Adult: Expressed as buprenorphine: Initially, 2-4 mg once daily, may admin an additional dose of 2-4 mg on day 1 depending on patient's response. Increased in increments of 2-8 mg according to response. Total wkly dose may be divided and given on alternate days or 3 times wkly. Max: 24 mg daily.
May be taken with or without food. Place under the tongue & allow to dissolve completely.
Severe resp insufficiency, acute alcoholism or delirium tremens. Severe hepatic impairment. Concomitant admin w/ opioid antagonists (naltrexone, nalmefene).
Patient w/ head injury, intracranial lesions, other circumstances where cerebrospinal pressure may be increased, history of seizure; hypotension, prostatic hypertrophy, urethral stenosis; myxoedema, hypothyroidism, adrenal cortical insufficiency (e.g. Addison's disease); biliary tract dysfunction. Severe renal and moderate hepatic impairment. Debilitated patients. Pregnancy and lactation.
This drug may cause drowsiness, dizziness or impaired thinking, if affected, do not drive or operate machinery.
Monitor LFTs prior to and periodically during treatment; resp and mental status, CNS depression, symptoms of withdrawal, signs of addiction.
Symptoms: Resp depression, amblyopia, miosis, somnolence, hypotension, nausea, vomiting, and speech disorders. Management: Supportive and symptomatic treatment. Assure a patent airway and assisted or controlled ventilation.
Concomitant admin w/ benzodiazepines may result to death due to resp depression. May increase CNS depression w/ other CNS depressants and other opioid derivatives (e.g. methadone, antitussives, analgesics), barbiturates, clonidine, neuroleptics, anxiolytics other than benzodiazepines, sedative H1-receptor antagonists, certain antidepressants. May reduce plasma levels w/ CYP3A4 inducers (e.g. phenobarbital, carbamazepine). May exaggerate effects w/ MAOIs. Potentially Fatal: Blocked pharmacological effects w/ opioid antagonists (naltrexone, nalmefene).
May enhance sedative effect w/ alcohol.
Description: Buprenorphine is a partial agonist/antagonist at the µ- and kappa-opioid receptor of the brain. Its activity is attributed to its slowly reversible properties w/ the µ-opioid receptors which, over a prolonged period may minimise the need of addicted patients for drugs. Naloxone, a potent antagonist at the µ-opioid receptors, produces marked opioid antagonist effects and opioid withdrawal, thus deterring IV abuse. Pharmacokinetics: Absorption: Buprenorphine: Absorbed through the buccal mucosa. Time to peak plasma concentration: 90 min. Naloxone: Absorbed from the GI tract. Distribution: Buprenorphine: It crosses the placenta, enters breast milk (small amounts). Plasma protein binding: Approx 96%. Naloxone: Extensively distributed into body tissues and fluids, particularly the brain; crosses the placenta. Plasma protein binding: Approx 32-45%. Metabolism: Buprenorphine: Hepatically metabolised via oxidation by CYP3A4 isoenzyme to active metabolite N-dealkylbuprenorphine (norbuprenorphine), and via conjugation to glucuronide metabolites. Naloxone: Hepatically metabolised via glucuronide conjugation, w/ naloxone-3-glucuronide as major metabolite. Excretion: Buprenorphine: Mainly via faeces (as unchanged drug); urine (as metabolites). Elimination half-life: 20 to >36 hr. Naloxone: Via urine (as metabolites).
N07BC51 - buprenorphine, combinations ; Belongs to the class of drugs used in the management of opioid dependence.
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