![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 6 to 30 of 49. Go back in thread:
Posted by okydoky on May 26, 2008, at 12:24:32
In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too?, posted by undopaminergic on May 25, 2008, at 23:08:32
First let me apologize for not understanding a lot of what you posted. My questions might be already answered by you or the studies.
I am have been on oxycontin since 2003. My doctor wants me among other trials to try Suboxone for pain. ANy reason it have a greater potential to help my depression? My original pdoc prescribed oxycodone for pain specifically because of my depression. Recently things have gotten so that I have been snorting some of my oxy ir. I think I might try and snort more than 10mg and see how I feel.
I have been on daily long term Ritalin 20mg for many years. I have had cognitive problems in the last 8-10 years. I have been tested by a neurologist and had several deficits abnormal for people my age. Do you think the constant use of Ritalin, besides living with enormous stress, could be causing the hypothalamus to shrink or related problems? I have been trying to find a neuroprotector. I ordered Selegiline and am now trying Stablon. There are so many medicines now and noorotropics I hardly know where to start. Figured something that might help the depression also would be a good starting point.
oky
Posted by undopaminergic on May 26, 2008, at 20:48:57
In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too? » undopaminergic, posted by okydoky on May 26, 2008, at 12:24:32
>
> I am have been on oxycontin since 2003. My doctor wants me among other trials to try Suboxone for pain. ANy reason it have a greater potential to help my depression?
>Oxycodone is a full agonist at the mu-opioid receptor but is also reported to stimulate kappa-opioid receptors. Due to its mu-agonism, oxycodone is generally more euphorigenic than buprenorphine, and is thus considered more attractive to recreational users. However, its stimulation of kappa-receptors may promote downregulation of dopamine D2-receptors and the dopamine transporter (DAT), and thus reduce your basal dopaminergic tone, and diminish your responsiveness to amineptine, methylphenidate and similar drugs.
Buprenorphine is a partial agonist at mu-opioid receptors, which effectively puts a ceiling (limit) to its effects, or in other words, as an example, 32 mg of buprenorphine may produce no greater effect than 16 mg of the drug. Due to the ceiling effect, it's very difficult to overdose on buprenorphine, unless it's mixed with alcohol, benzodiazepines or other CNS depressants.
Buprenorphine blocks kappa-opioid receptors, and this may serve to make it a more effective antidepressant. The blockade of kappa-receptors may allow an upregulation of the density of dopamine D2-recpetors and the dopamine transporter protein. As a consequence, your dopaminergic neurotransmission may be more effective, and your response to drugs like cocaine and amineptine may be enhanced.
I think it might be a good idea to give buprenorphine a chance - preferably Subutex rather than Suboxone - to see if you like it better than oxy. You can always switch back if it proves less effective or has more adverse effects.
>
> I have been on daily long term Ritalin 20mg for many years. I have had cognitive problems in the last 8-10 years. I have been tested by a neurologist and had several deficits abnormal for people my age. Do you think the constant use of Ritalin, besides living with enormous stress, could be causing the hypothalamus to shrink or related problems?
>Ritalin is not known to have any long terms adverse effects on the nervous system. However, the brain is in constant change, and life experience - including food and drugs - influences the brain to adapt in various ways, for better or worse. Sometimes neurotoxins, radiation, normal biological processes gone wrong, as well as other factors, may result in cancer or serious neurodegenerative conditions like Alzheimer's.
Posted by undopaminergic on May 26, 2008, at 21:51:45
In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too?, posted by undopaminergic on May 26, 2008, at 3:41:46
> I got some buprenorphine (Temgesic) sublingual tablets from the pharmacy today.
>
> I immediately took one 0.10 mg dose sublingually, and another 0.10 mg after about 30 minutes. No effects were noticed in the next 30 minutes or so, which led me to take a 0.20 mg dose intranasally, just a few minutes ago. In a few hours, I hope there's something new to report, or I may have to take another dose.
>I did not need to take another dose. Indeed, the 0.40 mg I took was probably a bit excessive, as I experienced moderate nausea, although I did not get close to throwing up. Slightly before the onset of nausea, I also noticed some dizziness, which was not related to a drop in blood pressure. Also somewhat before the onset of nausea, I became more tolerant to cold - or less tolerant to heat, and I sweating was noticeable increased, but not to a remarkable extent. The dizziness subsided before the nausea, which dissipated in a few hours. Because I did not establish baseline body temperature or blood pressure readings, and in fact didn't check my temperature at all, no meaningful comments can be made about the possible effects of the drug on these parameters.
