Buprenorphine - Revision history

Aidan: added BUP-XR

2023-03-12T21:22:27Z

added BUP-XR

← Older revision		Revision as of 21:22, 12 March 2023
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	\|stop all remaining opioids		\|stop all remaining opioids
	\|}		\|}

			=== Extended-Release Monthly Injection (BUP-XR) ===

			* Consider once stabilized on 8 to 24 mg buprenorphine for at least 7 days
			* 300 mg SC monthly for the first 2 months, followed by 100 mg SC monthly maintenance

	=== Perioperative Management ===		=== Perioperative Management ===

Aidan at 01:46, 27 July 2022

2022-07-27T01:46:53Z

← Older revision		Revision as of 01:46, 27 July 2022
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	\|}		\|}

	===Microdosing ~~Protocol~~===		===Microdosing Protocols===

	*Suboxone combined with a short-acting opioid such as [[hydromorphone]]		*Suboxone combined with a short-acting opioid such as [[hydromorphone]]
	*In general, all opioids can be stopped once at a dose of buprenorphine 12 mg daily		*In general, all opioids can be stopped once at a dose of buprenorphine 12 mg daily

			====Short-Acting Opioids (Daily Dosing)====
	====Standard====
	{\| class="wikitable"		{\| class="wikitable"
	!Day!!Burprenorphine!!Short-acting opioid		!Day!!Burprenorphine!!Short-acting opioid
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	\|}		\|}

			==== Short-Acting Opioids (Twice-Daily Dosing) ====
	====Moderate====
	{\| class="wikitable"		{\| class="wikitable"
	!Day!!Burprenorphine!!Short-acting opioid		!Day!!Burprenorphine!!Short-acting opioid
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	\|3\|\|1 mg bid\|\|maintain		\|3\|\|1 mg bid\|\|maintain
	\|-		\|-
	\|4\|\|2 mg bid\|\|~~maintain~~		\|4\|\|2 mg bid + 2 mg q1h prn (maximum of 12 mg)\|\|stop
⚫	\|-
⚫	\|5\|\|3 mg bid\|\|maintain
⚫	\|-
⚫	\|6\|\|4 mg ~~bid~~\|\|maintain
⚫	\|-
⚫	\|7\|\|5 mg ~~bid~~\|\|maintain
⚫	\|-
	\|8\|\|12 mg daily\|\|stop
	\|}		\|}

			==== Long-Acting Opioids (Daily Dosing) ====
	====Rapid====

			* Including fentanyl, fentanyl patches, and methadone

	{\| class="wikitable"		{\| class="wikitable"
	!Day!!Burprenorphine!!Short-acting opioid		!Day!!Burprenorphine!!Short-acting opioid
	\|-		\|-
	\|1\|\|0.5 mg ~~q4h x4~~\|\|maintain		\|1\|\|0.5 mg\|\|maintain
	\|-		\|-
	\|2\|\|1 mg ~~q4h x4~~\|\|maintain		\|2\|\|1 mg\|\|maintain
	\|-		\|-
	\|3\|\|2 mg ~~q4h x4~~\|\|maintain		\|3\|\|1.5 mg\|\|maintain
		⚫	\|-
		⚫	\|4\|\|2 mg\|\|maintain
		⚫	\|-
			\|5\|\|2.5 mg\|\|maintain
		⚫	\|-
		⚫	\|6\|\|3 mg\|\|maintain
		⚫	\|-
			\|7\|\|4 mg\|\|maintain long-acting; stop any short-acting opioids
			\|-
			\|8
			\|5 mg
			\|maintain
			\|-
			\|9
			\|6 mg
			\|maintain
			\|-
			\|10
			\|7 mg
			\|maintain
			\|-
			\|11
			\|8 mg
			\|maintain
			\|-
			\|12
			\|10 mg
			\|maintain
	\|-		\|-
			\|13
	\|4\|\|4 mg q4h x4\|\|stop
			\|12 mg
			\|maintain
	\|-		\|-
			\|14
	\|5\|\|16 mg daily + 2 mg prn\|\|stop
			\|12 mg
			\|stop all remaining opioids
	\|}		\|}

