Details About Generic Salt ::  Buprenop

Main Medicine Class:: Narcotic agonist-antagonist analgesic   

BYOO-preh-NAHR-feen HIGH-droe-KLOR-ide/NAL-ox-ohn HIGH-droe-KLOR-ide
Suboxone
Class: Narcotic agonist-antagonist analgesic

 

Drugs Class ::

 Action Buprenorphine: Analgesic effect caused by binding to opiate receptors in the CNS, while antagonist effects decrease abuse potential.

Naloxone: possibly antagonizes opioid effects by competing for the same receptor sites.

Indications for Drugs ::

 Indications Treatment of opioid dependence.

Drug Dose ::

 Route/Dosage

Adults and children (16 yr and older): SL Single daily dose in the range of 12 to 16 mg of buprenorphine. The dose should be adjusted in increments or decrements of 2 or 4 mg to a level that holds the patient in treatment and suppresses opioid withdrawal effects. This is likely to range between 4 and 24 mg/day.

Contraindication ::

 Contraindications Standard consideration.

Drug Precautions ::

 Precautions

Pregnancy: Category C. Lactation: Buprenorphine is excreted in breast milk. Children: Safety and efficacy not established in children below the age of 16 yr. Dependency: Buprenorphine has abuse potential. Psychological and physical dependence as well as tolerance may occur. Head injury or increased IOP: Use with caution; drug can increase CSF pressure. Special risk patients: Use with caution in elderly or debilitated patients; use with caution in patients with impaired hepatic, renal, or pulmonary function (eg, chronic obstructive pulmonary disease), myxedema or hypothyroidism, adrenal cortical insufficiency (eg, Addison disease), CNS depression or coma, toxic psychoses, prostatic hypertrophy or urethral stricture, acute alcoholism, delirium tremens or kyphoscoliosis, or biliary tract dysfunction. Withdrawal: Marked and intense withdrawal symptoms are likely to occur if misused parenterally by individuals dependent on opioid agonists; sublingual use may cause opioid withdrawal symptoms if administered before the agonist effects of the opioid have subsided.

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

CARDIOVASCULAR: Vasodilation. CNS: Headache; insomnia; anxiety; depression; dizziness; nervousness; somnolence. DERMATOLOGIC: Sweating. EENT: Rhinitis; pharyngitis; runny eyes. GI: Abdominal pain; constipation; diarrhea; nausea; vomiting; dyspepsia. RESPIRATORY: Increased cough. OTHER: Pain; back pain; withdrawal symptoms; abscess; asthenia; chills; fever; flu syndrome; infection; accidental injury.

Drug Mode of Action ::  

 Action Buprenorphine: Analgesic effect caused by binding to opiate receptors in the CNS, while antagonist effects decrease abuse potential.

Naloxone: possibly antagonizes opioid effects by competing for the same receptor sites.

Drug Interactions ::

 Interactions

Barbiturate anesthetics: May have additive effects with buprenorphine, increasing the respiratory and CNS effects. Benzodiazepines (eg, diazepam): Coma and death have been associated with misuse of buprenorphine and benzodiazepines. CNS depressants (eg, alcohol, phenothiazines, sedative-hypnotics): Increased CNS depression may occur. CYP3A4 inducers (eg, carbamazepine, phenytoin, rifampin): May reduce buprenorphine plasma levels, decreasing the efficacy. CYP3A4 inhibitors (eg, erythromycin, ketoconazole, ritonavir): May elevate buprenorphine plasma levels, increasing the risk of side effects.

Drug Assesment ::

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies. Note presence of hepatic or renal impairment, compromised respiratory function (eg, COPD), biliary tract dysfunction, acute abdominal condition, hypothyroidism, adrenal cortical insufficiency (Addison disease), CNS depression, toxic psychosis, prostatic hypertrophy or urethral stricture, acute alcoholism, delerium tremens, kyphoscoliosis, intracranial lesion, or history of recent head injury.
  • Document type of opioid dependence (eg, long-, short-acting), time since last opioid use, and degree of opioid dependence prior to starting therapy.
  • Ensure that liver enzymes and hepatic function are evaluated prior to starting therapy and periodically during treatment.
  • Monitor patient for respiratory depression. If noted, re-establish adequate ventilation with mechanical assistance and notify health care provider immediately. Naloxone may not be effective in reversing respiratory depression caused by this drug.
  • Monitor patient for narcotic withdrawal symptoms, CNS, GI, and general body side effects. Report to health care provider if noted and significant.
OVERDOSAGE: SIGNS & SYMPTOMS
  Pinpoint pupils, sedation, hypotension, respiratory depression, death

Drug Storage/Management ::

 Administration/Storage

  • For sublingual administration only. Do not chew, crush, or swallow tablets.
  • Buprenorphine and buprenorphine/naloxone tablets are interchangeable.
  • Do not initiate therapy until objective signs of opioid withdrawal are evident.
  • Administer prescribed dose once daily.
  • Place tablets under the tongue until they are dissolved. Swallowing tablets reduces effectiveness.
  • For dose requiring more than 2 tablets, place all tablets under the tongue and allow to dissolve. If patient cannot fit more than 2 tablets under the tongue at one time, then place 2 tablets under the tongue at a time.
  • Store tablets at controlled room temperature (59° to 86°F).

Drug Notes ::

 Patient/Family Education

  • Explain name, dose, action, and potential side effects of drug.
  • Advise patient to take prescribed dose once daily by placing tablet under the tongue until dissolved. For dose requiring more than 2 tablets, advise patient to place all tablets under the tongue and allow to dissolve. If patient cannot fit more than 2 tablets under the tongue at 1 time, then advise patient to place 2 tablets under the tongue at a time and repeat until entire dose has been taken.
  • Caution patient that swallowing tablets reduces effectiveness.
  • Advise patient to not change the dose or stop taking unless advised by the health care provider.
  • Caution patient to avoid alcoholic beverages and other CNS depressants (eg, narcotics, benzodiazepines) while taking this drug. Combined use may result in a serious toxicity and possibly death.
  • Advise patient to inform family members that, in the event of an emergency, the treating emergency personnel should be informed that the patient is physically dependent on narcotics and is being treated with buprenorphine.
  • Advise patient that drug may impair mental or physical abilities required for the performance of potentially hazardous tasks and to use caution while driving or performing other tasks requiring mental alertness until tolerance is determined.
  • Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
  • Instruct patient to lie or sit down if experiencing dizziness or lightheadedness when standing.
  • Advise patient to contact their health care provider if experiencing the following side effects: headache, insomnia, nausea, vomiting, abdominal pain.
  • Instruct patient not to take prescription or OTC drugs or dietary supplements without consulting with their health care provider.
  • Advise women to notify health care provider if pregnant, planning to become pregnant, or breastfeeding.
  • Advise patient that follow-up visits may be required to monitor therapy and to keep appointments.

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