Buprenorphine plus naloxone, a new substitution treatment

Abstract

I n 2001, about half of GPs were seeing opiate users and, of these, half prescribed an opioid substitute. 1 GP prescribing of methadone in England has nearly doubled since then, reaching a total of 2.2 million prescriptions in 2006. 2,3 Prescribing of buprenorphine (Subutex) for opioid substitution has increased nearly 20-fold since 2000, with 611 000 prescriptions dispensed in 2006. 3 These trends suggest an increase in treatment coverage for opioid substitution prescribing, 4 much of which occurs in the community.The National Treatment Agency for Substance Misuse estimates that the numbers of people in contact with treatment services in England was 192 248 in the year Buprenorphine plus naloxone, a new substitution treatment PRODUCT PROFILEProprietary name: Suboxone Constituents: buprenorphine and naloxone Indication: substitution treatment for opioid drug dependence Dosage and method of administration: sublingual tablets dissolved under the tongue; initially one to two 2mg/0.5mg tabs at least six hours after last use of opioid, one or two additional tablets may be administered if necessary; dosage increased according to patient response; maximum single daily dose 24mg; dosage titrated according to clinical and psychological status of the patient in steps of 2-8mg; not recommended for use in children under 15 due to lack of data on safety Contraindications: hypersensitivity to the active substance or to any of the excipients; severe respiratory insufficiency; severe hepatic insufficiency; acute alcoholism or delirium tremens Precautions: caution advised in adolescents (age 15-18) due to lack of data; patients should be closely monitored during switching period from buprenorphine or methadone to Suboxone since withdrawal symptoms have been reported; diversion; precipitated withdrawal due to the partial agonist profile of buprenorphine; withdrawal symptoms may also be associated with suboptimal dosing; risk of serious adverse effects such as overdose or treatment drop-out is greater if a patient is underdosed and continues to self medicate; dependence, buprenorphine is a partial agonist at the mu-opiate receptor and chronic administration produces dependence of the opioid type; respiratory depression; hepatitis and hepatic events; athletes must be aware that this medicine may cause a positive reaction to 'antidoping' tests; as with other opioids, caution is requested in patients using buprenorphine and having head injury, increased intracranial pressure, hypotension, prostatic hypertrophy or urethral stenosis; patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine Pregnancy and lactation: not recommended during pregnancy or breastfeeding Interactions: alcoholic drinks or medications containing alcohol; when co-administered with benzodiazepines may result in death due to respiratory depression; reduced level of alertness can make driving and using machines hazardous with other CNS depressants, other opioid der...