			====Long-Acting Opioids (Twice-Daily Dosing)====
	====Ultra-rapid====
	{\| class="wikitable"		{\| class="wikitable"
			!Day!!Burprenorphine!!Short-acting opioid
	!Day!!Buprenorphine!![[Hydromorphone]]
	\|-		\|-
	\|1\|\|0.5 mg ~~q3h (max 2.5 mg)~~\|\|~~3 mg po q4h + 2-4 mg po q4h prn~~		\|1\|\|0.5 mg daily\|\|maintain
	\|-		\|-
		⚫	\|2\|\|0.5 mg bid\|\|maintain
	\|2\|\|1 mg q3h (max 8 mg)\|\|3 mg po q4h + 2-4 mg po q4h prn
	\|-		\|-
	\|3\|\|12 mg ~~daily~~\|\|~~stop~~		\|3\|\|1 mg bid\|\|maintain
			\|-
			\|4\|\|2 mg bid\|\|maintain long-acting, stop any short-acting opioids
			\|-
			\|5
			\|3 mg bid
			\|maintain
			\|-
			\|6
			\|4 mg bid
			\|maintain
			\|-
			\|7
			\|12 mg + 2 mg q1h prn (maximum 16 mg)
			\|stop all remaining opioids
	\|}		\|}

	===Perioperative ~~management~~===		=== Perioperative Management ===

	*Ideally, continue buprenorphine treatment without interruption and use higher doses of opioid analgesia		*Ideally, continue buprenorphine treatment without interruption and use higher doses of opioid analgesia
	*If going to hold buprenorphine for surgery:		*If going to hold buprenorphine for surgery:
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	*[https://www.porticonetwork.ca/documents/204049/0/Opioids+enabler+PDF/f67d20ec-3666-489a-a2dc-ebb5d63225f6 Opioid Enabler] cheat sheet from Portico Network		*[https://www.porticonetwork.ca/documents/204049/0/Opioids+enabler+PDF/f67d20ec-3666-489a-a2dc-ebb5d63225f6 Opioid Enabler] cheat sheet from Portico Network
	*Use of microdoses for induction of buprenorphine treatment with overlapping full opioid agonist use: the Bernese method. ''Subst Abuse Rehabil''. 2016; 7: 99–105. doi: [https://doi.org/10.2147/SAR.S109919 10.2147/SAR.S109919]		*Use of microdoses for induction of buprenorphine treatment with overlapping full opioid agonist use: the Bernese method. ''Subst Abuse Rehabil''. 2016; 7: 99–105. doi: [https://doi.org/10.2147/SAR.S109919 10.2147/SAR.S109919]
			*Buprenorphine/Naloxone Microdosing: The Bernese Method. A Brief Summary for Primary Care Clinicians. 2019. Available at https://www.metaphi.ca/wp-content/uploads/Guide_Microdosing.pdf

	[[Category:Opioid substitution therapy]]		[[Category:Opioid substitution therapy]]

Aidan: /* Perioperative management */

2020-07-21T12:12:27Z

Perioperative management

← Older revision		Revision as of 12:12, 21 July 2020
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	\|}		\|}

	=== Perioperative management ===		===Perioperative management===

			*Ideally, continue buprenorphine treatment without interruption and use higher doses of opioid analgesia
⚫	* Consider tapering to 12 mg daily 2 to 3 days prior to surgery, or as low as 8 mg if a large or painful surgery
			*If going to hold buprenorphine for surgery:
⚫	* For the surgery itself, use NSAIDs, [[fentanyl]], regional blocks, adjuncts, and non-pharmacologic options
		⚫	**Consider tapering to 12 mg daily 2 to 3 days prior to surgery, or as low as 8 mg if a large or painful surgery
⚫	* Post-op, resume original dose as soon as possible, possibly split bid to tid to optimize for pain control, and continue non-buprenorphine pain management, including full agonist opioids if needed
		⚫	**For the surgery itself, use NSAIDs, [[fentanyl]], regional blocks, adjuncts, and non-pharmacologic options
		⚫	**Post-op, resume original dose as soon as possible, possibly split bid to tid to optimize for pain control, and continue non-buprenorphine pain management, including full agonist opioids if needed

	==Further Reading==		==Further Reading==

Aidan: /* Ultra-rapid */

2020-07-20T19:36:12Z

Ultra-rapid

← Older revision		Revision as of 19:36, 20 July 2020
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	====Ultra-rapid====		====Ultra-rapid====
	{\| class="wikitable"		{\| class="wikitable"
	!Day!!~~Burprenorphine~~!![[Hydromorphone]]		!Day!!Buprenorphine!![[Hydromorphone]]
	\|-		\|-
	\|1\|\|0.5 mg q3h (max 2.5 mg)\|\|3 mg po q4h + 2-4 mg po q4h prn		\|1\|\|0.5 mg q3h (max 2.5 mg)\|\|3 mg po q4h + 2-4 mg po q4h prn

