Q.12: Buprenorphine Sublingual Tablets are indicated for the treatment of opioid dependence. Which of the following statement is correct regarding Buprenorphine?
- (a) Induction with buprenorphine should be undertaken when objective and clear signs of withdrawal are not evident.
- (b) Buprenorphine can’t be abused in a similar manner to other opioids.
- (c) Monitor liver function tests prior to initiation and during treatment.
- (d) Buprenorphine sublingual tablets are appropriate as an analgesic.
- (e) Buprenorphine is metabolized to norbuprenorphine primarily by cytochrome CYP1A2.
Answer –> C
Buprenorphine: Basic Facts
(1) Prior to induction with buprenorphine, consideration should be given to
- (a) the type of opioid dependence (i.e. long- or short-acting opioid);
- (b) the time since last opioid use, and
- (c) the degree or level of opioid dependence.
(2) To avoid precipitating withdrawal, induction with buprenorphine sublingual tablets should be undertaken when objective and clear signs of withdrawal are evident.
(3) Patients Taking Heroin or Other Short-acting Opioids: At treatment initiation, the dose of buprenorphine sublingual tablets should be administered
- (a) at least 4 hours after the patient last used opioids, or
- (b) preferably when moderate objective signs of opioid withdrawal appear.
(4) Maintenance Dose: is generally in the range of 4 mg to 24 mg buprenorphine per day depending on the individual patient. Doses higher than this have not been demonstrated to provide any clinical advantage.
(5) Buprenorphine can be abused in a similar manner to other opioids.
(6) Cases of cytolytic hepatitis and hepatitis with jaundice have been observed in individuals receiving buprenorphine in clinical trials and through post-marketing adverse event reports.
- Liver function tests, prior to initiation of treatment is recommended to establish a baseline.
- Periodic monitoring of liver function during treatment is also recommended.
(7) Buprenorphine sublingual tablets are NOT appropriate as an analgesic. There have been reported deaths of opioid naïve individuals who received a 2 mg sublingual dose of buprenorphine.
(8) Buprenorphine is metabolized to norbuprenorphine primarily by cytochrome CYP3A4; therefore, potential interactions may occur when buprenorphine sublingual tablets are given concurrently with agents that affect CYP3A4 activity.
Source: Buprenoprphine package insert.
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Dr. Harvinder Singh, M.D. (Admin)
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