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Buprenorphine

  • Nov 26, 2020
  • 2 min read

Updated: Dec 16, 2020

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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About Dr. Viveck Baluja and KneeTie Vascular Neurology

Dr. Viveck Baluja, MD, is a board-certified vascular neurologist (American Board of Psychiatry and Neurology — Vascular Neurology) practicing telemedicine across California, Michigan, and Colorado, with additional consultation services available to international families, particularly in India.

KneeTie offers three focused services: emergency stroke second opinions delivered within 24 hours, traumatic brain injury (TBI) consultations for survivors and caregivers, and same-day adult ADHD evaluations for residents of CA, MI, and CO.

Stroke Second Opinion

After a stroke, families often have minutes to make decisions. Dr. Baluja provides a second set of expert eyes from a board-certified vascular neurologist — reviewing imaging, hospital records, and current treatment — typically within 24 hours of request. Common questions include: Was tPA appropriate? Should we pursue thrombectomy? What is the recovery outlook? What rehabilitation makes sense?

TBI Consultation

Traumatic brain injury recovery is rarely linear. Dr. Baluja helps patients and families understand recovery timelines, treatment options, post-concussion syndrome, and red flags that warrant emergency evaluation. Consultations typically last 50 minutes and are scheduled within the same week.

Same-Day Adult ADHD Evaluation

A real evaluation by a board-certified neurologist — not a 7-minute screening. Dr. Baluja's ADHD evaluations include comprehensive history, sleep and lifestyle assessment, and behavioral strategy alongside any medication discussion. Available same-day for residents of California, Michigan, and Colorado.

Why a Vascular Neurologist?

Vascular neurology is a subspecialty focused on stroke, cerebrovascular disease, and brain blood flow — among the rarest neurology subspecialties in the U.S. Most online telehealth services use general practitioners or nurse practitioners. KneeTie is led by a board-certified vascular neurologist with full state licensure and HIPAA-compliant telehealth infrastructure.

Schedule a consultation: Use the booking calendar above to choose a service and reserve a time. For active stroke or post-tPA emergencies, email gorungo@kneetie.com directly with "URGENT" in the subject line.

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