Buprenorphine dosage

The initial dose of buprenorphine should be given at least 12-24 hours after the last heroin dose, 24 hours after the last methadone dose, or 48 hours after the last LAAM dose (see Table 2-3). The methadone dosage of methadone maintenance patients should be reduced to 30 mg/day before the transfer to buprenorphine is attempted. Ideally patients should show clear evidence of opiate withdrawal before receiving the first dose of buprenorphine, to avoid the risk that buprenorphine will precipitate more severe withdrawal. For the first day, sublingual buprenorphine/naloxone doses of 2/0.5-4/1 mg can be given every 2-4 hours, up to a maximum total dose of 8/2 mg/day. On the... 

Sporadic use (e.g., for the induction of sleep after a psychostimulant binge) does not require specific detoxification. Sustained use can be treated as described in the previous sections on detoxification from therapeutic or high dosages but with added caution. In mixed opioid and benzodiazepine abuse, the patient should be stabilized with methadone (some clinicians use other oral preparations of opioids) and a benzodiazepine. Buprenorphine should not be administered with benzodiazepines, because a pharmacodynamic interaction is possible (Ibrahim et al. 2000 Kilicarslan and Sellers 2000) and fatalities have been reported with the combination (Reynaud et al. 1998). Sedative-hypnotic withdrawal is the more medically serious procedure, and we usually... 

Buprenorphine in two formulations (both assigned to schedule III) was recently made available for office-based management of opioid dependence by qualified physicians. Once-daily dosage is titrated to a target of 16 mg/day (range, 4 to 24 mg/day). 

Reducing dosage and stopping treatment - Make the decision to discontinue therapy with buprenorphine or buprenorphine/naloxone after a period of maintenance or brief stabilization as part of a comprehensive treatment plan. Gradual and abrupt discontinuation have been used but there is not a best method of tapering the dose at the end of treatment. 

This probably reflects a common range of methods in practice, although from our own experience I would add that it seems better not to allow too much (or any) prior discussion of forthcoming reductions in dosage, as many reasons tend to be given to avoid these Again as examined in Chapter 2 there is virtually no support for benzodiazepine maintenance as there is for that with methadone and buprenorphine, and almost certainly benzodiazepines are far more often diverted to others than the opioid substitutes whose consumption can be supervised, with in the worst cases the tablets representing little more than currency. 

In contrast to reservoir patches, there is no risk of dosedumping a with matrix patch, which releases buprenorphine from a prolonged-release matrix in direct contact with the skin for at least 3 days. The improved solubility necessary to achieve an adequate concentration of dissolved buprenorphine base is obtained by means of well tolerated organic acids that do not form practically insoluble salts with buprenorphine in the undercooled mass in the matrix of the TTS. In Europe transdermal buprenorphine was developed by Grunenthal as Transtec , which was launched in Germany in 2001 and recently approved in major Europoean markets with dosages of 35, 52.5 and 70 pg/h containing 20, 30 and 40 mg buprenorphine per TDS respectively (Fig. 10 Terlinden et al., 2000). 

Das, N.G., and S.K. Das. 2004. Development of mucoadhesive dosage forms of buprenorphine for sublingual drug delivery. Drug Deliv 11 89. 

What are the prominent pharmacological characteristics of methadone and buprenorphine How is the dosage titration process carried out when a treatment with either methadone or buprenorphine is started ... 

Varescon I, Vidal-Trecan G, Nabet N, Boissonnas A. Substitution et mesusage I injection intraveineuse de buprenorphine haut dosage. [Buprenorphine abuse high dose intravenous administration of buprenorphine.] Encephale 2002 28(5 Pt 1) 397 02. 

The two formulations of the drug have been placed into schedule III by the DBA. Bach product is available in two dosage strengths, 2 mg and 8 mg. Once-daily doses are titrated to a target of 16 mg/day of buprenorphine, but the dosing range extends from 4 mg/day to 24 mg/day. 

The intensity of symptoms depends both on the drug and on its mode of administration, the dosage that the individual has been using, and the time from abrupt discontinuance. Full agonist opioids used IV, which include heroin, cause the most severe withdrawal symptoms. Management involves administration of oral methadone , buprenorphine, or clonidine, with gradual dose tapering. 

Pregnancy The roles of buprenorphine and methadone in the clinical management of opioid dependence during pregnancy and breast feeding have been reviewed [190 ]. The dosages must be tailored to the needs of each opioid-dependent pregnant woman. 

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