Aidan: added small periop section

2020-07-10T00:08:47Z

added small periop section

Show changes

Aidan: /* Further Reading */ added Canadian guidelines

2020-07-05T13:41:31Z

Further Reading: added Canadian guidelines

← Older revision		Revision as of 13:41, 5 July 2020
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	== Further Reading ==		== Further Reading ==
			* Management of opioid use disorders: a national clinical practice guideline. ''CMAJ''. 2018;190(9):E247-E257. doi: [https://doi.org/10.1503/cmaj.170958 10.1503/cmaj.170958]
	* [https://www.porticonetwork.ca/documents/204049/0/Opioids+enabler+PDF/f67d20ec-3666-489a-a2dc-ebb5d63225f6 Opioid Enabler]		* [https://www.porticonetwork.ca/documents/204049/0/Opioids+enabler+PDF/f67d20ec-3666-489a-a2dc-ebb5d63225f6 Opioid Enabler] cheat sheet from Portico Network
	* ~~Hämmig R ''et al.'' [https://dx.doi.org/10.2147%2FSAR.S109919~~ Use of microdoses for induction of buprenorphine treatment with overlapping full opioid agonist use: the Bernese method]. ''Subst Abuse Rehabil''. 2016; 7: 99–105.		* Use of microdoses for induction of buprenorphine treatment with overlapping full opioid agonist use: the Bernese method. ''Subst Abuse Rehabil''. 2016; 7: 99–105. doi: [https://doi.org/10.2147/SAR.S109919 10.2147/SAR.S109919]

	[[Category:Opioid substitution therapy]]		[[Category:Opioid substitution therapy]]

Aidan: added Hamilton titration protocols

2020-07-05T13:38:43Z

added Hamilton titration protocols

@@ Line 1: / Line 1: @@
 == Background ==
-* Recommended as first-line treatment for [[opioid use disorder]]
+* Recommended as first-line treatment for [[opioid use disorder]] in Canadian guidelines
-* Typically coformulated with naloxone (trade name Suboxone) at a dose of 2 mg buprenorphine to 0.5 mg naloxone
+* Typically coformulated with [[naloxone]] (trade name Suboxone) at a dose of 2 mg buprenorphine to 0.5 mg [[naloxone]]
-* Buprenorphine is partial mu-opioid receptor agonist
+* Buprenorphine is partial μ-opioid receptor agonist
-* Theoretical ceiling effect
+* Theoretical ceiling effect on side effects
 == Dosing ==
-=== Full Start ===
+=== Standard Induction Protocol ===
 * It's use can precipitate withdrawal, so wait 12-24h after short-acting opioids, 18-36h after long-acting, or after tapering methadone, before starting buprenorphine
 == Further Reading ==

Aidan at 01:26, 4 July 2020

2020-07-04T01:26:36Z

@@ Line 1: / Line 1: @@
-== Further Reading ==
+== Background ==
 * [https://www.porticonetwork.ca/documents/204049/0/Opioids+enabler+PDF/f67d20ec-3666-489a-a2dc-ebb5d63225f6 Opioid Enabler]
 * Hämmig R ''et al.'' [https://dx.doi.org/10.2147%2FSAR.S109919 Use of microdoses for induction of buprenorphine treatment with overlapping full opioid agonist use: the Bernese method]. ''Subst Abuse Rehabil''. 2016; 7: 99–105.
 [[Category:Opioid substitution therapy]]

Maintenance script: Imported from text file

2020-07-04T01:17:26Z

Imported from text file

New page

== Further Reading ==

* [https://www.porticonetwork.ca/documents/204049/0/Opioids+enabler+PDF/f67d20ec-3666-489a-a2dc-ebb5d63225f6 Opioid Enabler]
* Hämmig R ''et al.'' [https://dx.doi.org/10.2147%2FSAR.S109919 Use of microdoses for induction of buprenorphine treatment with overlapping full opioid agonist use: the Bernese method]. ''Subst Abuse Rehabil''. 2016; 7: 99–105.

[[Category:Opioid substitution therapy]]