From the Guidelines
Buprenorphine (Suboxone) is contraindicated in patients taking QT-prolonging agents.
Contraindications and Precautions
- The use of buprenorphine with QT-prolonging agents is contraindicated due to the risk of QT-interval prolongation 1.
- Concomitant use of buprenorphine and certain medications, such as serotonergic agents, amphetamines, or MAO inhibitors, may increase the risk of serotonin syndrome 1.
- Buprenorphine may precipitate opioid withdrawal in patients who are physically dependent on opioids, and its use should be avoided in these patients unless they are being treated for opioid addiction 1.
- Patients with a history of opioid use disorder should be carefully evaluated before initiating buprenorphine therapy, and the risks and benefits of treatment should be weighed 1.
Important Considerations
- Buprenorphine has a high affinity for the μ receptor, which can complicate pain treatment with opioids 1.
- The use of buprenorphine in patients with acute pain requires careful consideration of the potential risks and benefits, and alternative treatment options should be explored 1.
- Patients taking buprenorphine should be closely monitored for signs of opioid withdrawal, respiratory depression, and other adverse effects 1.
From the FDA Drug Label
Buprenorphine hydrochloride is contraindicated in patients with: • Significant respiratory depression [see WARNINGS]. • Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment [see WARNINGS]. • Known or suspected gastrointestinal obstruction, including paralytic ileus [see WARNINGS]. • Hypersensitivity to buprenorphine (e.g., anaphylaxis) or any other ingredient in buprenorphine hydrochloride [see WARNINGS].
The contraindications for Buprenorphine (Suboxone) are:
- Significant respiratory depression
- Acute or severe bronchial asthma in an unmonitored setting or without resuscitative equipment
- Known or suspected gastrointestinal obstruction, including paralytic ileus
- Hypersensitivity to buprenorphine or any other ingredient in buprenorphine hydrochloride 2
From the Research
Contraindications for Buprenorphine (Suboxone)
There are no direct contraindications mentioned in the provided studies. However, some potential concerns and limitations can be noted:
- The studies do not provide a comprehensive list of contraindications for buprenorphine.
- The addition of naloxone to buprenorphine may cause adverse effects in some patients, although these are generally considered mild and rare 3.
- The use of buprenorphine/naloxone in patients physically dependent on full agonist opioids may cause withdrawal effects if administered parenterally 4, 5.
- The studies suggest that buprenorphine can be safely used in patients with renal dysfunction, as it is mainly excreted through the liver 6.
- The pharmacokinetics of buprenorphine are unchanged in haemodialysis patients, which means that there is no need for dose-reduction with this drug 6.
Potential Barriers to Care
Some studies suggest that the insistence on prescribing combination product (buprenorphine/naloxone) can foster stigma and mistrust, creating barriers to care and increased risk of overdose and death 3.
- Limited access to buprenorphine monoproduct may be a barrier to treatment for some patients 3.
Key Points
- Buprenorphine is an effective treatment for opioid use disorder, with a superior safety profile compared to full opioid agonists 7.
- The addition of naloxone to buprenorphine is intended to reduce the potential for misuse, but may cause adverse effects in some patients 3.
- Buprenorphine can be safely used in patients with renal dysfunction, and its pharmacokinetics are unchanged in haemodialysis patients 6.