Buprenorphine (Suboxone, Norspan)

Last updated 20.09.12

 

Index

 

Definition

-  Partial opiod agonist

 

Features

-  Safe in OD as only partial opioid agonist

-  Patch = 7 days continuous analgesia

 

Indications

-  Maintainance therapy in opiod dependance (narcotics)

-  Decreases symptoms of withdrawal & cravings

-  Long term analgesia in chronic pain

-  When Tramadol or Codeine has been ineffective

-  Commonly combined w Naloxone for opiod withdrawal

-  Prevent diversion to IV

 

Contraindications

-  Myasthenai gravis

-  Delerium tremens

-  Pregnancy

-  Severe respiratory depression

 

Side Effects

-  Constipation, dyspepsia

-  Hypotension, dizzyness

-  Bradycardia

-  Nausea, vomiting

-  Patch

-  Site reaction

-  Somnolence

 

Doses

-  Oral (Suboxone)

-  Often crushed

-  Takes 2–10 min to dissolve

-  +/- 2–4mg in pm (day 1)

-  Inititation

-  Initial 4mg sublingually in am

-  Increase intial dose by 2–4mg every 2–3  days

-  Usual maintainance range 12–24mg/day

-  Patch (Norspan)

-  Transdermal patch for use over 7 days

-  Available as 5, 10, 15, 20, 25, 30, 40mcg/hr

-  Apply to hairless skin of upper arm, back or chest

-  Avoid scarred areas

-  Press in place for 30 seconds

-  Apply subsequent patches in another site (dont reuse for 3-4 weeks)

-  Inititation

-  5mcg/hr starting dose

-  Conversions

-  Codeine 60-150mg/day = 5mcg/hr Norspan

-  Codeine >150mg/day = 20mcg/hr Norpsan

-  Tramadol 100-200mg/day = 5mcg/hr Norpsan

-  Tramadol >200mg/day = 10mcg/hr Norspan

 

 

 

References

 

Norpsan Product Information, 2013