Buprenorphine/Naloxone: Difference between revisions
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Terminology: medicine → med (shorter form per user preference) |
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| duration = 24–36 h (driven by buprenorphine) | | duration = 24–36 h (driven by buprenorphine) | ||
| halflife = 24–42 h (buprenorphine); 1–2 h (naloxone) | | halflife = 24–42 h (buprenorphine); 1–2 h (naloxone) | ||
| bioavailability = Buprenorphine ~30% SL; naloxone <10% SL (intentional | | bioavailability = Buprenorphine ~30% SL; naloxone <10% SL (intentional, inactive sublingually, matters only if injected) | ||
| pregnancy = Category C (buprenorphine-only formulations preferred in pregnancy) | | pregnancy = Category C (buprenorphine-only formulations preferred in pregnancy) | ||
| legal = Schedule III in US; X-waiver no longer required (as of 2023) | | legal = Schedule III in US; X-waiver no longer required (as of 2023) | ||
| mechanism = Buprenorphine: high-affinity partial agonist at the μ-opioid receptor with ceiling effect on respiratory depression. Naloxone: abuse-deterrent | | mechanism = Buprenorphine: high-affinity partial agonist at the μ-opioid receptor with ceiling effect on respiratory depression. Naloxone: abuse-deterrent, inactive SL but precipitates withdrawal if injected. | ||
| intro = Buprenorphine/naloxone (most widely known as Suboxone) is one of the two pillars of med-assisted treatment for opioid use disorder. The partial-agonist nature of buprenorphine gives it a ceiling effect on respiratory depression | | intro = Buprenorphine/naloxone (most widely known as Suboxone) is one of the two pillars of med-assisted treatment for opioid use disorder. The partial-agonist nature of buprenorphine gives it a ceiling effect on respiratory depression, far safer than full agonists like methadone. The naloxone is essentially inert SL; it exists as an injection deterrent. See [[Buprenorphine]] for the pharmacology of the active component. | ||
| indications = | | indications = | ||
| dosing = | | dosing = | ||
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| pharmacodynamics = | | pharmacodynamics = | ||
| interactions = <pharmaInteractions/> | | interactions = <pharmaInteractions/> | ||
| pregnancy_details = Prefer buprenorphine monoproduct (Subutex) in pregnancy when possible | | pregnancy_details = Prefer buprenorphine monoproduct (Subutex) in pregnancy when possible, more pregnancy data. | ||
| monitoring = Withdrawal scale (COWS) during induction; LFTs at baseline + periodically; toxicology screens per program. | | monitoring = Withdrawal scale (COWS) during induction; LFTs at baseline + periodically; toxicology screens per program. | ||
| counseling = '''Precipitated withdrawal''': do not induct until in moderate withdrawal (COWS ≥ 8–12). Hold under tongue until fully dissolved | | counseling = '''Precipitated withdrawal''': do not induct until in moderate withdrawal (COWS ≥ 8–12). Hold under tongue until fully dissolved, do not chew or swallow. Combine with counseling and recovery support. | ||
| anecdotes = | | anecdotes = | ||
| seealso = [[Buprenorphine]], [[Methadone]], [[Naltrexone]], [[Naloxone]] | | seealso = [[Buprenorphine]], [[Methadone]], [[Naltrexone]], [[Naloxone]] | ||