lunes, 7 de agosto de 2017

Buprenorfina / Buprenorphine

Agosto 7, 2017. No. 2773

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Buprenorfina para el dolor crónico. Una revisión de su efectividad
Buprenorphine for Chronic Pain: A Review of the Clinical Effectiveness [Internet].
Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2017 Jan.
CADTH Rapid Response Reports.
Buprenorphine is an opioid analgesic available in Canada as transdermal patches and sublingual tablets (tablets also contain naloxone).1,2Buprenorphine/naloxone is indicated for substitution treatment in opioid drug dependence in adults whereas transdermal buprenorphine is indicated for the management of pain severe enough to require daily, continuous, long-term opioid treatment. Buprenorphine produces typical opioid agonist effects and in higher doses its agonist effects reach a ceiling and it can act as an antagonist. This property distinguishes it from morphine. It has high affinity for mu opioid receptors but only weakly activates them.3 For this reason, buprenorphine may be less likely to cause respiratory depression than full opioid agonists such as fentanyl or morphine.4 When buprenorphine is given concomitantly with other opioids, it antagonizes the effects of the other opioids by displacing them from the mu receptors. This can lead to withdrawal syndrome if buprenorphine is added to another opioid. If buprenorphine is withdrawn while the dose of the other opioid is being increased, it can increase the risk of overdose.3 The role of opioids in chronic cancer pain has been well established but their role and the relative effectiveness of opioids such as buprenorphine in the context of chronic non-cancer pain is unclear.
Uso y mal uso de agonistas opioides en la adicción a los opioides.
Use and misuse of opioid agonists in opioid addiction.
Cleve Clin J Med. 2017 May;84(5):377-384. doi: 10.3949/ccjm.84a.16091.
Although methadone (an opioid agonist) and buprenorphine (a partial opioid agonist) have evidence to support their use in treating opioid use disorder, they remain misunderstood and underutilized. In this article, we outline the risks and benefits of using these drugs as maintenance therapy in opioid-dependent patients.
Nuevos desarrollos en el manejo de la adicción a opioides. Impacto del implante subdérmico de buprenorfina
New developments in managing opioid addiction: impact of a subdermal buprenorphine implant.
Drug Des Devel Ther. 2017 May 10;11:1429-1437. doi: 10.2147/DDDT.S109331. eCollection 2017.
Opioid addiction to prescription and illicit drugs is a serious and growing problem. In the US alone, >2.4 million people suffer from opioid use disorder. Government and pharmaceutical agencies have begun to address this crisis with recently released and revised task forces and medication-assisted therapies (MAT). For decades, oral or intravenous (IV) MATs have helped patients in their recovery by administration of opioid agonists (methadone, buprenorphine, oxycodone), antagonists (naltrexone, naloxone), and combinations of the two (buprenorphine/naloxone). While shown to be successful, particularly when combined with psychological counseling, oral and IV forms of treatment come with constraints and challenges. Patients can become addicted to the agonists themselves, and there is increased risk for diversion, abuse, or missed dosages. Consequently, long-acting implants have begun to be developed as a potentially preferable method of agonist delivery. To date, the newest implant approved by the US Food and Drug Administration (May 2016) is Probuphine®, which delivers steady-state levels of buprenorphine over the course of 6 months. Numerous studies have demonstrated its efficacy and safety. Yet, implants come with their own risks such as surgical site irritation, possible movement, and protrusion of implant out of skin. This review introduces the opioid abuse epidemic, examines existing medications used for therapy, and highlights Probuphine as a new treatment option. Costs associated with MATs are also discussed.
KEYWORDS: Probuphine®; addiction; buprenorphine; long-acting implant; medication-assisted therapy; opioids
Probufina® (implante de buprenorfina). Un candidato prometedor en la dependencia oipioide
Probuphine® (buprenorphine implant): a promising candidate in opioid dependence.
Ther Adv Psychopharmacol. 2017 Mar;7(3):119-134. doi: 10.1177/2045125316681984. Epub 2016 Dec 19.
Opioid dependence leads to physical dependence and addiction which finally results in profound medical, psychological and social dysfunction. One of the useful medications for opioid dependence is buprenorphine, the partial opioid agonist, which is used alone or in combination with naloxone. However, buprenorphine is the victim of its own success due to its illicit use and accidental poisoning in children. Also, buprenorphine typically requires daily self-administration and its effectiveness heavily depends on patient adherence. So, poor treatment adherence results in ineffective treatment manifesting as craving and withdrawal symptoms. Short-term use of buprenorphine in opioid dependence is also often followed by relapse. Buprenorphine when used sublingually often results in inadequate or fluctuating blood concentrations and poorer treatment retention compared with methadone. All of these led to the development of Probuphine®, a polymeric matrix composed of ethylene vinyl acetate and buprenorphine in the form of implants, that are implanted subdermally in office practice and deliver the active drug over 6 months. Buprenorphine release from such implant is fairly consistent, avoiding plasma peaks and troughs, and the implant is also reported to be safe. In this review article, we have highlighted these aspects of treatment of opioid addiction, stressing on the pharmacology of buprenorphine and Probuphine®, and relevant clinical trials addressing the efficacy and safety of Probuphine®. This sustained-release implantable formulation of buprenorphine has the potential to be a suitable alternative to daily or alternate day sublingual buprenorphine which can thereby eliminate the need for daily supervision, minimizing fluctuations in plasma concentrations, and allowing these patients to reduce clinic or pharmacy visits.
KEYWORDS: Probuphine®; addiction; buprenorphine; implant; opioid dependence

XIV Congreso Virtual Mexicano de Anestesiología 2017
Octubre 1-Diciembre 31, 2017
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Anestesiología y Medicina del Dolor

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