Restless Legs Syndrome (RLS) Discussion Board

I take Buprenorphine every day at 330pm for my severe RLS. I've been on the same dose for about 4 years now. Recently though I've been having issues with increased levels of inflammation, muscle aches, fatigue, brain fog, anxiety, and depression. I've noticed that these things seem to be less severe in the evenings, and I'm starting to wonder if I'm having mild withdrawal symptoms in the mornings and afternoons before I take my meds. With that in mind, I was hoping to hear what other people's opioid med schedule is and if they've had problems with something similar. Thank you for your input and helping me clarify this!

It certainly makes sense that one dose at 330 wouldn't last 24 hours until the next dose. But also I've been on the meds for 4 years and this has only really become an issue in the last few months, so this idea only very recently occurred to me. Of course, bodies are weird, so who knows.

The half life of buprenorphine is 38 hrs, so it isn't a matter of it not lasting for 24 hrs but it could be that after all this time, you need a bit higher dose and so you might be dropping below the dose that you need to control your RLS and other symptoms, especially with increased inflammation.

As for the inflammation, that increases your body's demand for ferritin. So it is also possible that your ferritin availability to your brain is a bit reduced right now. A ferritin test wouldn't show this because that is just a measure of the amount of ferritin in your bloodstream and not the amount that is actually getting to your brain.

Another thing to think about is your comment about increased anxiety and depression. Buprenorphine is not only an opioid, but it is also a different type of anti-depressant that functions when classical ADs fail. Your anxiety and depression could also be signs of needing a bit more buprenorphine right now.

Finally, to answer your question about other people's schedules, I take methadone, which is also a long acting opioid. I take my pills at 11A because I experience the alerting side effect. If I take them at 3PM or later, I cannot get to sleep until midnight or later. When I forget to take my pills at 11A, I start to get "flu-like" symptoms around 3PM. I feel achy, sweaty and cold all at the same time. I also feel like I need to take a nap. It is usually when I crawl into bed and cannot warm up and stop shivering that I usually realize that I forgot my lunchtime pills. As for anxiety and depression, I found out on my own (despite complaining to my doctor for years), that opioids cause a reduction in hormone production in men (but not women). I was able to address with by going onto male hormone replacement therapy but am still fighting to get the dose for that worked out, which often leaves me soaking in a tub or hot water at 11P trying to chase away my mental demons.

I take cocodamol and pregabalin at around 10am, again at 6pm, and cocodamol at 11pm (I go to bed around 1am.)
Sometimes I take cocodamol also during the night.... about 25% of the time.
If I don't need the the cocodamol during the night I will usually have rls when I waken in the morning.
Should I become distracted and not take my 10am morning dose I will have full body aches, feel really sore, but only realise I've missed my morning dose when I go for my 6pm dose.
This regime works well for me - as long as I don't miss a dose!!

Rustsmith wrote: Tue Nov 12, 2024 8:16 pm The half life of buprenorphine is 38 hrs, so it isn't a matter of it not lasting for 24 hrs but it could be that after all this time, you need a bit higher dose and so you might be dropping below the dose that you need to control your RLS and other symptoms, especially with increased inflammation.

Interesting, thank you so much for all the info! This all gives me some things to look into and try out. Perhaps I need a small dose in the AM as well, or to just up the dose in general. I was hoping to avoid that, but it may be necessary.

Wow, that is a long half life! Strangely enough, my RLS has actually been well controlled for much of this time. Perhaps it is because I'm timing it so it hits peak concentration around my bedtime and thus I still have enough to satisfy my nervous system at that time? Then my levels drop enough by the morning and I start to feel a bit rough. I did have a few weeks recently where I was getting RLS symptoms in the early morning, but that also might be related to my sciatica since it was accompanied by nerve pain and has since passed.