Soyka Michael
Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany ; Private Hospital Meiringen, Meiringen, Switzerland.
Subst Abuse Rehabil. 2015 Jan 6;6:1-14. doi: 10.2147/SAR.S45585. eCollection 2015.
Opioid maintenance therapy is a well-established first-line treatment approach in opioid dependence. Buprenorphine, a partial opioid agonist, has been found by numerous studies to be an effective and safe medication in the treatment of opioid dependence. At present, buprenorphine is available as a monodrug or in a fixed 4:1 ratio combination with naloxone. A diminished risk of diversion and abuse for the buprenorphine-naloxone combination is likely but not firmly established. Conventional formulations are given sublingually to avoid the hepatic first-pass effect. A novel film tablet is available only in the US and Australia. Other novel, sustained-release formulations (implant, depot) are currently being developed and tested. Recent studies, including a Cochrane meta-analysis, suggest that the retention with buprenorphine is lower than for methadone, but that buprenorphine may be associated with less drug use. Higher doses of buprenorphine are associated with better retention rates. Buprenorphine has a ceiling effect at the opioid receptor with regard to respiratory depression, and may cause fewer fatal intoxications than methadone. Possible antidepressant effects of buprenorphine and its use in comorbid psychiatric patients has not been studied in much detail. Clinical implications are discussed.
阿片类药物维持治疗是阿片类药物依赖中一种成熟的一线治疗方法。丁丙诺啡作为一种阿片类部分激动剂，众多研究已发现其在治疗阿片类药物依赖方面是一种有效且安全的药物。目前，丁丙诺啡有单一药物剂型，也有与纳洛酮按4:1固定比例的复方制剂。丁丙诺啡 - 纳洛酮复方制剂被转移和滥用的风险可能降低，但尚未得到确凿证实。传统剂型采用舌下给药以避免肝脏首过效应。一种新型薄膜片仅在美国和澳大利亚有售。其他新型缓释制剂（植入剂、长效注射剂）目前正在研发和测试中。近期研究，包括一项Cochrane系统评价，表明丁丙诺啡治疗的患者留存率低于美沙酮，但丁丙诺啡可能与较少的药物使用相关。更高剂量的丁丙诺啡与更好的留存率相关。在呼吸抑制方面，丁丙诺啡在阿片受体上有封顶效应，且可能比美沙酮导致更少的致命中毒情况。丁丙诺啡可能的抗抑郁作用及其在合并精神疾病患者中的应用尚未得到详细研究。本文讨论了其临床意义。