My focus and alertness seemed enhanced, starting around the time of the dizziness, and may have been the first clearly noticeable effect of the drug. Paradoxically, at the same time I found myself with a tendency to nod - as if to fall asleep from almost irresistible sleepiness, which was not really the case, although I did indulge in an attempt at a nap, lasting half an hour or so. The most significant result of lying down for a while was a clear reduction of the nausea, which started to yield from this point onward.
My motivation and executive function seemed enhanced, and I found myself less prone to procrastination, laziness and cutting corners. Consequently, I engaged in uncharacteristically thorough vacuuming of my office as well as tidying up, in the form of taking away empty bottles and tetra-pak cartons that had been lying around on the desk for days, and I took some envelopes (with contents) that been lying around on the desk for months - contributing to the mess and disorganisation - and moved them away to a more suitable place for archival.
While researching neuroscientific matters on PubMed and the web, I found myself unusually thorough and capable of organising my data in a manner likely to be useful for future reference. I commented on some PsychoBabble posts, in an unusually verbose - but possibly not more eloquent - manner.
Well, I suppose my first day of buprenorphine was a nice start. Only time will tell whether my novel capacity for organisation and efficiency was an accident unlikely to repeat itself, or a dependable effect of the new addition to my psychopharmacological regimen.
Oh, I almost forgot that I haven't eaten - or drunk - much at all this day, so there's a fair chance that the new drug may possess appetite-suppressant activity, although the episode of nausea may have contributed to my disinterest in food.
Posted by okydoky on May 27, 2008, at 9:39:33
In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too?, posted by undopaminergic on May 26, 2008, at 20:48:57
Just wanted to thank you.
oky
Posted by okydoky on May 27, 2008, at 9:43:19
In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too?, posted by undopaminergic on May 26, 2008, at 21:51:45
The nausea, tiredness and body temp change could be all beacuse your body is not used to it. When I take extra oxycontin , which i am used to takeing I get almost the same result with the added benefit of depressed breathing!
Posted by okydoky on May 27, 2008, at 9:59:02
In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too?, posted by undopaminergic on May 26, 2008, at 20:48:57
"preferably Subutex rather than Suboxone "
Can you give me a reason that my doctor will accept?
THanks,
oky
Posted by okydoky on May 27, 2008, at 10:28:29
In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too?, posted by undopaminergic on May 26, 2008, at 20:48:57
Okay I have posted too many messages to you. Need to get it together.
I was thining what a pain it is going to be as my doc does not prescribe Suboxone but was going to send me elsewhere for it. He wants to try other opiates besides oxycontin because he thinks I will get better pain management. He is not set on Suboxone. So are ther any other ones that you think might not interfeir with the Amineptine? I really do not like changing. I tried hydromorphone and could not breath and have a bottle of Anvinza if I choose to try it.
oky
Posted by okydoky on May 27, 2008, at 11:48:44
In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too?, posted by undopaminergic on May 26, 2008, at 21:51:45
Please keep us updated as to your success with Temgesic. It woudl be bery helpful.
oky
Posted by undopaminergic on May 27, 2008, at 18:52:52
In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too? » undopaminergic, posted by okydoky on May 27, 2008, at 10:28:29
> "preferably Subutex rather than Suboxone "
>
> Can you give me a reason that my doctor will accept?
>Generally, it is thought that the naloxone in Suboxone is poorly bioavailable when the tablet is used sublingually as intended, and that it will have no effect. However, some people claim to have hypersensitivity reactions to it, and I'm also concerned that it may have subtle effects that may interfer with either the buprenorphine or with the endogenous opioid system. It's also possible that the naloxone may be beneficial and perhaps lessen side effects. It would be nice if you could compare Subutex and Suboxone side by side to determine whether there's a difference at all.
The naloxone is mainly only added to deter abusers from injecting it, as it is an opioid antagonist that will precipitate a withdrawal syndrome in some individuals and under some circumstances. However, unless you have a history of selling or injecting your opiate medications, there's no reason why Suboxone should be prescribed in preference to Subutex. I recommend trying both, side by side, in an attempt to detect subtle differences.
