Buprenorphine
Buprenorphine
CLINICAL USE
Opioid analgesic
DOSE IN NORMAL RENAL FUNCTION
Sublingual: 200–400 mcg every 6–8 hoursIM, Slow IV: 300–600 mcg every 6–8 hoursTransdermal:Transtec: 35–140 mcg/hour every 96 hoursButrans: 5–40 mcg/hour, change patch every 7 days PHARMACOKINETICS
Molecular weight :467.6 %Protein binding :96 %Excreted unchanged in urine : Minimal Volume of distribution (L/kg) :2.5half-life – normal/ESRD (hrs) :20–25 (Transdermal 30 hours)/Unchanged DOSE IN RENAL IMPAIRMENT
GFR (mL/MIN)
20 to 50 : Dose as in normal renal function 10 to 20 : Dose as in normal renal function, but avoid very large doses <10 : Reduce dose by 25–50% initially and increase as tolerated; avoid very large single doses Transdermal: Dose as in normal renal function DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD :Dialysed. Dose as in GFR <10 : mL/min HD :Dialysed. Dose as in GFR <10 : mL/minHDF/high flux :Dialysed. Dose as in GFR <10 : mL/minCAV/VVHD :Not dialysed. Dose as in GFR=10–20 mL/min IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugsAntidepressants: possible CNS excitation or depression (hypotension or hypertension) if administered with MAOIs or moclobemide – avoid concomitant use; sedative effects possibly increased when given with tricyclicsAntifungals: metabolism inhibited by ketoconazole –reduce buprenorphine doseSodium oxybate: avoid concomitant use ADMINISTRATION
Reconstition
– Route
Sublingual, IM, IV, transdermal Rate of Administration
–Comments
– OTHER INFORMATION
It may take up to 30 hours for plasma buprenorphine concentration to decrease by 50% after the Transtec or Butrans patch has been removedDo not give another opiate for 24 hours after the Transtec or Butrans patch has been removedNaloxone 5–12 mg may reverse the effects of Transtec or Butrans but the effect may be delayed by 30 minutesPatches are not suitable for acute pain
See how to identify renal failure stages according to GFR calculation
See how to diagnose irreversible renal disease
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