Department of Medicine, Division of General Internal Medicine, University of Kentucky College of Medicine, (DAO, CT); Center for Drug and Alcohol Research, University of Kentucky College of Medicine, (PAN, LCF); Department of Medicine, Division of Infectious Diseases, University of Kentucky College of Medicine (LCF).
J Addict Med. 2021;15(3):187-190. doi: 10.1097/ADM.0000000000000730.
It is not known whether buprenorphine/naloxone (bup/nx) can be safely initiated in hospitalized patients with acute hepatitis A infection. We assessed liver function and tolerability of bup/nx induction in patients with acute Hepatitis A Virus (HAV).
Retrospective review of patients (N = 31) admitted to a tertiary care facility for acute HAV who were evaluated by an addiction medicine consultant.
No significant difference was seen in aspartate aminotransferase, alanine aminotransferase, total bilirubin, or INR trends in patients receiving bup/nx during hospitalization versus those not receiving bup/nx. Nausea was the most common reported symptom in patients receiving bup/nx.
With careful monitoring and induction dose adjustment, bup/nx can be administered to patients with acute HAV without hepatic encephalopathy. Similarly, patients on bup/nx before hospitalization should not have this medication held in the setting of acute HAV.
This strategy may engage patients with acute HAV in treatment of OUD earlier and minimize disruptions in treatment.
目前尚不清楚在急性甲型肝炎感染住院患者中是否可以安全地开始使用丁丙诺啡/纳洛酮（丁丙诺啡/纳洛酮）。我们评估了急性甲型肝炎病毒（HAV）感染患者中丁丙诺啡/纳洛酮诱导的肝功能和耐受性。
回顾性分析了在一家三级保健机构住院的急性 HAV 患者（N=31），这些患者由一名成瘾医学顾问进行了评估。
在住院期间接受丁丙诺啡/纳洛酮治疗的患者与未接受丁丙诺啡/纳洛酮治疗的患者相比，天门冬氨酸氨基转移酶、丙氨酸氨基转移酶、总胆红素或 INR 趋势没有显著差异。接受丁丙诺啡/纳洛酮治疗的患者最常见的报告症状是恶心。
在仔细监测和诱导剂量调整的情况下，没有肝性脑病的急性 HAV 患者可以使用丁丙诺啡/纳洛酮。同样，在急性 HAV 情况下，不应在住院前使用丁丙诺啡/纳洛酮的患者停止使用该药。
这种策略可以使急性 HAV 患者更早地接受阿片类药物使用障碍的治疗，并减少治疗中断。
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