Hepatitis buprenorphine

Buprenorphine is metabolized by the liver mediated by cytochrome P450 3A4, and its clearance is related to hepatic blood flow. Plasma protein binding is about 96%. The mean elimination half-life from plasma is 37 hours. 

Hepatitis Cases of cytolytic hepatitis and hepatitis with jaundice have been observed in the addict population receiving buprenorphine both in clinical trials and in postmarketing adverse event reports. 

The sublingual surface area is relatively small but has a rich blood supply. The major advantage of this route is avoidance of intestinal destruction and hepatic first pass metabolism. However, absorption can be highly variable critical factors are the residence time of the drug in the mouth and saliva flow. Premature swallowing or excessive saliva production preclude efficient absorption. Nitroglycerin, nifedipine, propranolol, and buprenorphine are all available as sublingual preparations. Rectal... 

OPIOIDS ANTIFUNGALS 1, Ketoconazole T effect of buprenorphine 2. Fluconazole and itraconazole T the effect of alfentanil 3. Fluconazole and possibly voriconazole T effect of methadone this is a recognized pharmacokinetic effect but of uncertain clinical significance 1. Ketoconazole 1 the CYP3A4-mediated metabolism of buprenorphine 2.1 clearance of alfentanil 3.1 hepatic metabolism 1. The dose of buprenorphine needs to be 1 (by up to 50%) 2. i dose of alfentanil 3. Watch for T effects of methadone... 

A 33-year-old man developed severe hepatitis after an oral overdose of buprenorphine tablets 112 mg over 48 hours (8). He presented with an acute confusional state, including disorientation in time and space. The condition led to anuria and hepatorenal insufficiency. He was successfully treated with hemodialysis. 

With increasing use of buprenorphine in the treatment of opioid dependence, it has been confirmed that the use of buprenorphine in opioid-dependent individuals with a history of hepatitis causes significant increases in aspartate transaminase and alanine transaminase activities (9). Liver enzymes should be monitored before giving buprenorphine to patients with hepatitis. 

Intravenous buprenorphine abuse precipitated acute-on-chronic hepatitis in a 25-year-old woman who was hepatitis C positive with a history of chronic diamorphine dependence (11). 

Petty NM, Bickel WK, Piasecki D, Marsch LA, Badger GJ. Elevated liver ettzyme levels in opioid-dependent patients with hepatitis treated with buprenorphine. Am J Addict 2000 9(3) 265-9. 

Berson A, Gervais A, Cazals D, Boyer N, Durand F, Bernuau J, MarceUm P, Degott C, VaUa D, Pessayre D. Hepatitis after mtravenoirs buprenorphine misuse in heroin addicts. J Hepatol 2001 34(2) 346-50. 

Verrando R, Robaeys G, Madiei C, Buntinx F. Mediadone and buprenorphine maintenance therapies for patients wiA hepatitis C virus infected after intravenous drug use. Acta Gastroenterol Belg (2005) 68, 81-5. 

Liver Therapeutic doses of buprenorphine have been linked to acute hepatitis and renal failure [185 ]. 

A 33-year-old man with a history of heroin addiction, alcohol abuse, and hepatitis C infection, developed hepatic and renal failure after switching from methadone to buprenorphine 20 mg/day. Investigations excluded the possibility of hepatitis reactivation. 

The authors highlighted the need for liver function monitoring in the first few weeks of buprenorphine treatment in susceptible patients, such as those with hepatitis, alcohol abuse, or concomitant use of drugs that cause mitochondrial toxicity. 

Two patients developed acute hepatitis that occurred after abuse of buprenorphine intravenously [186 ]. Both were taking... 

Peyriere H, Tatem L, Bories C, Pageaux G-P, Blayac J-P, Larrey D. Hepatitis after intravenous injection of sublingual buprenorphine in acute hepatitis C carriers report of two cases of disappearance of viral replication after acute hepatitis. Ann Pharmacother 2009 43(5) 973-7. 

LIVER A long-term study of patients with hepatitis C who were randomised to buprenorphine versus methadone for long-term pain control did not show any adverse elevation to transaminases over a 4-week period [85 -]. The combination product buprenorphine/naloxone, however, was associated with an elevated aminotransferase in 25/150 (17%) HIV-negative patients over 4 weeks in a different study [86 ]. 

Drug-drug interactions Treatment of pain with opiates can be complicated by respiratory depression and lethargy from overmedication. Buprenorphine is hepatically metabolised by the CYP3A4. Coadministration with a CYP3A4 inhibitor, ketoconazole had no effect on the metabolism of buprenorphine from a transdermal patch delivering drug at 10 Tg/h [91 -]. 

A. Berson, A. Gervais, D. Cazais, N. Boyer, F. Durand, J. Bernau, P. Marcellin, C. Degott, D. Valla and D. Pessayre, Hepatitis after intravenous buprenorphine misuse in heroin addicts, J. Hepatol., 2001, 34, 346-350. 

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