Experience specifically with Buprenorphine buccal for chronic pain...

[Rysiek]

... not for acute, temporary pain or surgical related relief, and not through injection or topical.

This is looking for input from folks who administer this med at home to their cats because of chronic pain, due to things like arthritis or cancer, for example. All the information on the internet varies so much that it is hard to decipher anything from it. Hearing from others with their individual experiences would at least give me some personal level appreciation.

While dosing is different based on a number of factors, for what it is worth Feeby has been prescribed 0.1ml every 12 hours - calculated/determined by the following equation: her weight 5.82kg x 'dose' .01mg/kg divided by strength 0.6mg/ml. The specific brand is Buprenex.

So, tell me -
- Dosage (how much you are giving your cat each time)
- Frequency (how often do you give the dosage each time)
- Adjustment time - (how long it took your cat to adjust to this new med)
- Efficacy (how long each dosage seems to last)
- Side effects, both short term and longer term
- Adverse reactions if any - and resolution, if needed
- Duration (how long your cat has been receiving this med)
- Other input (not covered above)

Thanks.

As my cat has been on other meds (gabapentin, metacam and omeprasole) it is difficult to answer to your questions as the effects of buprenorphine have been altered by other meds.

He was on 0.15ml given at the same time as gabapentin. Twice a day, every 12 hours...for two weeks...he appeared much happier on this...We had not had any adjustment neither adverse reactions, but this was possibly altered by other meds...no short term side effects, but when we have stopped it yesterday I have noticed that he has been more lethargic, which is possibly related to some kind of withdrawal...but when he wakes up after his morning gaba he is just normal...
He had an episode of foaming after omeprasole yesterday...

I wonder if there is a withdrawal from buprenorphine and what to expect?

 

[silent meowlook]

Cheetah gets buprenorphine applied to the buccal mucosal for pain due to cancer. I give 0.1cc because she is a lightweight. She will sleep more soundly with it. It works and I haven’t seen any side effects. Her actual label dose is 0.5cc but that would be to much for her.

 

[FeebysOwner]

I wonder if there is a withdrawal from buprenorphine and what to expect?

I presume there might be, given it is a form of opioid. You should call your vet and ask how to wean your cat off of it. If you have concerns about drug interactions with other meds your cat is on that is another thing to check with your vet about.

In reading about Bupe, there was not much addressed regarding withdrawal. I suppose that might be because, until more recently, it was considered a short-term pain relief drug in a lot of cases for cats. Not much was mentioned about any issues with drug interactions either, other than using it combination with other drugs that cause central nervous system depression.

Sedation seems to be the 'biggest' side effect. Feeby's form of sedation appears to be more 'zoned out' than sleepy - staring off into space a couple hours after having received a dose. However, there are other cats who are actually more active on Bupe, so it stands to reason that if you stop giving it to a cat that appears 'happier', they could become what would be viewed as lethargic.

 

[FeebysOwner]

Her actual label dose is 0.5cc but that would be to much for her.

That sounds like quite a bit. But the amount is dependent on the dose (usually 0.1-0.3 mg/kg) and strength (0.3 mg/ml, 0.6 mg/ml, as common examples) in conjunction with a cat's weight, so there are variables that play a role.

 

[Rysiek]

I presume there might be, given it is a form of opioid. You should call your vet and ask how to wean your cat off of it. If you have concerns about drug interactions with other meds your cat is on that is another thing to check with your vet about.

In reading about Bupe, there was not much addressed regarding withdrawal. I suppose that might be because, until more recently, it was considered a short-term pain relief drug. Not much was mentioned about any issues with drug interactions either, other than using it combination with other drugs that cause central nervous system depression.

Sedation seems to be the 'biggest' side effect. Feeby's form of sedation appears to be more 'zoned out' than sleepy - staring off into space a couple hours after having received a dose. However, there are other cats who are actually more active on Bupe, so it stands to reason that if you stop giving it to a cat that appears 'happier', they could become what would be viewed as lethargic.

I spoke to the vet and she said that I could get back to a lower dose if necessary, as we had stopped his buprenorphine yesterday...
Also, I need to observe if his lethargic response may relate to him hiding some pain ..
She said exactly what you mentioned that some cats a zoned out and some happier...mine was happier therefore lack of it made him zoned out, he was so lethargic that he did not even open his eyes!
But normally active and eating in the afternoon...

