# Buprenorphine



## cmh9023 (Aug 3, 2007)

Sherry had major oral surgery last night. This morning I thought she was showing interest in food but couldn't really eat it, but since then she's not interested in eating anything or even drinking. I'm notseeing anypoops, but she has urinated.

I called the vet back and insisted on some stronger pain medication. So far she has only had Metacam. I am going to pick up some Buprenorphine in about half an hour. How long before it will have an effect on her pain, e.g. is it fast-acting?

I don't think it will be flavored as it is coming from our emergency clinic so she probably won't drink it on her own. I had to syringe feed her since she had three teeth pulled and major work done in her mouth yesterday. I tried to syringe feed her a Critical Care slurry w/pineapplie juice, etc. and more ended up on me than in her month.

I'm hoping with better pain meds she will be more likely to eat on her own????


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## seniorcats (Aug 3, 2007)

I found this in a post Randy made about pain meds after spay surgery. Perhaps it will help. Here is Randy's post:



A vet said they don't need pain meds?? IDIOT!!! I have an offer for that vet....let me do surgery on him/her without pain meds. I wouldn't even charge for the procedure (sorry, stuff like that really ticks me off). I don't even want to get started on that. My primary vet is quick to pull the trigger on pain meds for anything. Here is the deal on pain meds.

Metacam---Most vets give it because it is considered "safe". A marginal analgesic at best. But better than nothing. It's the animal version of Tylenol. Not good on the liver for long term or if the animal is anywhere near dehydrated (and remember that being sedated is dehydrating in itself).

Torbugesic (Butorphenol)-Very effective but is very short lived...in some cases less than 2 hours. Better options available. This is a controlled drug.

Buprenex ([highlight= #ffff88]*Buprenorphine*)-The absolute best. It can be given PO, SQ or IM. It is very effective for up to 12 hours. This is a controlled drug.

Tramadol-Very effective. Many vets do not know of this wonderful drug...and although it requires a prescription, it is not as tightly controlled as the other narcotics. Up side---it's not expensive at all and very effective. Down side---It only comes in a 50mg tablet so it has to be compounded into a suspension. There is also some evidence of some issues when it is compounded in higher concentrations. And it can be easily flavored to make it more palatable...grape is the flavor of the month around here.

And just a comment on needle jabs....it is the most effective way to adminster meds. You know it's there in the right dosage. I use the tiny human insulin needles....30g in most cases...and it's so much easier for me and less stressful for the animal.

Randy


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## Maureen Las (Aug 3, 2007)

If you have to feed her by syringe I wouldn't even try to deal with critical care as I have never been successful in getting it in. 
You can syringe plain pumkin and pedialyte easier (separately...no it doesn't have all the vitamins but it is easierto get in them because it is so soft.)

You might also try baby foods

It is easier to get pellet slurry in a syringe than CC
At Petco stores they sell larger syringes to give dogs medications but I have used it for rabbits
At Walgreens they sell syringes for infants and I have used it for the bunnies too

After she gets her pain meds in I would try to get almost anything you can down her just to keep her GI tract moving.


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## ra7751 (Aug 4, 2007)

Buprenorphine (Buprenex)is an excellent drug. It can be administered orally, sub-q or IM. When given orally, it does not have to be swallowed. It is absorbed into the membranes of the mouth. But....I have heard of a couple of rabbits that would not absorb the drug...no idea why not. It also has almost no taste so flavoring isn't necessary. I have never had a rabbit have any problem taking this drug by mouth. If I remember correctly, it is a synthetic narcotic.

I prefer to inject the drug sub-q. It requires such a small dosage that it can be easily accomodated by a human U-100 insulin syringe with a very small needle. It seems to work faster and better when injected...plus you are sure the correct dosing is there.

Buprenex also tends to slow down the GI tract just a bit....I have never had any major concern with that....just something to look for. I have no problem shooting adose of buprenex at the slightest hint of pain. The first dosing may make your bun a little drowsy but that won't last long....we call it the "Magic Carpet Ride". It usually takes about 15-20 minutes to get full level and effectiveness. Duration is close to 12 hours and we routinely schedule the dosing twice a day.

You can also use Buprenex with Metacam...which I am sure the doctor will suggest. I would not exceed 5 days (preferably 3) with the Metacam and make sure your bun is well hydrated while taking Metacam. This is another case (like spays) where Metacam is overmatched by the pain. In this case, I would use the Metacam as a secondary treatment to help control the inflammation after the surgery.

Dont' rush the food. I plan on 72 hours of very intensive care after major dental work (been there..done that...several times). Do have it available for her in case she wants something...but don't panic yet. It will take some time. Something that is very important is to supplement hydration with sub-q fluids. I am impressed that your vet would offer Buprenex....so I don't think it would be a stretch to ask for some Lactated Ringers and give her some fluids. The set up is not expensive, you can learn to do it in a matter of minutes and the electrolytes in the LRS will make your bun feel much better.

