Buprenorphine

Buprenorphine has the brand name Buprenex used for treating moderate to severe pain. Buprenorphine is a narcotic analgesic which works by its activities in the brain and nervous system to decrease pain. Avoid using buprenorphine if you are allergic to any ingredient in buprenorphine or you are taking sodium oxybate (GHB). Contact the doctor or health care provider right away if any of these apply.

Before the use of buprenorphine

suboxoneBefore one will start using buprenorphine, inform your doctor as some medical conditions may interact with buprenorphine. Let your doctor or pharmacist be aware if any of these medical conditions apply to you:

  • if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
  • if you are pregnant, planning to become pregnant, or are breast-feeding
  • if you have allergies to medicines, foods, or other substances
  • if you have a history of blood or electrolyte problems, breathing or lung problems (eg, chronic obstructive pulmonary disease), underactive thyroid, adrenal gland problems (e.g, Addison disease), liver or kidney problems, an enlarged prostate gland, trouble urinating, a blockage of your bladder or urethra, gallbladder problems, or stomach problems
  • if you have a history of recent head injury, groMhs in the brain (eg, tumor), or increased pressure in the brain, or muscle problems (eg, myasthenia gravis)
  • if you have a history of mental or mood problems, drug or alcohol abuse, or if you have a physical dependence on narcotic medicines (e.g. morphine) or other opiates (e.g. heroin).

Some medicines may interact with buprenorphine. Let your health care provider be also aware if you are taking any other medicines, especially any of the following:

  • Azole antifungals (e.g. ketoconazole), HIV protease inhibitors (e.9, ritonavir), or macrolide antibiotics 1e.g, erythromycin) because the side effects of buprenorphine may be increased
  • Benzodiazepines (e.g, diazepam), cimetidine, narcotic pain medicine (e.g, codeine), phenothiazines (e.g, chlorpromazine), or sodium oxybate (GHB) because the risk of severe drowsiness, severe breathing problems, and seizures may be increased
  • Naltrexone or rifampin because the effectiveness of buprenorphine may be decreased
  • Methadone because effectiveness may be decreased by buprenorphine

Do ask your health care provider if buprenorphine may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

Steps on how to use buprenorphine:

For the Consumer, buprenorphine dosage forms could be film, tablet, injection solution, intradermal implant and transdermal patch extended release.

  • Use buprenorphine as directed by your doctor. Check the label on the medicine for exact dosing instructions.
  • Buprenorphine is usually administered as an injection at your doctor’s office, hospital, or clinic. lf you are using buprenorphine at home, carefully follow the injection procedures taught to you by your health care provider.
  • If buprenorphine contains particles or is discolored, or if the vial is cracked or damaged in any way, do not use it.
  • If you miss a dose of buprenorphine, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.
  • Keep this product, as well as syringes and needles, out of the reach of children and away from pets. Do not reuse needles, syringes, or other materials. Dispose of properly after use. Ask your doctor or pharmacist to explain local regulations for proper disposal.

Ask your health care provider any questions you may have about how to use buprenorphine.

Precautions:

suboxone precautions

  • Buprenorphine may cause drowsiness or dizziness. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to buprenorphine. Using buprenorphine alone, with certain other medicines, or with alcohol may lessen your ability to drive or perform other potentially dangerous tasks.
  • Avoid drinking alcohol or taking other medications that cause drowsiness (eg, sedatives, tranquilizers) while taking buprenorphine. Buprenorphine will add to the effects of alcohol and other depressants. Ask your pharmacist if you have questions about which medicines are depressants.
  • Buprenorphine may cause dizziness, lightheadedness, or fainting. Alcohol, hot weather, exercise, and fever can increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Also, sit or lie down at the first sign of dizziness, lightheadedness, or weakness.
  • Buprenorphine may cause withdrawal symptoms if you have a physical dependence on narcotic medicines (eg, morphine) or other opiates (e.g., heroin). Talk with your doctor if you are dependent on narcotic medicines or other opiates.
  • Before you have any medical or dental treatments, emergency care, or surgery, tell the doctor or dentist that you are using buprenorphine.
  • Lab tests, including liver function tests, may be performed to monitor your progress or to check for side effects. Be sure to keep all doctor and lab appointments.
  • Use buprenorphine with caution in the elderly because they may be more sensitive to its effects, especially decreased breathing and drowsiness.
  • Use buprenorphine with extreme caution in children younger than 2 years of age. Safety and effectiveness in this age group have not been confirmed.
  • Pregnancy and breast-feeding: lf you become pregnant while taking buprenorphine discuss with your doctor the benefits and risks of using buprenorphine during pregnancy. Buprenorphine is excreted in breast milk. Do not breast-feed while taking buprenorphine.

