Menard Shannon, Jhawar Archana
Clinical Pharmacy Specialist, Department of Pharmacy Services, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; Clinical Pharmacy Specialist, University of Illinois at Chicago, College of Pharmacy, Chicago, Illinois.
Ment Health Clin. 2021 Nov 8;11(6):369-372. doi: 10.9740/mhc.2021.11.369. eCollection 2021 Nov.
Buprenorphine is a partial mu-opioid receptor agonist approved for the treatment of opioid dependence. The risk of withdrawal symptoms and wait time required to safely initiate buprenorphine provides challenges to both patients and providers. Microdose induction is proposed as a possible solution to ease the transition to buprenorphine; however, little data has been published to date on patients stabilized on methadone doses greater than 100 mg.
A 29-year-old patient stabilized on methadone 105 mg was successfully transitioned to sublingual buprenorphine-naloxone using a 7-day microdose protocol on an inpatient psychiatric service. During the transition, the patient reported only minimal symptoms.
This report adds to the growing literature supporting the use of a microdose induction to initiate buprenorphine-naloxone. Additionally, this approach may be significant for patients stabilized on high doses of methadone who may not be able to tolerate a traditional buprenorphine induction.
丁丙诺啡是一种被批准用于治疗阿片类药物依赖的μ-阿片受体部分激动剂。戒断症状风险以及安全启动丁丙诺啡所需的等待时间给患者和医疗服务提供者都带来了挑战。微剂量诱导被提议作为一种可能的解决方案，以缓解向丁丙诺啡过渡的过程；然而，迄今为止，关于服用大于100毫克美沙酮剂量且病情稳定的患者的数据很少。
一名服用105毫克美沙酮病情稳定的29岁患者，在住院精神科服务中采用7天微剂量方案成功过渡到舌下含服丁丙诺啡-纳洛酮。在过渡期间，患者仅报告了轻微症状。
本报告进一步丰富了支持使用微剂量诱导启动丁丙诺啡-纳洛酮的文献。此外，这种方法对于服用高剂量美沙酮且病情稳定但可能无法耐受传统丁丙诺啡诱导的患者可能具有重要意义。