>
> I was thining what a pain it is going to be as my doc does not prescribe Suboxone but was going to send me elsewhere for it.
>Some doctors mistakenly believe that they need a special permission (called a "waiver") to prescribe Subutex or Suboxone. The waiver is only needed when Suboxone/Subutex is prescribed for addicts as a substitution therapy - that is, as a replacement for heroin or other opioids (that the addict is usually obtaining illegally). It is perfectly acceptable to prescribe Subutex/Suboxone in place of any other opiate for the treatment of pain, depression, or other medical uses other than substitution therapy. Here is a letter from the DEA clarifying the rules:
http://www.naabt.org/links/DEA_Bup_for_pain_letter.pdf>
> He wants to try other opiates besides oxycontin because he thinks I will get better pain management. He is not set on Suboxone. So are ther any other ones that you think might not interfeir with the Amineptine? I really do not like changing. I tried hydromorphone and could not breath and have a bottle of Anvinza if I choose to try it.
>There are numerous options to choose from, and most of them are unlikely to interfer with amineptine. It may be prudent to avoid pethidine/meperidine, however, as it has actions on the monoamine system - the same site of action that amineptine and methylphenidate also target.
If you experience a tendency to reduced breathing, it is probable that you are starting the medication at a dose too high. Most people quickly become tolerant to the respiratory depressant effects of opiates at the doses they are familiar with - as well as lower doses, and only a large overdose will depress breathing.
People react differently to different opioids, and some find that morphine has fewer side-effects than buprenorphine, while others experience the opposite. Some find that methadone causes less impairment than morphine or buprenorphine.
You may also wish to investigate dextromethorphan (DXM) and memantine, as they usually interact favourably with opiates, and may allow the dose to be reduced.
Posted by okydoky on May 27, 2008, at 19:54:25
In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too?, posted by undopaminergic on May 27, 2008, at 18:52:52
Thanks
I'll check those two out. I'm tired.
Thanks
oky
Posted by okydoky on May 27, 2008, at 20:00:18
In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too?, posted by undopaminergic on May 27, 2008, at 18:52:52
Looked briefly at dextromethorphan (DXM) and memantine. The first says it is for cough suppressant. The second alzeimers... I am not sure why you suggested them? With teh opiate to potentiate it? Or for other reasons?
oky
Posted by undopaminergic on May 28, 2008, at 0:43:48
In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too? » undopaminergic, posted by okydoky on May 27, 2008, at 20:00:18
> Looked briefly at dextromethorphan (DXM) and memantine. The first says it is for cough suppressant. The second alzeimers... I am not sure why you suggested them? With teh opiate to potentiate it? Or for other reasons?
>Both drugs, when taken with opiates, can attenuate, prevent or even reverse tolerance to - as well as potentiate - the latter.
The above was the reason why I suggested looking into memantine and dextromethorphan. However, both of these drugs are also interesting in their own right. Especially memantine, which has stimulant and antidepressant properties, and may be able to attentuate tolerance also to stimulants, such as mehtylphenidate. It is also of some usefulness in Parkinson's disease, ADD/ADHD, OCD, the negative symptoms of schizophrenia, autism or Asperger's syndrome, cognitive dysfunction, glaucoma, and probably other conditions.
Posted by undopaminergic on May 28, 2008, at 2:32:05
In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too?, posted by undopaminergic on May 26, 2008, at 21:51:45
> > I got some buprenorphine (Temgesic) sublingual tablets from the pharmacy today.
> >That was on the 26th.
> > I immediately took one 0.10 mg dose sublingually, and another 0.10 mg after about 30 minutes. No effects were noticed in the next 30 minutes or so, which led me to take a 0.20 mg dose intranasally, just a few minutes ago. In a few hours, I hope there's something new to report, or I may have to take another dose.
> >
>
> I did not need to take another dose.However, at bedtime, in the early morning of the 27th, I did take another 0.20 mg intranasally in order to put the sedative [side-]effects of the drug to good use. It worked well, and my "night" (morning-day-evening actually) seemed more comfortable than usual, although I cannot tell whether my sleep was more restful or refreshing than usual.