One word of caution with Buprenex. It is light sensitive and will lose it's "punch" if exposed to even small amounts of light for short periods of time. It should come wrapped and most likely in a dark brown vial. Keep it out only long enough to pull dosing. Many vets will go ahead and pre-pull the drug into syringes to make sure you have the correct dosing. Keep it covered!!

Again, I am impressed with your doctor for offering this analgesic. Maybe we are making some progress.

Randy


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## cmh9023 (Aug 4, 2007)

I'm glad you said I don't have to rush the food. I think that's what I've been trying to do. What I have been worried about is her going into stasis. She is urinating (but I haven't seen her drinking) and I've seen about 15-20 poops, pretty much normal looking. The only thing she's really been interested in eating is pumpkin with nothing mixed in. Is that enough poop to indicate her gut is still moving well? She's very alert and pretty active.

I know a person certainly wouldn't be eating normally after having three molars pulled along with some other stuff! I'm REALLY hesitant to syringe feed her because she struggles against it. I can't see what I'm doingvery wellso I'm sure to hit some sore areas. I tried it once earlier today and it didn't go well. I really don't want to do it again unless it is absolutely necessary. 

I've have a wide array of things set out for her for the night: plain pumpkin; pumpkin w/pedialyte and ground up pellets; applesauce (which she has been eating a bit of); pedialyte w/a bit of apple juice; some banana; long timothy hay; timothy hay cut into small pieces; alfalfa hay; carrots, parsley, and romaine cut into very small pieces, some whole; water; whole pellets; and ground up pellets. I hope that's enough..haha. 

The Buprenorphine did come in a dark green bottle with small vials inside. The dose is .33 ml every 8 hours for 4 days. She's also getting injections of Bicillin every other day; Metacam; and Baytil twice/day.

I think I will take her in in the morning for some fluids if not much of her water is gone when I wake up.

When you say you give 72 hrs of intensive care, is there anything I'm missing??

Cara


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## ellissian (Aug 4, 2007)

I have no advice but wanted to say I'm thinking of you both and hope Sherry feels better soon.


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## ra7751 (Aug 4, 2007)

Hi Cara,

I will make a comment on each of your paragraphs. Keep in mind that I am not a vet....I have just been doing this a very long time. So understand that some of my comments are just to provide you with points of conversation to discuss with your vet.

Let her eat anything she wants. Pumpkin is fantastic. It has lots of nutrition and fiber. I use pumpkin and mix in Critical Care or even medicine from time to time. Anything that is bunny safe....let her have at it in unlimited quantities until she heals up. And she really wouldn't go into stasis....it would be another type of event. However, these types of events can be easily worked by doing exactly what you are doing. Don't sweat that. Now if she doesn't start eating morein maybe 5 days....my concern level would start rising.

Force feeding is usually a challenge regardless. It would only add stress to the mix at this point. Let her rest and she will come around as time goes by.

Sounds like she has quite a buffet. Something that works great for us is dandelion greens. But I think she should be able to find something in that offering that will tempt her taste buds as she recovers. I think you have excellent coverage here.

She certainly shouldn't be feeling any pain. Just wondering how much does she weigh? That is a huge amount of Buprenex....both in actual dosing amount and times administered. I suspect it is at the higher range of dosing but that is a lot. She must be really tripping. Since I am not a vet, I can't discuss actual dosing but I would really be interested in knowing her weight and how they came up with that amount. I don't think it will hurt her...but she should be in no discomfort at all. Might want to bring out some of the hippie stuff from the '60s...maybe some tie dye, a lava lampand a VW Van...LOL....cause she should really be on that "Magic Carpet Ride". I would ask the vet about how long to use the Metacam. It is vitally important to protect the liver when using that drug long term. In wildlife, 3 days max. I have done it longer with domestics but with additional hydration support. You certainly also have coverage with the Procaine and Baytril. I am not a big fan of Baytril but since it is being used in a secondary support role....you should be OK. The Procaine is very effective at taking care of most of the bacteria that might cause a problem. I hope the doctor told you that Procaine (Bicillin) is safe only when injected. It also is quite uncomfortable when it goes in. I usually buffer the shot by mixing the drug with Lactated Ringers....a two for one injection. Baytril also seem to be more effective when injected rather than offered orally....maybe something to do with the pH in the gut.

Why take her in for fluids? Get trained and do it yourself. Most vets charge upwards of $30 for one round. A bag of fluids with a drip infusion kit should be less that $10. A new needle every day only a few more cents. Plus by doing it yourself, it saves a lot of travel stress since some buns don't like travel. I do it a little differently (I use a butterfly catheter with a large syringe) but it is usually easier to learn the regular drip method first. I use my method with wildlife since it is much quicker. Any entry level vet tech can teach you easily in just a few minutes. And, as I have mentioned many time previously on this forum, being capable of adminstering fluids can be a life saver....it has here many times and has literally saved hundreds of animal both domestics and wildlife.

Have you missed anything? Yep. A big pat on the back for doing such a good job. From what I see, it looks like you have all the bases covered. Great work.

Randy


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## cmh9023 (Aug 4, 2007)

Hi and thanks!

