Buprenorphine

Introduction


The drug buprenorphine is used for the management of opioid disorder. The uses of buprenorphine are dominant over its side effects. The drug buprenorphine is used for the helps in the reduction of cravings without having harmful effects and euphoria. The FDA of United States approved the use of this drug for the treatment of opioid withdrawal.


It has high affinity for mu-opioid receptors as compared to other drugs.


Buprenorphine formulations


It is available in two ways which are “Buprenorphine mono-product and buprenorphine/naloxone combination.” The combination of this drug is available in the form of sublingual tablet and is contraindicated for pregnant females.


Treatment goals and patient selection


Buprenorphine is used for patients who are not hypersensitive to opioid agonists. A consent form is signed by the patient before the treatment of disorders.


Goals


· For suppression of opioid withdrawal

· For blocking the effects of illicit opioids

· For reduction of cravings

· For promotion of patient engagement in psychosocial intervention

There is enough evidence on the effectiveness of buprenorphine. (T.V. Parran,b,e,* C.A. Adelman,a,b B. Merkin,b,e M.E. Pagano,d R. Defranco,b R.A. Ionescu, 2010)


Precautions


Careful monitoring is required for the patient receiving

· Alcohol

· Sedative

· Hypnotics

· Anxiolytics


Course of Treatment


The trained physicians are allowed to prescribe narcotics for the treatment of this disorder according to DATA 2000. (Food and Drug Administration (FDA) to treat Opioid Use Disorder (OUD), 2020)


Induction

Patients need to experience the withdrawal symptoms before starting this drug otherwise the patient may experience precipitated withdrawal.

Buprenorphine is recommended to use after:

We use COWS score for evaluation of the withdrawal of the patient. (Donald R Wesson 1, 2003)


There is a benefit of this therapy as it can be induced at home. (Erik W Gunderson 1, Xin-Qun Wang, David A Fiellin, Benjamin Bryan, 2010)


Induction dose


2-4mg buprenorphine dose is recommended for initiation. After this the patient is monitored, if no withdrawal symptom appears in 1 to 2 hours, the next dose of 2-4mg is given.


Maintenance dose


After the induction, the dose of buprenorphine given is approximately 8mg. The maintenance dose usually depends upon the patient. If he is taking the drug, the dose is increased to approximately 12-16mg. Food and Drug Administration of United States has approved to use this drug to a maximum of 24mg in one day. Higher doses than this limit will have more risks as compared to its benefits.


Adverse Effects


It is well tolerated. Some of the side effects of buprenorphine include fluid retention, anxiety, headache, perspiration and constipation. This drug has a benefit of not inducing QT-interval prolongation in the patients having this treatment.


Psychosocial treatment


This treatment is recommended along with buprenorphine therapy.


Monitoring


Mostly, weekly visits are recommended for the patients after dose titration of dose. The stability of the patient depends upon the factors which are participation in psychosocial treatment, and abstinence from illicit drugs.


Length of treatment


There is no definite time limit of this therapy; however, it is a slow process. The termination of therapy includes following indicators:

· Sustained abstinence from drugs during treatment

· Positive attitude

· Persistent participation in the meaningful activities


Switching treatment


If a patient experience intolerance, the therapy can be switched to another drug.


Switching to naltrexone


It is recommended to ensure that the patient has no buprenorphine in his blood before starting naltrexone therapy.


Switching to methadone


You can readily switch to this drug for buprenorphine with no delay.

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