> Indeed, the 0.40 mg I took was probably a bit excessive, as I experienced moderate nausea, although I did not get close to throwing up. Slightly before the onset of nausea, I also noticed some dizziness, which was not related to a drop in blood pressure. Also somewhat before the onset of nausea, I became more tolerant to cold - or less tolerant to heat, and I sweating was noticeable increased, but not to a remarkable extent. The dizziness subsided before the nausea, which dissipated in a few hours. Because I did not establish baseline body temperature or blood pressure readings, and in fact didn't check my temperature at all, no meaningful comments can be made about the possible effects of the drug on these parameters.
>Today, on the 28th of May (actually around 3 o'clock in the middle of the night), after getting out of bed, I took 0.20 mg intranasally, and noticed no side effects, which led me to take another 0.10 mg i.n. - not long afterwards, I again experienced a slight tendency to nodding, as if I were tired, and I decided to take an extra dose of methylphenidate. There was no dizziness today, and practically no nausea - until later, as detailed below.
I took the initiative to take a shower, which is something I might not have found the motivation to do if it weren't for buprenorphine (BUP). Moreover, before the shower, I intentionally engaged in vigorous physical exercise, which I would definitely not have done without BUP. Furthermore, I was able to tolerate as much of 10 minutes of the exercise, which is more than 5 minutes longer than what I've been able to endure for a long time (months, or perhaps even years - unless the excercise had a very compelling practical purpose). During the exercise, my breathing was much more relaxed than usual - I would normally breathe heavily and quit the exercise for lack of air long before my muscular powers ran out, but this time it was the opposite - my strength ran out first. The only negative effect of my experience was the dawn of some slight nausea, which subsided during the shower that followed.
During the shower, I found my skills of cleaning myself improved. The task was much more rationally executed, and my working memory was capable of keeping track of the areas already washed and those remaining, and as a result I was able to avoid redundant repetitions. Rather than constantly drifting off into my usual distacting throughts and daydreams, I was able to focus on the task of washing myself, and to execute it rationally and thoroughly. This experience is absolutely exceptional for me, and I cannot recall anything of the kind ever happening in my lifetime of showering - this remarkable experience can definitely be attributed to the use of BUP - possibly with a little help from methylphenidate, as synergism between these drugs is quite possible.
The excessive sweating seen with yesterdays use of BUP has not repeated itself so far today - during my exercise (see above), I actually found myself less prone to sweating than has usually been the case during previous occasions of exercise. I still find my tolerance to cold to be greatly enhanced, as I did after yesterday's dose of BUP.
Despite a near absence of nausea today, the disinterest in food that I experienced yesterday appears to remain in effect this day as well. However, the reduced intake of fluids (mostly tea and fruit juices) is now much less apparent.
I've also noticed an enhanced disinterest in matters related to sex. Although I do not find BUP to be as sexually numbing as the SSRIs, it appears to reduce - or nearly abolish - any tendency to sexual arousal to a much greater extent than the serotonergics, and I thus found orgasm impossible during my shower. However, the loss of a few seconds of modest pleasurable sensation is not a significant sacrifice as far as I'm concerned, and the loss is more than fully compensated for by the benefit of increased freedom from distractions of a sexual nature.
Yesterday, I forgot to report the side effects of dryness of the mouth and constriction of the pupils (miosis). The miosis fully remains till this point, but the dryness of the mouth seems to have lessened slightly. I've also been experiencing an unusual tendency to muscular tension - in particular around the neck and shoulders - which is completely unexpected and the opposite of the remarkable relaxation previously experienced with codeine.
The improved motivation, enhancement of executive function - including the capacity for organisation, and the reduced tendencies to procrastination and laziness are at least as apparent today as they were yesterday. The improvement of working memory may have been present yesterday, but was not clearly noticed until today.
In summary, so far so good.
Posted by okydoky on May 28, 2008, at 12:28:28
In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too?, posted by undopaminergic on May 28, 2008, at 2:32:05
Thank you for your frankness. It is difficult for me to speak about the mess my home is in or the distractions of my mind and how the effect my life. Embarrassing and difficult to put into words. You are descriptive and eloquent. These things you are talking about so frankly are not obvious conclusions when reading your posts, the extensive knowledge and ability to organize it usefully and the eloquence with which you write.I am glad the Temgesic is helping you and hope it continues. I am now looking forward to trying it, before I was afraid.
oky
Posted by rgb on May 28, 2008, at 17:16:08
In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too?, posted by undopaminergic on May 28, 2008, at 2:32:05
Hello undopaminergic,
from what I've read so far, you remind me of myself a lot (intense psychopharmacology research, your self-observation after trying something new etc).
