Opioid use disorder: Buprenorphine/Naloxone, Methadone & Naltrexone.

MET

BUP

NTX

BASELINE LABS

• EKG

• Liver function test (transaminases)

• Liver function test (transaminases, bilirubin)

• Kidney function test (CrCl > 50 mL/min).

• B-HCG for females.

MONITORING

• Signs of respiratory and CNS depression

• Liver function tests: prior to initiation and during therapy.

• Liver function tests: 6 months then 12 months and then every 12 monthly.

DOSAGE

INITIAL DOSE: 20-30 mg daily dose. 

MAINTENANCE DOSE: 60- 120 mg daily dose.

Titrate carefully, consider methadone’s delayed cumulative effects.

Patients dependent on short acting opioids:

• Day 1: up to 8mg/2mg (in divided doses).

• Day 2: up to 16mg/4mg (as single dose).

Patients dependent on methadone or long acting opioids:

• induction onto BUP mono-therapy on Day 1 & 2. 

MAINTENANCE DOSE:

• 16 mg/4mg.

380 mg delivered intramuscularly every 4 weeks or once a month.

HEPATIC

IMPAIRMENT

• Reduce dose

• Reduce dose

• not evaluated

RENAL

IMPAIRMENT

• Reduce dose

• unknown

• Mild renal impairment: no dosage adjustment.

• Moderate- severe renal impairment: caution.

CONTRA-INDICATION

• Hypersensitivity.

• Patients with respiratory depression.

• Patients with acute bronchial asthma or hypercarbia.

• Patient who has or is suspected of having a paralytic ileus.

• Hypersensitivity.

• Hypersensitivity.

• Acute hepatitis or liver failure. 

• receiving opioid analgesics. 

• current physiologic opioid dependence. 

• acute opioid withdrawal.

• failed naloxone challenge test or has positive urine screen for opioids.