Buprenorphine

Administration

  • Type: Opioid- maintenance therapy in opioid use disorder, rapid detox
  • Dosage Forms: injectable solution, sublingual tablet
  • Dosage Strengths: injectable solution: 0.3 mg/mL; sublingual tablet: 2, 8mg
  • Routes of Administration: Buccal, sublingual, intradermal, transdermal, IV, IM
  • Common Trade Names: Suboxone (buprenorphine + naloxone), Buprex

Adult Dosing

Highly variable dependent on individual

  • Initial dose for patients with Clinical Opioid Withdrawal Scale (COWS) >8: 4mg, observe 45min, redose if COWS remains >8 *Suboxone initial induction dose: 2mg/0.5mg or 4mg/1mg, titrate up by 2-4mg q2h based on withdrawal symptoms up to 8mg/1mg[1]
NIH National Institute on Drug Abuse ED Buprenorphine algorithm[2]

Pediatric Dosing

Variable

Special Populations

  • Pregnancy Rating: C
  • Lactation risk: Infant risk has been demonstrated
  • Hepatic dosing: reduce dose or do not use in moderate - severe impairment
  • Renal dosing:

Contraindications

  • Allergy to class/drug
  • SBO, paralytic ileus
  • Acute/severe asthma (if unmonitored), respiratory depression

Adverse Reactions

Serious

  • Hypotension, prolonged QT, MI
  • Respiratory depression
  • SBO
  • Hepatotoxicity
  • Stroke
  • Sedation, coma
  • Drug dependence or withdrawal

Common

  • Pruritus
  • Constipation, nausea, diarrhea, xerostomia
  • Dizziness, headache, somnolence
  • URI symptoms

Pharmacology

  • Half-life: 24-48 hours
  • Metabolism: Extensive hepatic, CYP3A4 substrate
  • Excretion: Mostly fecal, some renal

Mechanism of Action

  • Mixed opiate agonist-antagonist, partial mu-opioid agonist, kappa-opioid antagonist

Comments

  • No DATA 2000 Waiver (aka X Waiver) required to administer within the ED for up to 72h (e.g. patient can come back to ED for daily dose for 3 days)[3]

See Also

References

Authors:

Claire, Matin Shah