The thing with mu agonism is that it tends to solve just about any problem (with the possible exception of itching and nodding). It's all too easy to tell oneself that some specific therapeutic effect is happening... Your observations are easily explained by mild euphoria and the resulting effect of "Wow, it's doing something! Now I can do all these things I'd been too depressed to do!".
Just food for thought; I'm not to judge what is right for you. Neither am I saying that there is no such thing as endogenous opioid deficiency, just that a profound feeling of safety and protection happens to be pretty nice when the rest of one's life isn't so solacing :)
Not that there's anything wrong with euphoria; the question is what you'll do if it turns out that it doesn't last after you're already neurophysiologically and/or psychologically dependent on it. Incidentally, the prospect of this is what prevented me from trying long-term tramadol (or other low-potency opioids), which used to make a night-day difference for me on days of sporadic use.
Yes, the kappa antagonism thing is intriguing and makes bupe somewhat special, but IMHO you shouldn't let this distract you from the above mu agonism thing (partial or not, to my knowledge it's plenty for the non-tolerant user).
Best of luck,
rgb
Posted by okydoky on May 28, 2008, at 18:07:34
In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too?, posted by undopaminergic on May 27, 2008, at 18:52:52
My doctor had asked me to give him a list of narcotic analgesic that myinsurence would cover. So I have a lost. How do I go about looking up whether it is a kappa-opioid receptor antagonist?
Posted by undopaminergic on May 28, 2008, at 18:40:00
In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too? » undopaminergic, posted by okydoky on May 28, 2008, at 18:07:34
> My doctor had asked me to give him a list of narcotic analgesic that myinsurence would cover. So I have a lost. How do I go about looking up whether it is a kappa-opioid receptor antagonist?
>You could search PubMed and the web, although sometimes the results are ambiguous and a definite answer will remain elusive.
As far as I know, most of the drugs on the market are either agonists at - or have negligible affinity to - the kappa-receptor.
The most potent kappa-antagonist is buprenorphine, followed by naltrexone and naloxone - and those three are the only ones clinically available to my knowledge.
Posted by okydoky on May 28, 2008, at 20:40:23
In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too?, posted by undopaminergic on May 28, 2008, at 18:40:00
Thanks,Based on this would Suboxone be potentially better than Subutex with an antidepressant like amineptine or other DA reuptake inhibiter or agonist? On the other hand maybe I understand you to say the effects for pain might be better with Subutex?
I see one doc tomorrow who said he would prescribe Parnate. I think I should hold off. The other who wants to change my pain med I see Monday. I think he would be open to suggestion. He did suggest Suboxone before. I went off everything I was on for depression that was new. Tianeptine and Amineptine and I feel better already. Still in a fog and having worse memory problems with no motivation. Getting on here to ask this was a task. It's remarkable how bad things can get. I guess it's my depression talking but I see no way out anymore. Maybe a way to be a bit more comfortable living.Well that was all about me.
How is your trial going? Are you still getting positive effects? Are you taking the Subutex for depression only? Not for pain? Your post was quite inspirational.
oky
Posted by undopaminergic on May 28, 2008, at 21:29:43
In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too?, posted by rgb on May 28, 2008, at 17:16:08
>
> The thing with mu agonism is that it tends to solve just about any problem (with the possible exception of itching and nodding). It's all too easy to tell oneself that some specific therapeutic effect is happening... Your observations are easily explained by mild euphoria and the resulting effect of "Wow, it's doing something! Now I can do all these things I'd been too depressed to do!".
>I know what you mean - for example, it took me much longer than it should have to see the truth about the efficacy of the combination of phenylethylamine (PEA) and selegiline. Fortunately, the experience wasn't a complete waste of resources, as it certainly taught me a number of useful lessons, including the fact that positive feelings do not necessarily translate to positive results.
By the way, the addition of buprenorphine (BUP) to my regimen hasn't produced anything that might qualify as mild euphoria as far as I'm concerned, although my standards may be unusually demanding, as I don't consider myself to ever have experienced anything close to euphoria at any time during my 30-year experience of what they call "life".
> Just food for thought; I'm not to judge what is right for you. Neither am I saying that there is no such thing as endogenous opioid deficiency, just that a profound feeling of safety and protection happens to be pretty nice when the rest of one's life isn't so solacing :)
>I imagine that it would be, but I'm not sure what point you're trying to make by bringing it to my attention.
