● Unlike treatment for OUD, buprenorphine for analgesia should be given in three to four daily doses. Other patients with poor pain control and function who do not tolerate taper well may do better with a very slow taper over many months or even years. 137 Tapering decision points are shown in the following flow chart with the reminder that follow- up timing should be frequent and individualized (Figure 4). 73 Patients who continue on high-dose or otherwise high-risk regimens should be monitored, provided with overdose education and naloxone, and periodically encouraged toward appropriate therapeutic changes. 73
Check the prescribing information for safe induction practice, 147 and consider the following safety principles with buprenorphine analgesia treatment as endorsed by an expert panel: 137 ● Buprenorphine may produce acute opioid withdrawal in patients on full mu agonists. ● Patients discontinue all opioids the night before initiation (time depending on duration of action). ● After mild withdrawal is present, initiate 2-4 mg (repeated at two-hour intervals, if well tolerated, until withdrawal symptoms resolve). ● Typically, 4-8 mg will be needed the first day. ● Reevaluate on day two and increase dose if needed. ● Total dose given on day two can then be prescribed as the daily dose.
Figure 4
Book Code: MDCO1025
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