Buprenorphine + Naloxone

Thông tin thuốc gốc
Chỉ định và Liều dùng
Opioid dependence
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.
Suy gan
Severe: Contraindicated.
Cách dùng
May be taken with or without food. Place under the tongue & allow to dissolve completely.
Chống chỉ định
Severe resp insufficiency, acute alcoholism or delirium tremens. Severe hepatic impairment. Concomitant admin w/ opioid antagonists (naltrexone, nalmefene).
Thận trọng
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.
Tác dụng không mong muốn
Influenza, infection, pharyngitis, rhinitis, depression, anxiety, nervousness, abnormal thinking, decreased libido, migraine, hypertonia, dizziness, paraesthesia, somnolence, amblyopia, lacrimal disorder, HTN, vasodilatation, cough, diarrhoea, abdominal pain, vomiting, flatulence, dyspepsia, pruritus, urticaria, rash, back pain, arthralgia, myalgia, muscle spasms, urine abnormality, erectile dysfunction, chest pain, asthenia, pyrexia, chills, malaise, pain, peripheral oedema, abnormal LFT, decreased wt, injury.
Thông tin tư vấn bệnh nhân
This drug may cause drowsiness, dizziness or impaired thinking, if affected, do not drive or operate machinery.
Chỉ số theo dõi
Monitor LFTs prior to and periodically during treatment; resp and mental status, CNS depression, symptoms of withdrawal, signs of addiction.
Quá liều
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.
Tương tác
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).
Tương tác với thức ăn
May enhance sedative effect w/ alcohol.
Tác dụng
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.
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).
Đặc tính

Chemical Structure Image

Source: National Center for Biotechnology Information. PubChem Database. Buprenorphine, CID=644073, https://pubchem.ncbi.nlm.nih.gov/compound/Buprenorphine (accessed on Jan. 22, 2020)

Chemical Structure Image

Source: National Center for Biotechnology Information. PubChem Database. Naloxone, CID=5284596, https://pubchem.ncbi.nlm.nih.gov/compound/Naloxone (accessed on Jan. 22, 2020)

Bảo quản
Store between 20-25°C.
Phân loại MIMS
Thuốc giảm đau (opioid)
Phân loại ATC
N07BC51 - buprenorphine, combinations ; Belongs to the class of drugs used in the management of opioid dependence.
Tài liệu tham khảo
Anon. Buprenorphine and Naloxone. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 07/03/2016.

Buckingham R (ed). Buprenorphine. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/03/2016.

Buckingham R (ed). Naloxone Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/03/2016.

Buprenorphine Hydrochloride and Naloxone Hydrochloride Dehydrate Tablet (Actavis Pharma, Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 07/03/2016.

Joint Formulary Committee. Buprenorphine with Naloxone. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/03/2016.

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