From the Guidelines
Bupropion is not recommended for treating oxymorphone withdrawal, and instead, medications like buprenorphine, methadone, or clonidine should be used under medical supervision. The standard treatment for opioid withdrawal, including from oxymorphone, involves these medications, not bupropion, which is primarily an antidepressant that works on norepinephrine and dopamine systems, but doesn't address the mu-opioid receptor activity needed to manage opioid withdrawal symptoms 1. For oxymorphone withdrawal, a patient should seek medical supervision for a proper detoxification protocol, which typically includes buprenorphine starting at 4-8mg sublingually when withdrawal symptoms appear, then titrated to control symptoms (usually 12-16mg daily), followed by a gradual taper, as supported by the clinical policy for critical issues related to opioids in adult patients presenting to the emergency department 1.
Key Points to Consider
- Buprenorphine is a partial opioid agonist that can occupy the same receptors as oxymorphone, preventing severe withdrawal while causing less respiratory depression and euphoria than full agonists.
- Supportive medications may include clonidine for autonomic symptoms, loperamide for diarrhea, and non-opioid pain relievers.
- Medical supervision is essential during opioid withdrawal due to potential complications and the high risk of relapse.
- The treatment protocol may vary, but buprenorphine-based algorithms are commonly used, with the goal of managing withdrawal symptoms and facilitating a gradual taper.
- It's crucial to note that bupropion, being an antidepressant, does not have a role in the management of opioid withdrawal symptoms, and its use in this context is not supported by evidence 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment for Oxymorphone Withdrawal
There are no research papers to assist in answering this question regarding the treatment for oxymorphone withdrawal using bupropion (Wellbutrin). However, the following information is available regarding opioid withdrawal treatment:
- Buprenorphine is a partial opioid agonist commonly used to treat opioid dependence 2, 3, 4, 5.
- Buprenorphine can be used to manage opioid withdrawal, with studies showing it to be more effective than clonidine in ameliorating withdrawal symptoms and increasing the likelihood of completion of withdrawal treatment 3, 4, 5.
- The severity of withdrawal is similar for withdrawal managed with buprenorphine and withdrawal managed with methadone, but withdrawal symptoms may resolve more quickly with buprenorphine 3, 4, 5.
- Buprenorphine may offer some advantages over methadone, at least in inpatient settings, in terms of quicker resolution of withdrawal symptoms and possibly slightly higher rates of completion of withdrawal 5.
- Newer agents, including tramadol and tizanidine, are being explored for the management of opioid withdrawal, but more research is needed to determine their effectiveness 6.
Key Findings
- Buprenorphine is effective in managing opioid withdrawal 3, 4, 5.
- Buprenorphine is more effective than clonidine in managing opioid withdrawal 3, 4, 5.
- Buprenorphine may have advantages over methadone in terms of quicker resolution of withdrawal symptoms and completion of withdrawal 5.