Buprenorphine Side
Effects
By Dr.Fourkan Ali
Headache, Constipation, Dry Mouth, Sexual
Dysfunction
Summary:
When at the optimal dose, four side effects are experienced most
often;
Headache, Constipation, Dry mouth, and low
libido
.
Keeping well hydrated often takes care of the
first three.
But when that is not enough over the counter medications can help.
A wider variety of
side effects occur when the dose is incorrect
.
Finding the correct dose is the first step
to eliminating side effects.
The correct dose is the lowest dose which still
suppresses cravings and withdrawal
Constipation:
Many medications can
cause constipation, including opioids, but especially long-acting opioids.
Fast-acting, short-duration opioids, such as heroin and hydrocodone, produce
periods of great effect followed by periods of lesser effect. It is during
those periods of lesser effect that the body is able to produce bowel
movements. However, long-acting opioids, such as buprenorphine, methadone and
time-released oxycodone, have a continuous influence on the body without the
period of lesser effect that would allow for bowel movements. This can lead to
chronic constipation if preventative strategies aren't employed.
Constipation can become
serious, and, in extreme cases, require surgery, but for most, it's an
unnecessary inconvenience and discomfort. Fortunately, it is usually avoidable
with dose/formulation changes, OTC remedies, exercise, good diet and good
hydration.
If drinking more water
along with a high fiber diet and increased exercise isn't enough, stool
softeners such as docusate sodium (brand name Colace®) which comes in soft gel
tablets are an option. This product softens stools and has a lubricating
effect, but is not a laxative. Polyethylene glycol 3350 (brand name Miralax®)
is a powder that dissolves into drinks and both softens stools and increases
the frequency of bowel movements. It works by drawing water into the colon, and
for that reason drink plenty of water to avoid dehydration - a contributor to
constipation. According to an informal survey conducted online, either one or a
combination of both has been effective at relieving most buprenorphine-induced
constipation. Avoid harsh and habit-forming laxatives if possible; and, of
course, consult your doctor before using any of the remedies mentioned here.
New formulations of buprenorphine have better bioavailability, and as a result, less bupe is
required. The theory is if there is less buprenorphine in total, less will get
diverted to the GI track (thought to be a contributor to opioid-induced
constipation) and constipation should be reduced.
Headache:
Headache is one of the most commonly reported buprenorphine side
effects. A common remedy for headaches is aspirin or other OTC pain remedies
with a glass of water; but water alone may be all that's needed. Medications,
including laxatives and all opioids, can contribute to dehydration; and one of
the first symptoms of dehydration is a headache. Just staying hydrated throughout
the day may be enough to solve the headache side effect, and reduce some of the
other side effects as well.
Be mindful there are
other things that can cause headaches such as caffeine and nicotine
withdrawals. Drinking plenty of water is the easiest first step in trying to
figure out the cause of headaches. But if the headaches persist, consult with a
medical professional to be on the safe side.
Dry mouth (xerostomia):
This may seem like an
innocuous symptom and is not often cited as a buprenorphine side effect, but it
can be very serious and very costly.
Saliva is the mouth's
primary defense against tooth decay, gun disease, and maintains the health of
the soft and hard tissues in the mouth. Saliva washes away food and other
debris, neutralizes acids produced by bacteria in the mouth and provides
disease-fighting substances throughout the mouth.
With dry mouth (which is
a side effect from all opioids) these benefits are diminished which allows
bacteria to multiply and often leads to gingivitis which can lead to
periodontitis disease, and eventually bone and tooth loss.
·
Gingivitis: This is the earliest stage of gum disease, some
bleeding with brushing and inflammation of your gums caused by plaque buildup
at the gumline. At this early stage in gum disease, damage can be reversed,
since the bone and connective tissue that hold the teeth in place are not yet
affected.
·
Periodontitis: At this stage, the supporting bone and fibers
that hold your teeth in place are irreversibly damaged. Your gums may begin to
form a pocket below the gumline, which traps food and plaque. Proper dental
treatment and improved home care can usually help prevent further damage.
·
Advanced
Periodontitis: In this final stage of
gum disease, the fibers and bone supporting your teeth are destroyed, which can
cause your teeth to shift or loosen. This can affect your bite and, teeth may
need to be removed.
Bacteria in plaque are
the main cause of gingivitis and periodontitis. Plaque is a biofilm that
continuously forms on the teeth and under the gumline. These bacteria may
release toxins, especially below the gumline, that irritate the gum tissue and
cause inflammation. Toxins or poisons - produced by the bacteria in plaque as
well as the body's "good" enzymes involved in fighting infections -
start to break down the bone and connective tissue that hold teeth in place.
The gums may eventually break down and separate from the teeth causing a deep
space called periodontal pockets. These pockets are very difficult to clean,
allowing the bacteria to grow and multiply. As the disease progresses, the
pockets deepen and more gum tissue and bone are destroyed. When this happens,
teeth are no longer anchored in place, they become loose, and tooth loss
occurs.
Other contributors to
the risk and severity of periodontal gum disease and oral health problems are
smoking and diabetes.
According to the CDC,
researchers have uncovered potential links between gum disease and other
serious health conditions. In people with healthy immune systems, the bacteria
in the mouth that makes its way into the bloodstream is usually harmless. But
under certain circumstances, these microorganisms are associated with health
problems such as stroke and heart disease.
Avoid the pain and cost
from the consequences of buprenorphine-induced dry mouth by keeping well
hydrated, use OTC treatment for dry-mouth such as Biotene®, and pay especially
close attention to good oral hygiene with routine dentist visits. Water
flossers may be even more effective than floss at reducing plaque buildup.
Preventative oral care might be the single best way to save money associated
with your addiction treatment. Do not overlook the importance of it.
Sexual Dysfunction
Buprenorphine, like all
opioids, can reduce libido. This can be a good thing as it might prevent
someone from becoming pregnant, until they have resolved their addiction. But
it may not seem like a good thing to others. This is a common and well known
side effect. It is dose related so lower doses have less impact on libido.
Exercise, good nutrition, adequate rest, and/or a sexier partner can help.
Above buprenorphine side
effects can occur when dosed correctly. When dosed incorrectly however, other
symptoms have been reported. Here are some of them.
·
Too
high of a dose: lethargy, a medicated
feeling ( described as " cloudy" "foggy" or "
slow"), tiredness, nausea, constricted pupils in low light, a general
unmotivated feeling, unjustified feeling of contentment, dehydration (indicated
by dark urine)
·
Too
low of a dose: sweating, chills, goose
bumps, dilated pupils in normal light, diarrhea, cramps, insomnia, nausea,
anxiety, depression, dehydration, cravings
The optimal dose of
buprenorphine, when prescribed for addiction, is the lowest dose that
suppresses cravings and withdrawal symptoms. Dose requirements may change as
treatment progresses.
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