buprenorphine transdermal (patch) dosis

[evoltino]

I am starting the opioid journey.
I am at a point where I rarely sleep more than 5 hours in multiple one-hour sessions and have RLS also during the day. I also had numerous sleepless nights in the past 12 months. I take 450 mg pregabalin before bed. However, it doesn’t work well or help during the day. Also, going to 600 mg has little added effect.

So now I want to try opioids. I want to try buprenorphine because it is long-lasting and appears to have less severe side effects and issues at the low dose I hope to need.
I got a prescription for a transdermal patch at the lowest dose available (in Switzerland) at 35 mcg/h. After the first night, I immediately removed it as the dose was way too strong. I was sick for two days (dry mouth, need to vomit, difficulty walking and talking, intense dizziness). I was out for 24 hours and bad for the second 24 hours.

I decided to start very low and slowly increase. I now take 1/8 of a patch, about 4.4 mcg/h. As it is long-lasting, I must wait for the dose to build up, but I can sense it will not be nearly enough.

So my question: for those who take a buprenorphine patch, what is your dose? Also, is it possible to relate the patch dose to a sublingual or film dose?

[Rustsmith]

I have not been able to convince my doctor to let me try buprenorphine, but would prefer the patch if I can eventually get it.

I checked a couple of opioid conversion calculators and only found one that includes buprenorphine. It specifically excludes the patch because they said that there wasn't enough experience with it yet to provide a reliable conversion factor.

[evoltino]

yes, it appears to be challenging to compare a patch to other forms. It's a shame, I would like to know where I stand.
I am also puzzled by the dose calculation. The patch is rated at 35 mcg/h and must be changed after 4 days. It is also written on the patch that it contains 20 mg of buprenorphine. This makes no sense to me: 4 days is about 100 hours, at 35 mcg/h, that is 3500 mcg or 3.5 mg. That's six times less than what is written on the patch.
In any case, I'll trust the 35 mcg/h dose and will slowly increase the patch fraction. Next step is 1/6.

[buglegs]

I've had RLS for the past 24 years, been through all the dopamine antagonist drugs, currently in augmentation with Requip. Few years ago I was having issues with lower back pain, several spine stimulators that failed, eventually ended up on BelBucca Patches like a film you put inside your mouth and it dissolves ..started at 100mg ended at 300mg daily. It worked great hardly ever any RLS, after couple years started having real dangerous side effects, extreme claustrophobia, anxiety, breathing difficulty, panic attacks, seemed worse than RLS, so I stopped the BelBucca and switched back to Requip again..I'm currently considering going back on the BelBucca and tapering off the dopamine antagonist then maybe start a slow switch towards GABAPENTIN / HORIZANT hopefully it will control the RLS bugs, creepy crawly, electrical tingling sensations...Thats been my experience with any type of Buprenorphine type medications.

[evoltino]

Thanks for the feedback. How "easy" was it to stop 300 mcg Belbuca?

I found this conversation table from a Swiss hospital:
https://www.palliativ-luzern.ch/applica ... chnung.pdf
A transdermal 35 mcg/h correspond to 0.8 mg oral. So 300 mcg Belbuca would correspond to about 1/3 patch of 35 mcg/h. I could sense that 1/3 of a patch would be effective. Now I'm on 1/6 and will write down the efficacy over the week.

I augment very quickly on dopamine antagonist drugs, including Rotigotine patch (which are very effective for a few days). Only pregabalin helped somewhat. But I am on the high end of the scale and have no life anymore (day or night).

Constipation is already a problem, even with OTC help and I am worried about the effects on the testosterone. But that's for another topic.

[debbluebird]

I take the buprenorphine film 2 mg every day dividing into doses. I looked up conversion to patch.
10 micro grams in a 12.5 cm2 area over 7 days = 10 mg
My RLS has been controlled for months. So my dose is a 5th of a patch.
My doctor also told me it's better for older people instead of taking methadone, which I used to take. My RLS was not controlled then. I was taking 10 mg methadone but was not allowed to take more.