He also had a foaming response to liquid omeprasole yesterday and she said it is most likely response to the taste of it, they ordered a flavoured form for him...
She suggested making a chicken stock from the chicken cube and dilute omeprasole in it as this will take the taste away...

She also suggested making an omeprasole ball from a crushed tablet and bit of butter and freeze it... unfortunately I do not have a freezer! But this is a great idea

 

[silent meowlook]

Cheetah’s is 0.6mg/ml

 

[FeebysOwner]

Cheetah’s is 0.6mg/ml

Same for Feeby, with a dose of 0.1 mg/kg. She weighs ~12.5 pounds and the calculation came to an amount just under 0.1 ml. Even a dose of .03 mg/kg at that strength wouldn't come out to more than 0.3cc/ml for her. That is why I am shocked that anyone would prescribe 0.5cc/ml to a cat - of any size. Glad you don't adhere to the prescription you were given!

 

[cmshap]

That is why I am shocked that anyone would prescribe 0.5cc/ml to a cat - of any size. Glad you don't adhere to the prescription you were given!

Yes, good call.

There's a saying in the human-bupe world, "less is more." Meaning, once you get towards the upper end of dosages, adding more does nothing of benefit. It only makes withdrawal more likely later on when trying to stop the medication. It's better to find the minimum dose that comfortably achieves the desired result.

I wonder if there is a withdrawal from buprenorphine and what to expect?

I dove into the literature on opioid withdrawal in cats, which I discussed in an earlier post in this thread.

There is shockingly little concrete information. Just one old (and cruel) study from the 70s, and otherwise, an absolute ton of the phrase "little is known." There's some speculation that it's not as bad as humans, but really nothing to back up such claims.

My personal theory is that since cats are so good at hiding pain, they are also good at hiding withdrawal symptoms. But they actually experience it just like we do.

Even though this is entirely theoretical on my part, having gone through opioid withdrawal myself, I'd be super-sensitive about it if my cat ever gets prescribed any.

 

[heatherwillard0614]

Yes, good call.

There's a saying in the human-bupe world, "less is more." Meaning, once you get towards the upper end of dosages, adding more does nothing of benefit. It only makes withdrawal more likely later on when trying to stop the medication. It's better to find the minimum dose that comfortably achieves the desired result.



I dove into the literature on opioid withdrawal in cats, which I discussed in an earlier post in this thread.

There is shockingly little concrete information. Just one old (and cruel) study from the 70s, and otherwise, an absolute ton of the phrase "little is known." There's some speculation that it's not as bad as humans, but really nothing to back up such claims.

My personal theory is that since cats are so good at hiding pain, they are also good at hiding withdrawal symptoms. But they actually experience it just like we do.

Even though this is entirely theoretical on my part, having gone through opioid withdrawal myself, I'd be super-sensitive about it if my cat ever gets prescribed any.

I found a study from 1979 which made my stomach churn a little, where they gave cats morphine for a while, then administered naloxone to precipitate withdrawal and observe behavioral changes. Observations included "wet-dog shakes and a catatonic-like posturing."

I actually have the same thoughts on this. Also I can't believe they had the cats all on morphine then gave them naloxone, throwing them into precipitated withdrawal. Imagine how bad those cats had to be feeling if the observations included "wet-dog shakes and a catatonic like posturing"
They had to have felt like they were going to die...

I know this is off topic and i apologize so I'm going to get back to it.

Something to consider as well FeebysOwner if she is on any other opiate like medication there could potentially be withdrawal symptoms (if she has been on any opiate longterm before starting the bupe)
There are certain meds that will have adverse reactions when mixed with this drug. Also certain health issues should be considered before taking bupe

Buprenorphine | VCA Animal Hospitals

Buprenorphine is used to treat pain in dogs and cats. Buprenorphine is a synthetic partial opiate agonist.

vcahospitals.com

 

[FeebysOwner]

if she is on any other opiate like medication there could potentially be withdrawal symptoms (if she has been on any opiate longterm before starting the bupe)...There are certain meds that will have adverse reactions when mixed with this drug. Also certain health issues should be considered before taking bupe... Also I can't believe they had the cats all on morphine then gave them naloxone, throwing them into precipitated withdrawal.

