Formulaciones de buprenorfina / Buprenorphine Formulations

Enero 30, 2018. No. 2979

Formulaciones de buprenorfina: recomendaciones de estrategias clínicas de mejores prácticas para el manejo perioperatorio de pacientes sometidos a procedimientos de dolor quirúrgico o intervencional. Buprenorphine Formulations: Clinical Best Practice Strategies Recommendations for Perioperative Management of Patients Undergoing Surgical or Interventional Pain Procedures. Jonan AB1, Kaye AD, Urman RD2. Author information Pain Physician. 2018 Jan;21(1):E1-E12. Abstract BACKGROUND: Starting with approval for clinical use in the treatment of opioid dependence in October 2002 by the Food and Drug Administration (FDA), buprenorphine has become an integral treatment option and in recent years, in chronic pain management. Buprenorphine possesses a unique pharmacodynamic and pharmacokinetic profile that can potentially make perioperative analgesiachallenging. OBJECTIVES: To date no unified guidelines or recommendations are available for buprenorphine product management during the perioperative period. The present investigation aims to review the literature and provide recommendations when encountering a patient on buprenorphine therapy who is scheduled for a surgical or interventional pain procedure. METHODS: Clinical studies and reviews were searched using the PubMed National Center for Biotechnology Information database using MeSH terms buprenorphine, buprenorphine and naloxone, suboxone, perioperative, and postoperative pain. RESULTS: PubMed National Center for Biotechnology Information database search resulted in one randomized control trial, one prospective case matched cohort, one retrospective cohort, 0 case series, 4 case reports, and 6 review articles. Key literature is reviewed and summarized. LIMITATIONS: Only 12 articles were included, which permits only limited recommendations drawn from this review. CONCLUSIONS: The perioperative management of buprenorphine and buprenorphine/naloxone are dependent on several key factors. The nature of the surgery, namely the postoperative opioid requirement, elective versus emergency surgery, patient characteristics, formulation of buprenorphine, and indication for buprenorphine or buprenorphine/naloxone therapy must be considered when devising a plan. Several options exist when formulating a plan for the perioperative management, including continuing buprenorphine therapy or holding buprenorphine therapy for a defined period of time with or without bridging to alternative opioids. Additionally, social support people and patient motivation should be addressed and optimized, as well as nonopioid adjuvant therapy should be maximized as applicable to each patient undergoing a surgical or interventional pain procedure. KEY WORDS: Buprenorphine, naloxone, surgery, pain management, anesthesia, suboxone, opioid abuse. PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information World Congress on Regional Anesthesia & Pain Medicine April 19-21, 2018, New York City, USA Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Buprenorfina en dolor postoperatorio / Buprenorphine for postoperative pain