> Not that there's anything wrong with euphoria; the question is what you'll do if it turns out that it doesn't last after you're already neurophysiologically and/or psychologically dependent on it.
>Although I'm not familiar with euphoria, I've had excellent results with a number of drugs to which tolerance always developed rapidly - sometimes to the point of complete loss of benefit, and sometimes with substantial effects remaining. Each time, I handled the problem by moving on to further research - and pursue - potential solutions to my problems. There was really little else that I could do.
So far, I've been able to quit all drugs I've had reasons to quit, and to do so abruptly. Perhaps some day I will encounter persistent and troublesome withdrawal symptoms of a medication (or dietary supplement, or whatever else may be applicable) that I'm trying to stop, but that would merely be one more issue to be dealt with, perhaps by continuation of the drug indefinitely or by treating the withdrawal symptoms with other agents. I see no reason to waste my time worrying about such hypothetical matters - whatever will be, will be.
> Incidentally, the prospect of this is what prevented me from trying long-term tramadol (or other low-potency opioids), which used to make a night-day difference for me on days of sporadic use.
>Indeed, tramadol may not be the best treatment for your problems, and even if it really is, your problems may not be serious enough to justify any risk that treatment with tramadol may involve - the decision is yours. I, however, have little to lose and much to gain by testing BUP.
> Yes, the kappa antagonism thing is intriguing and makes bupe somewhat special, but IMHO you shouldn't let this distract you from the above mu agonism thing (partial or not, to my knowledge it's plenty for the non-tolerant user).
>In my opinion, kappa-antagonism is the salient feature of BUP, and the property that makes the drug the treatment of choice at this point, especially since I found codeine (and probably others, if I were to try) to be more mood-brightening, relaxing, anxiolytic and generally more satisfying, as well as less prone to causing some adverse effects (notably nausea).
Furthermore, my use of BUP should be seen in the proper context - as part of a regimen of drugs. I'm not expecting BUP to solve all my problems on its own, but I'm hoping that it will synergise with the other (primarily dopaminergic) components of my cocktail and thus contribute to better control of the symptoms.
>
> Best of luck,Thank you, and good luck yourself in finding safe treatments (or perhaps gathering the courage to employ tramadol on a more regular basis).
Posted by undopaminergic on May 28, 2008, at 22:27:09
In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too? » undopaminergic, posted by okydoky on May 28, 2008, at 20:40:23
>
> Based on this would Suboxone be potentially better than Subutex with an antidepressant like amineptine or other DA reuptake inhibiter or agonist? On the other hand maybe I understand you to say the effects for pain might be better with Subutex?
>There is probably no practical difference between them (except if injecting them), but there is a small possiblity of subtle distinctions - the only way to know is to test both.
>
> I see one doc tomorrow who said he would prescribe Parnate. I think I should hold off.
>Let him write the prescription - you can still hold off taking the medication until you feel ready.
> Still in a fog and having worse memory problems with no motivation. Getting on here to ask this was a task. It's remarkable how bad things can get.
>Yes, but it's also amazing how fast things can change for the better.
>
> How is your trial going? Are you still getting positive effects?
>I've taken 0.20 mg more since my last report, which still holds true: the appetite has remained suppressed, my motivation has been stable at the improved level, and so on.
>
> Are you taking the Subutex for depression only? Not for pain? Your post was quite inspirational.
>Fortunately, I have no chronic pains, so I'm taking it (Temgesic) only for its neuropsychiatric effects.
Posted by Crotale on June 1, 2008, at 12:00:50
In reply to Suboxone???? Is it only for Opiates or an Ad Too?, posted by Phillipa on May 25, 2008, at 13:07:47
> I know this is used for opiate addiction no I don't take opiates but the sender of the link the link says it is good for depression too. Is that true? Love Phillipa
I take Buprenex (buprenorphine HCl injectable) for depression and have been taking it for around 8 years. It has the same active ingredient that is in Suboxone, but there are a couple of key differences between the two:
1. As I mentioned, Buprenex is intended for IM or IV injection (I use it IM). Suboxone is a pill intended to be taken sublingually.
