been reading this thread with interest. I have a question if you don't mind answering it: where were you getting the Vicodin for self-medicating?
>
> Best,
> Wendy

 

Re: buprenorphine » jojo

Posted by Neal on August 9, 2001, at 1:28:32

In reply to Re: buprenorphine, posted by jojo on August 7, 2001, at 9:59:07


> Do you find the action of Temgesic more like a "euphoriant"* (you feel the "lift" soon after taking it, but it wears off in less than a day or two) or an "antidepressant"* (if you miss a day it is not immediately noticeable)?

jojo

Yes, at .2mg it mildly lifts my mood. I like the way it feels very much. The effect starts about an hour after taking it, and lasts about 5 or 6 hours. I'd like to take .4 or .6mgs/day, but I have only a small supply of tabs. If I take .4 or .6mgs in a short span of time, my mood really lifts, but I get a little spacey in the sense of attention span, ie., I find it hard to read anything for instance.

 

Re: buprenorphine » jojo

Posted by Alex1 on October 4, 2001, at 18:10:14

In reply to Re: buprenorphine, posted by jojo on August 4, 2001, at 16:24:42

Jojo,

I have only acces to Temgesic (sublingual). Can I dissolve it in water and use a nasal spray as you suggest?

Alex

> > Elizabeth,
> > You might consider Temgesic. I am currently taking just one .2mg pill a day and I can feel it working. You might want to take more than one a day, but it's easier than the intra-nasal method.
>
> I'm telling you guy's, a metered nasal spray dispenser
> makes it no problem at all. If you plan on taking
> 3.0 ml that day in 1 ml increments, 7 sprays 3
> times per day. Put your 3 vials in the dispenser
> using a syringe, in the morning. Calibrate it
> yourself, so that you trust the dose you're getting.
>
> jojo


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