Very well aware of all of this. I think from the entire thread/posts, it should be pretty obvious that I am not a novice when it comes to research, study, and appreciation of the implications of meds that are prescribed to my cat.

And, just for additional information, buprenorphine is NOT the same as morphine. There are some fairly well-defined differences, so there is a bit of an 'apples to oranges' distinction that folks must recognize. Maybe this will help you appreciate the differences.
A Review of the Studies Using Buprenorphine in Cats - PMC (nih.gov)

 

[cmshap]

And, just for additional information, buprenorphine is NOT the same as morphine.

The only reason morphine was brought up at all was because of my doing, as I was just saying that morphine study is the only study I ever found specifically looking at opioid withdrawal in cats.

 

[FeebysOwner]

The only reason morphine was brought up at all was because of my doing, as I was just saying that morphine study is the only study I ever found specifically looking at opioid withdrawal in cats.

I understand, and no worries!! But many people are under the impression that what applies to morphine applies to buprenorphine, and that is not really the case, at least not in the administration/dosage differences - and, of course, the obvious lack of studies done on cats (in all kinds of scenarios, above and beyond just this topic)!

 

[heatherwillard0614]

I know there is a difference between morphine and buprenorphine.

That part of discussion of morphine was about the study not your post as you see I got it back on track after I responded to cmshap

The part I was talking about with your cat in this situation was this part.

Something to consider as well FeebysOwner FeebysOwner if she is on any other opiate like medication there could potentially be withdrawal symptoms (if she has been on any opiate longterm before starting the bupe)
There are certain meds that will have adverse reactions when mixed with this drug. Also certain health issues should be considered before taking bupe

And the link that says the drug interactions and health issues that would cause your cat to not be a good candidate for bupe because I don't know what meds she is on nor her health issues. That is why I provided the link.

I am fully aware of the 2 being completely different. Some people might see the 2 as the same but they are not at all.

I hope that makes sense.

 

[FeebysOwner]

And the link that says the drug interactions and health issues that would cause your cat to not be a good candidate for bupe because I don't know what meds she is on nor her health issues. That is why I provided the link.

Thank you for your clarification. I appreciate you are concerned that I might not have done my due diligence and may have missed something. I assure you that is not the case but thank you for your careful and persistent work to help others. I also understand that you are relatively new to this site and appreciate that you feel you have a lot to offer and prefer to ensure 'no stone is left unturned', so to speak, when you think you might make a difference.

I didn't expound on all of her meds, etc. because it tends to bog down the point/goal of the thread to begin with, which I thought I made pretty clear. Of course, no matter how hard we try to be clear, we don't always reach that goal, do we?

 

[heatherwillard0614]

Thank you for your clarification. I appreciate you are concerned that I might not have done my due diligence and may have missed something. I assure you that is not the case but thank you for your careful and persistent work to help others. I also understand that you are relatively new to this site and appreciate that you feel you have a lot to offer and prefer to ensure 'no stone is left unturned', so to speak, when you think you might make a difference.

I didn't expound on all of her meds, etc. because it tends to bog down the point/goal of the thread to begin with, which I thought I made pretty clear. Of course, no matter how hard we try to be clear, we don't always reach that goal, do we?

That is so true. Unfortunately sometimes it feels like we try our hardest to be crystal clear and still for whatever reason there are still things left unclear. You definitely hit the nail on the head with that for sure.

Anyway I really hope whatever route you do take medication wise helps her. Will you update us with the decision you and your vet make and what works best for her.

I think if you do decide that to go the bupe route is the best option for her, you will be able to add some good information for future references.

 

[FeebysOwner]

I think if you do decide that to go the bupe route is the best option for her, you will be able to add some good information for future references.

She actually has been taking Bupe since late June. Given what I know from comments made on this thread, and other criteria I have/had researched and gathered, there may not be much 'learned' to share, as there are so many varying, broad-range aspects. Should I decipher something I think might be of value to others I will most certainly share it.