2. Buprenex contains a *much* lower dose of buprenorphine, because Suboxone *is* intended to be for drug addicts who have a high tolerance to opioids. (supposedly, the dosage is the same: that is, if you take 0.3mg buprenorphine IM, you are supposed to take 0.3mg SL.) Based on my experience, the 2mg of buprenorphine in a single Suboxone tablet (and this is the lowest dose, mind you) would make a non-tolerant person sick.
3. Suboxone contains, in addition to the 2mg buprenorphine, 0.5mg naloxone. This is to prevent the addicts who are prescribed this drug from injecting it. (Kind of silly IMO, as buprenorphine doesn't get people high anyway.) Basically, the naloxone would block the opioid-agonist effects of the buprenorphine if you tried to inject it (naloxone only works if injected: it isn't absorbed sublingually).
In some countries (e.g., France, Mexico) you can get a SL pill called Temgesic containing a low dose of buprenorphine, similar to the dose in Buprenex. I would probably be taking this instead of Buprenex but it isn't available in the USA, where I live.
Crotale
Posted by Crotale on June 1, 2008, at 12:25:21
In reply to Re: Suboxone???? Is it only for Opiates or an Ad Too?, posted by undopaminergic on May 27, 2008, at 18:52:52
> Some doctors mistakenly believe that they need a special permission (called a "waiver") to prescribe Subutex or Suboxone.
I've had a terrible time with this since the DATA was passed (I started taking Buprenex several years before then); several pdocs have refused to prescribe Buprenex on the grounds that they don't have a waiver. Fortunately I've found one who actually understands what the law says! I downloaded your letter in case I have problems in the future.
Do you live in the US, and if so how did you get Temgesic?
I had terrible problems with nausea & vomiting when I first started taking buprenorphine (0.3mg q.i.d.). I dealt with the problem by dropping back to 0.15mg q.i.d., then increasing it gradually. Some other side effects I tend to get are: dry mouth, constipation (a pain in the *ss, so to speak <g>), sweating, itching, stimulation (I get this from mu-opioid agonists in general - one of my personal quirks), and possibly some skin irritation and inflammation (am not sure whether the BUP causes/exacerbates the skin problems or not). I've been able to decrease my dose since I started ECT.
To the best of my knowledge respiratory depression from BUP is minimal. I have heard of deaths from overdosage, but never of BUP alone - it was always in combination with something like benzodiazepines.
I'd like to continue hearing about your experience with Temgesic. If I could get my hands on some of this, I'd be happy to switch to it if I could get some; I don't like the amount of medical waste generated by the IM Buprenex (I tried taking it intranasally but it was just too much hassle).
Crotale
Posted by okydoky on June 1, 2008, at 13:39:46
In reply to Re: Suboxone???? Is it only for Opiates or an Ad T » Phillipa, posted by Crotale on June 1, 2008, at 12:00:50
This is all very interesting. I see my urologist tomorrow. He had wanted me to try Suboxone several months ago. My gp says he can and will prescribe it, (took a special course and got special DEA number or something) but never heard of it for anything but addiction and will ony do so if he gets the okay form someone else. Not me!. He is supposed to get in touch with some Rep to discuss it.
All that aside. I will of course need to take some equivalent dose as per the 30mg oxycintin bid. Probably more as I also occasionally take oxy ir or fentora for breakthrough pain.
I would also like to get as much benefit from it as an antidepressant. So which one would be the preferred drug? Pain management is the priority here.
oky
Posted by undopaminergic on June 1, 2008, at 19:52:44
In reply to Re: Suboxone???? Is it only for Opiates or an Ad T, posted by okydoky on June 1, 2008, at 13:39:46
> This is all very interesting. I see my urologist tomorrow. He had wanted me to try Suboxone several months ago. My gp says he can and will prescribe it, (took a special course and got special DEA number or something)
>Remember, that the special number should not be used on a prescription of Suboxone/Subutex for purposes other than opiate addiction. I don't know what the practical consequences of erroneously including the number would be - perhaps it is just for statistics, or perhaps you would be "flagged" as an opiate-addict in some database, causing you to be more carefully watched in the future and making pharmacies more suspicious about your prescriptions, etc. I'm just speculating.
> but never heard of it for anything but addiction and will ony do so if he gets the okay form someone else. Not me!. He is supposed to get in touch with some Rep to discuss it.
>Did you print out the DEA letter and show him?
> All that aside. I will of course need to take some equivalent dose as per the 30mg oxycintin bid. Probably more as I also occasionally take oxy ir or fentora for breakthrough pain.