The vet dentist prescribed the Bup. after I said she needed more than Metacam. I didn't suggest that med, he did, but he didn't sound extremely familiar with it. He wanted to go check some things in a book and then called me back to say he would call it in for her. She's very small, 2.4 lbs. Let me know how much you would give because, like I said, he must be just beginning to prescribe this. I overslept this morning so it is currently 12 hours since her first dose.

I'm suprised to see she's still not drinking her water (it's in a bowl). She usually is a pretty big drinker. So, the only moisture she's gettng is from the pumpkin and the applesauce. I will definitley have my vet teach me to do fluids when I see her next week. My problem is that she isn't in until Monday (and I wouldn't be able to take Sherry in until Tuesday) and I want to get her through the weekend safely.

I see quite a few poops this morning so i'm very glad about that! 

Cara


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## Maureen Las (Aug 4, 2007)

If you have a 3cc syringe I would syringe her fluids if she is not drinking and you can't take her to thevet to learn sub q's. I would usepedialyte and give her as much as she wants. Beau got pedialyte before we went in the vet on Wed because he would not drink in the car. he liked the grape flavor and actually drank it off the syringe , I also gave him about20 ccs before we started home

You barely have to get the syring in her mouth just squirt a little and she probably will swallow ..make sure that she swallows...if not you will probably have to do the subq route.

I pm'd you before I read this I do think that you should try to get fluids in her. before Mon.


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## Maureen Las (Aug 4, 2007)

oh I just re-read your last post..try to get pedialyte in a flavor like grape or berry


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## Maureen Las (Aug 4, 2007)

Look up Dr Chark's drug dose calculator for rabbits..sorry I can't send it


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## ra7751 (Aug 4, 2007)

Hi Cara,

Let me know the dosing (and the drug concentration which should be.3)that is on the label before you give it. If the dosing is still at .33cc....that is way too much drug for her size. I can't legally tell you the dosing amount since I am not a vet...but there is no way I can live with myself if I let you dose too much. I can either give you a link to a dosing calculator or I would be glad to speak to the doctor directly (some doctors will do this and some won't) to give them the correct dosing. It's not really the doctor's fault...there isn't a lot of info out there to rely on and some of it is incorrect. To give you an idea of the dosing....I recently had a Flemish spayed and she weighed about 20 pounds at the time.At the dosing level you mentioned, you will be giving your rabbit nearly the same amount my much bigger bun got in almost two days.

Randy


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## Maureen Las (Aug 4, 2007)

Randy's right..I just looked it up on the dosage calculator..don't give her that much its too big a dose.


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## cmh9023 (Aug 4, 2007)

Uh oh. The label doesn't say anything other than what I wrote above. The labels on the little vials just say Buprenex, the lot number, and expiration date.

Based on the chart, how much should I give? I haven't given her any yet today. Just the Metacam and the Baytril. The injection is tonight.

Cara


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## cmh9023 (Aug 4, 2007)

I just looked at that chart. That is a great tool! I never knew about it.

Since the chart lists the correct dose at .034, I wonder if the label was typed up wrong because it reads .33.

Randy- I'm going to give her .034 right now, but let me know if you think that is correct. Thanks!

Maureen- I'm going to go get some flavored Pedialyte. I'm sure (well, I hope) she prefers that. I didn't get that originally because it says it contains fructose (sugar).


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## ra7751 (Aug 4, 2007)

Hi Cara,

That dosing would be at the very low end of the dosing range. I usually do a little higher. I also do a little more on the first dosing...in wildlife we call it "shock dosing". But the amount you are giving is OK. Might have to increase it just a little but just keep a watch and see what the reaction is. Even at the lower amount, it will provide much more pain relief than any dosing of metacam.

Randy


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## naturestee (Aug 4, 2007)

Hi Cara! You're doing a great job with Sherry!:bouquet:

Pedialyte is good- Mocha gives a paws-up to the apple flavor. It does have fructose but not very much, I wouldn't worry about it. Not any worse than applesauce or pumpkin. Maybe try putting it in a little saucer for her. Could that be easier to drink out of than a bowl right now? It's worth trying different containers to see if she has a preference.

Do you have Nutri-Cal on hand? You can put just a little dab on her paw so she licks it off. It provides energy and some vitamins, tends to be helpful for sick animals.


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## cmh9023 (Aug 4, 2007)

Thanks!! I do have a variety of containers set out for her buffet which is becoming more and more extensive. 

Does Mocha drink the Pedialyte off of a saucer of do you have to give it to her by syringe?

Would a pet store have Nutri-Cal?


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## naturestee (Aug 4, 2007)

I've only used it via syringe for her, when she has gas/stasis issues. She likes it more than plain water and licks her lips when she gets it. If Sherry likes applesauce, this will smell like apples too so might encourage her.

Nutr-cal is at a lot of pet stores in the cat/dog sections. I bought mine at a Petsmart.


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## Maureen Las (Aug 4, 2007)

Nutrical is in the dog and cat areas of the store not the small animals.


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