Bhatia Gayatri, Sarkar Siddharth
National Drug Dependence TreatMent Centre, All India Institute of Medical Sciences, New Delhi, India.
Asian J Psychiatr. 2020 Oct;53:102121. doi: 10.1016/j.ajp.2020.102121. Epub 2020 May 16.
Buprenorphine- Naloxone Fixed Dose Combination (BNX) is widely used to manage opioid use disorders. Contrary to evidence based concepts about sublingual bio-availability of naloxone, a few small studies have reported non-negligible amounts absorbed sublingually. But the extent to which these amounts exert opioid antagonist effects is yet to be established. We hereby report the first case of opioid dependence who developed a rare phenomenon of moderate to severe opioid withdrawal symptoms on administration of sublingual BNX after several days of being stabilized on plain buprenorphine (BUP). The case demonstrates the need to consider using buprenorphine monotherapy whenever such adverse effects are encountered. We also discuss the possible pharmacological explanations behind this rare side effect.
丁丙诺啡-纳洛酮固定剂量复方制剂（BNX）被广泛用于治疗阿片类药物使用障碍。与基于证据的关于纳洛酮舌下生物利用度的概念相反，一些小型研究报告称舌下吸收的量不可忽略。但这些量发挥阿片类拮抗剂作用的程度尚待确定。我们在此报告首例阿片类药物依赖患者，该患者在使用普通丁丙诺啡（BUP）稳定数天后，服用舌下BNX后出现了罕见的中度至重度阿片类戒断症状现象。该病例表明，遇到此类不良反应时需要考虑使用丁丙诺啡单一疗法。我们还讨论了这种罕见副作用背后可能的药理学解释。
