Buprenorphine

• Type: Opioid- maintenance therapy in opioid use disorder, rapid detox
• Dosage Forms: injectable solution, sublingual tablet
• Dosage Strengths: injectable solution: 0.3 mg/mL; sublingual tablet: 2, 8mg
• Routes of Administration: Buccal, sublingual, intradermal, transdermal, IV, IM
• Common Trade Names: Suboxone (buprenorphine + naloxone), Buprex

Highly variable dependent on individual

• Initial dose for patients with Clinical Opioid Withdrawal Scale (COWS) >8: 4mg, observe 45min, redose if COWS remains >8 *Suboxone initial induction dose: 2mg/0.5mg or 4mg/1mg, titrate up by 2-4mg q2h based on withdrawal symptoms up to 8mg/1mg[1]

NIH National Institute on Drug Abuse ED Buprenorphine algorithm[2]

Variable

• Pregnancy Rating: C
• Lactation risk: Infant risk has been demonstrated
• Hepatic dosing: reduce dose or do not use in moderate - severe impairment
• Renal dosing:

• Allergy to class/drug
• SBO, paralytic ileus
• Acute/severe asthma (if unmonitored), respiratory depression

• Half-life: 24-48 hours
• Metabolism: Extensive hepatic, CYP3A4 substrate
• Excretion: Mostly fecal, some renal

• Mixed opiate agonist-antagonist, partial mu-opioid agonist, kappa-opioid antagonist

• No DATA 2000 Waiver (aka X Waiver) required to administer within the ED for up to 72h (e.g. patient can come back to ED for daily dose for 3 days)[3]

• Opioids
• Opioid overdose
• Opioid withdrawal