Buprenorphine

Davis, Mellar P.; Behm, Bertrand; Fernandez, Carlos

doi:10.1136/spcare-2022-003954

Cited by 2 publications

(4 citation statements)

References 10 publications

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“…The buprenorphine dose is doubled daily until ~12 mg when the schedule II opioid can be discontinued without withdrawal. With its high affinity, buprenorphine blocks the schedule II opioid at the MOR [ 5 ].…”

Section: Initiation Methodsmentioning

confidence: 99%

“…Buprenorphine does not inhibit serotonin reuptake, unlike methadone, fentanyl, and tramadol, and therefore does not contribute to possible serotonin syndrome [ 5 ].…”

Section: Pharmacologymentioning

confidence: 99%

“…Compared to methadone, buprenorphine has less of an effect on QTc prolongation [ 3 ]. Buprenorphine is metabolized via the CYP3A4 pathway, whereas methadone is metabolized through three CYP3A4, CYP2B6, and CYP2D6 pathways [ 5 , 6 ]. The half-lives of IM, buccal, and transdermal buprenorphine are 2 to 3 h, 27 h, and 26 h, respectively [ 7 , 8 ].…”

Section: Pharmacologymentioning

confidence: 99%

“…Cannabis can increase serum buprenorphine levels; thus, patients should be counseled on the risk of withdrawal symptoms if cannabis is stopped or the risk of intoxication with new cannabis use [ 5 , 9 ]. In addition, one study found that the metabolite-to-parent ratio is higher in non-users (0.98) than in cannabis users (0.38), p = 0.02, thus indicating that cannabis use decreases norbuprenorphine formation, while elevating blood concentration of buprenorphine and norbuprenorphine, likely due to inhibition of CYP3A4.…”

Section: Pharmacologymentioning

confidence: 99%

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Buprenorphine Use for Analgesia in Palliative Care

Jackson,

Poon,

Garcia

et al. 2024

Pharmacy

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Buprenorphine is a semi-synthetic long-acting partial µ-opioid receptor (MOR) agonist that can be used for chronic pain as a sublingual tablet, transdermal patch (Butrans®), or a buccal film (Belbuca®). Buprenorphine’s unique high receptor binding affinity and slow dissociation at the MOR allow for effective analgesia while offering less adverse effects compared to a full agonist opioid, in particular, less concern for respiratory depression and constipation. It is underused in chronic pain and palliative care due to misconceptions and stigma from its use in opioid use disorder (OUD). This case report discusses the unique pharmacology of buprenorphine, including its advantages, disadvantages, available formulations, drug–drug interactions, initiation and conversion strategies, and identifies ideal populations for use, especially within the palliative care patient population.

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Section: Initiation Methodsmentioning

confidence: 99%

“…Buprenorphine does not inhibit serotonin reuptake, unlike methadone, fentanyl, and tramadol, and therefore does not contribute to possible serotonin syndrome [ 5 ].…”

Section: Pharmacologymentioning

confidence: 99%

Section: Pharmacologymentioning

confidence: 99%

Section: Pharmacologymentioning

confidence: 99%

See 2 more Smart Citations

Buprenorphine Use for Analgesia in Palliative Care

Jackson,

Poon,

Garcia

et al. 2024

Pharmacy

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Reliability of urine drug testing among patients on buprenorphine transdermal patch

Amaram-Davila,

Reddy,

Clark

et al. 2023

Pall Supp Care

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Background Urine drug testing (UDT) plays a significant role in monitoring patients on chronic opioid therapy (COT) for non-medical opioid use (NMOU). UDT, at times, can be inconsistent and misleading. We present a case where a patient on a buprenorphine patch had false negative results. Case description A female in her 70s with metastatic breast cancer presented with uncontrolled pain from a T6 compression fracture. She had no relief with tramadol 50 mg every 6 hours as needed. Due to an allergic reaction to hydromorphone, our team prescribed a buprenorphine patch of 5 μg/h. Subsequently, she expressed excellent pain control, and the clinician confirmed the patch placement on examination. She underwent a UDT during the visit. The UDT was negative for both buprenorphine and its metabolites. The literature review showed that false negative UDT results are relatively common among patients with low-dose buprenorphine patches. The combination of a thorough physical examination, a review of the Prescription Drug Monitoring Program, and reassuring scores on screening tools placed her at low risk for NMOU. Discussion Buprenorphine has a ceiling effect on respiratory depression and a lower risk for addiction. However, when used in low doses, the drug might not have enough metabolites in the urine, leading to a false negative UDT. Such results might affect patient–physician relationships. Conclusion In addition to the UDT, a thorough history, screening for NMOU, physical exam, a review of PDMP, and a good understanding of opioid metabolism are necessary to help guide pain management.

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Buprenorphine

Abstract: .

Cited by 2 publications

References 10 publications

Buprenorphine Use for Analgesia in Palliative Care

Buprenorphine Use for Analgesia in Palliative Care

Reliability of urine drug testing among patients on buprenorphine transdermal patch

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