Agosto 8, 2017. No. 2774

¿Es la Buprenorfina una buena opción en el manejo  de dolor postoperatorio? J. V. Pergolizzi Jr., R. Taylor Jr., R. Plancarte, D. Bashkansky y E. Muniz Rev Soc Esp Dolor 2012; 19(6): 281-292 RESUMEN Antecedentes: El dolor es uno de los eventos más temidos por los pacientes después de una cirugía, y en la actualidad el manejo del dolor es subóptimo. La falta de control del dolor agudo postoperatorio puede tener una serie de consecuencias que afectan a los aspectos físicos y emocionales de los pacientes. El manejo habitual del dolor postoperatorio se basa en la utilización de opioides, pilar de tratamiento desde hace muchos años. Sin embargo, el uso de opioides puede tener riesgos moderados, como son las náuseas y vómitos, mareos y constipación, o riesgos más severos que incluyen a la inmunosupresión y depresión respiratoria. Objetivo: Para poder determinar algunos de los factores circundantes del dolor postoperatorio, se realizó una reunión cumbre internacional en la que un grupo de líderes de opinión analizó las prácticas habituales de manejo de dolor postoperatorio. Uno de los temas abordados fue el rol de la buprenorfina en el manejo del dolor perioperatorio, y la información discutida se presenta a lo largo de este artículo. Conclusión: La buprenorfina ha demostrado ser eficaz y segura en muchos modelos de dolor postoperatorio. Su versatilidad de administración, sus efectos secundarios manejables y su posibilidad de ser combinada con otros analgésicos hacen que la buprenorfina sea exitosa en el manejo del dolor perioperatorio. Palabras Clave: Buprenorfina. Dolor. Perioperatorio. Opioide. Dolor agudo. PDF Buprenorfina en el dolor postoperatorio Rev Soc Esp Dolor 2012; 19(6): 279-280 PDF Uso de un parche transdérmico buprenorfina para la analgesia perioperatoria en pacientes que se sometieron a discectomía lumbar simple. Application of a buprenorphine transdermal patch for the perioperative analgesia in patients who underwent simple lumbar discectomy. Tang J1, Fan J, Yao Y, Cai W, Yin G, Zhou W. Medicine (Baltimore). 2017 May;96(20):e6844. doi: 10.1097/MD.0000000000006844. Abstract This study aimed to investigate the perioperative analgesic effect of a buprenorphine transdermal patch in patients who underwent simple lumbar discectomy. The buprenorphine transdermal patch had a better perioperative analgesic effect in patients who underwent simple lumbar discectomy. PDF Parches transdérmicos de buprenorfina para el control del dolor postoperatorio en cirugía abdominal. Transdermal Buprenorphine Patches for Postoperative Pain Control in Abdominal Surgery. Kumar S1, Chaudhary AK2, Singh PK3, Verma R2, Chandra G4, Bhatia VK4, Singh D4, Bogra J4. Author information J Clin Diagn Res. 2016 Jun;10(6):UC05-8. doi: 10.7860/JCDR/2016/18152.7982. Epub 2016 Jun 1. Abstract INTRODUCTION: Buprenorphine is a semi-synthetic derivative of thebaine; its low concentration is sufficient to provide effective pain relief. AIM: To evaluate the efficacy of transdermal buprenorphine patch in postoperative pain management. MATERIALS AND METHODS: After ethical approval and taking informed consent from the patients, they were randomized into three groups (n=30 in each group) using a computer generated random number table. Group A: placebo patch; Group B: buprenorphine (10mg) patch and Group C: buprenorphine (20mg) patch. Haemodynamic and analgesic effects were compared by using analysis of variance (ANOVA) followed by Turkey's post hoc test. The proportion of side effects was compared using the Chi-square test. RESULTS: Haemodynamic changes were not statistically different in all the three groups A, B and C, whereas at the end of surgery VAS score of Group A subjects was significantly higher (4.93±0.98) as compared to Group B (1.73±0.64) and Group C (1.40±0.50). On 2(nd) postoperative day, no pain was reported by the Group C patients and on 4(th) day after surgery, no pain was reported by Group B patients. CONCLUSION: The transdermal buprenorphine patch (20mg) was effective in attenuating postoperative pain, maintaining haemodynamic stability requiring no rescue analgesia, with fewer postoperative rescue analgesic requirements in low dose of buprenorphine patch (10mg) group. KEYWORDS: Analgesia; Haemodynamic; Patch; Transdermal delivery system PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information California Society of Anesthesiologists Reuniones / Events Informacion / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Buprenorfina / Buprenorphine

Agosto 7, 2017. No. 2773

Buprenorfina para el dolor crónico. Una revisión de su efectividad Buprenorphine for Chronic Pain: A Review of the Clinical Effectiveness [Internet]. Source Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2017 Jan. CADTH Rapid Response Reports. Excerpt 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. PDF Uso y mal uso de agonistas opioides en la adicción a los opioides. Use and misuse of opioid agonists in opioid addiction. Modesto-Lowe V1,2,3, Swiezbin K2, Chaplin M3,4, Hoefer G5. Cleve Clin J Med. 2017 May;84(5):377-384. doi: 10.3949/ccjm.84a.16091. Abstract 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. PDF 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. Itzoe M1, Guarnieri M1. Drug Des Devel Ther. 2017 May 10;11:1429-1437. doi: 10.2147/DDDT.S109331. eCollection 2017. Abstract 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 PDF Probufina® (implante de buprenorfina). Un candidato prometedor en la dependencia oipioide Probuphine® (buprenorphine implant): a promising candidate in opioid dependence. Barnwal P1, Das S2, Mondal S3, Ramasamy A4, Maiti T5, Saha A6. Ther Adv Psychopharmacol. 2017 Mar;7(3):119-134. doi: 10.1177/2045125316681984. Epub 2016 Dec 19. Abstract 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 PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org