Posted by ed_uk on November 19, 2005, at 21:14:05
In reply to Thanks!! » ed_uk, posted by pseudoname on November 19, 2005, at 16:47:59
Hi PN
>But she is willing to try it when no others would, so I can certainly put up with a learning curve.
LOL she sounds pretty cool!
>She suggested Reglan (metoclopramide) to work against both the vomiting and the anticipated constipation, however.
Metoclopramide sometimes helps, but not always by any means. Anyway... you probably won't need an antiemetic provided that you initiate buprenorphine at a very low dose and increase gradually. Tolerance to the 'nauseating' effect of buprenorphine usually develops quite quickly. If an antiemetic *is* necessary and metoclopramide doesn't help, cyclizine might be effective. Haloperidol (eg 0.5mg three times a day prn) is another option. Fortunately, antiemetics are not usually necessary after the first five (or so) days of opioid treatment.
Metoclopramide and haloperidol sometimes cause akathisia (restlessness) and/or dystonia (abnormal muscle contractions - often affecting the mouth, tongue, face or neck). Such reactions can be treated with an anticholinergic drug or diphenhydramine (Benadryl) while you wait for the antiemetic to be excreted. Benadryl can be unpleasantly sedating - less sedating anticholinergics are preferable.
Cyclizine (Marezine) is a popular treatment for opioid-induced nausea in the UK but I don't think it's much used in the US. Although cyclizine can be sedating, it's not as bad as Benadryl! As far as I know, cyclizine (Marezine) is available without a precription in the US. It's approved for the treatment of motion sickness. The usual dose for opioid-induced nausea/vomiting is one 50mg tablet every 4-6 hours up to a maximum of four times a day.
I guess you could buy some cyclizine if metoclopramide doesn't help. Please check that cyclizine would be safe for you to take.......
http://health.yahoo.com/drug/d00858a1
>constipation
Buprenorphine is (apparantly) much less constipating than most opioids. It's quite possible that it won't make you constipated at all. Nevertheless, if constipation does occur, metoclopramide is (probably) not a suitable treatment. Mild constipation can be treated with a bulk-forming agent such as Metamucil. Severe opioid-induced constipation can be treated with a combination of a 'stimulant' laxative (such as bisacodyl) and an osmotic laxative (such as MiraLax). If severe constipation develops, long term (daily) use of laxatives will be necessary.
>Three hours later and I have no problems like I had with the "Day 1" dose – except slight dizziness for which I will lie down. :)
Please do - it works :-)
>If my dosing is going to be consistently in the one-tenth-of-a-tablet range........
You'll probably need a higher dose in time. 0.1mg is just a starting dose.
>I may need some advice on cutting & measuring tiny crumbs of brittle, oval-shaped pills.
Hmmmmmm, I haven't really thought about that. We have the 0.2mg tablets (Temgesic) in the UK so it's not really necessary. I suppose you could crush a tablet to form a powder and separate the powder into (approximately) equal piles. Not sure how you'd get the powder under your tongue though - could be messy ;-)
Kind regards
Ed
poster:ed_uk
thread:579345
URL: http://www.dr-bob.org/babble/20051119/msgs/580501.html