>
> I would also like to get as much benefit from it as an antidepressant. So which one would be the preferred drug? Pain management is the priority here.
>In general, the antidepressant doses of buprenorphine (BUP) have all been less than 4 mg, but the optimal (or useful) range of doses for this purpose hasn't really been sufficiently investigated. If you wish to explore, use whatever dose of BUP is effective enough for your pain. If you would rather stick to doses that have been found efficacious in depression, use up to about 4 mg of BUP, in combination with another opiate, such as oxycodone, for additional pain control, as required.
Low doses of BUP combine well with other opioids, whereas high doses will antagonise their effects. One of the reasons for using high BUP doses - up to about 32 mg - for addiction-treatment is that they block the effects of heroin.
Posted by okydoky on June 1, 2008, at 22:39:45
In reply to Re: Suboxone???? Is it only for Opiates or an Ad T, posted by undopaminergic on June 1, 2008, at 19:52:44
> Remember, that the special number should not be used on a prescription of Suboxone/Subutex for purposes other than opiate addiction. I don't know what the practical consequences of erroneously including the number would be - perhaps it is just for statistics, or perhaps you would be "flagged" as an opiate-addict in some database, causing you to be more carefully watched in the future and making pharmacies more suspicious about your prescriptions, etc. I'm just speculating.>
I must look like a complete idiot.
I printed out the DEA letter as soon as you posted it.
My pdoc retired a couple years ago and I was only taking Ritalin sr and an occasional perphenazine. I had no where to go so I see my retired gp who works part time as a therapist. In our usual bullshi** the Suboxone came up and he said he could prescribe it. I had not anticipated him being involved with my pain management so I never thought to bring the information. He refused to take my word for it. He is supposed to call me after he clears it up with someone. Not sure who? I spoke with the office personnel on Friday and she said she had put he call in but it had not been returned. He was not interested in my emailing him the information so I forgot. My urologist wanted me to travel about two hours away to get it from a doc he knows. Hopefully my urologist will read the information I bring him tomorrow and prescribe for me. He is an hour and a half away.
If it is not for addiction I see no reason he cannot just write the script. The gp is insisting he provide the first dose in office and then I have to go to get the script.
He would not sanction any use of any other pain medication with the Suboxone he told me. I was concerned about break through pain.My only reason for even attempting to make this change is the information posted on this thread about DA reuptake inhibiters working better with it. I am keenly interested in taking Parnate also. My gp one time explained how the oxycontin permanently erases memory. I cannot remember what all he said.
So it sounds like it is possible to take oxycontin or fentora with it if needed?
Still not sure whether to ask for Subutex or Suboxone? I think the urologist would be open to discussion about the reasons why I would have a preference. I know I have asked once before but could you provide a clear reasoning that I could just copy and bring to him? I take that back. There is plenty her already for me to copy for him to read:
http://www.dr-bob.org/babble/20080519/msgs/831152.html
http://www.dr-bob.org/babble/20080519/msgs/831482.html
The discussion with Scott about Nardil was of interest.
http://www.dr-bob.org/babble/20080528/msgs/832391.html
I am looking at Suboxone/subutx with Amineptine and Memantine to try first. Then I would like to try Parnate again. It worked well before but pooped out and had so many side effects that if I can get Amineptine to work again I would prefer it even if it does not work as well. Nothing ever got rid of the depression wholly.Well Thanks. This all sounds so forward looking and optimistic. Im not sure but that you might imagine that things arent so rosy here. I rarely leave my house. Never clean Like I wrote to you yesterday Now I just never want to be .That is my mindset most of the time. I tried to sleep the entire day today.
If you would rather stick to doses that have been found efficacious in depression, use up to about 4 mg of BUP, in combination with another opiate, such as oxycodone, for additional pain control, as required.That would be at odds with what I am trying to do here, would it not?
I know this is entirely last minute as I see the urologist tomorrow. I leave the house at 11pm. It took me almost an hour and a half jus to write this email to you. That is where I am at .Of course I can always try to communicate with him after the appointment if need be.
Honestly my brain is rapidly turning to mush as my body becomes frail and brittle and painful from it all. Thank you so much again. I can only hope that I have not wasted your time. I see no future but having tried for a way out several times I am worried about what would be left of me if it did not work. If I am to stay around for a while at least let it not be so dam*** painful!
oky
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