When used for long periods of time or at high doses, some people develop a need to continue taking buprenorphine. This is known as dependence or addiction.

If you suddenly stop taking buprenorphine, you may experience withdrawal symptoms including anxiety; diarrhea; fever, runny nose, or sneezing; goose bumps and abnormal skin sensations; nausea; vomiting; pain; rigid muscles; rapid heartbeat seeing, hearing or feeling things that are not there; shivering or tremors; sweating; and trouble sleeping.

Side Effects

Commonly reported side effects of buprenorphine include: constipation, dizziness, drowsiness, headache, nausea, and sedation. Other side effects include: dizziness, drowsiness, drug withdrawal, fatigue, headache, vomiting, hyperhidrosis, and xerostomia.

Major side effects are blurred vision, confusion, difficult or troubled breathing, dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position, drowsiness, irregular, fast, slow, or shallow breathing, pale or blue lips, fingernails, or skin, pinpoint pupils, relaxed and calm feeling, sleepiness and unusualtiredness or weakness.

Minor side effects are back pain, cough or hoarseness, difficulty having a bowel movement (stool), fever or chills, headache, lower back or side pain, nausea, painful or difficult urination, runny nose, sneezing, stomach pain, stuffy nose, trouble sleeping, vomiting, diarrhea, feeling faint, dizzy, feeling of warmth or heat, flushing or redness of the skin, especially on the face and neck, lack or loss of strength and sweating.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest swelling of the mouth, face, lips, or tongue); anxiety or nervousness; dark urine; fast or irregular heartbeat; mental or mood changes (eg, depression); pale stools; pain, redness, or swelling at the injection site; slow or shallow breathing; unusual weakness; vision changes; yellowing of eyes or skin.

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these side effects persist.

Naloxone

Brand names are Evzio, and Narcan. Naloxone blocks or reverses the effects of opioid medication, including extreme drowsiness, slowed breathing, or loss of consciousness. An opioid is sometimes called a narcotic. Naloxone is used to treat a narcotic overdose in an emergency situation. This medicine should not be used in place of emergency medical care for an overdose. Naloxone is also used to help diagnose whether a person has used an overdose of an opioid. ln an emergency situation, it may not be possible before you are treated to tell your caregivers about your health conditions or if you are pregnant or breast feeding. Make sure any doctor caring for you afterward knows that you have received naloxone. Drinking alcohol can increase certain side effects of naloxone. Naloxone may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. If you are using any narcotic pain medication, the pain-relieving effects of the narcotic will be reversed while you are also receiving naloxone.

Other drugs may interact with naloxone, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Before receiving naloxone

suboxone and naloxoneYou should not receive this medicine if you are allergic to naloxone. To make sure naloxone is safe for you, tell your doctor if you have heart disease, or pregnant or breast feeding (nursing baby). In an emergency situation, it may not be possible to tell your caregivers if you are pregnant or breast feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received naloxone.

Naloxone is injected into a muscle, under the skin, or into a vein through an IV. The injection may be given by a healthcare provider, emergency medical provider, or a family member or caregiver who is trained to properly give a naloxone injection. lf you are a caregiver or family member giving a naloxone injection, read all instructions when you first get this medicine. If provided, use the “trainer” device to practice giving an injection so you will know how to do it in an emergency. Ask your doctor or pharmacist if you have any questions. Be sure you know how to recognize the signs of an opioid overdose in the person you are caring for. Overdose symptoms may include slowed breathing, or no breathing; very small or pinpoint pupils in the eyes; slow heartbeats; or extreme drowsiness, especially if you are unable to wake the person from sleep.

Even if you are not sure an opioid overdose has occurred, if the person is not breathing or is unresponsive, give the naloxone injection right away and then seek emergency medical care. Do not assume that an overdose episode has ended if symptoms improve. You must get emergency help after giving a naloxone injection. Naloxone injected into a muscle is given in the outer thigh. ln an emergency, you may give an injection through the person’s clothing. After injecting naloxone, stay with the person and watch for continued signs of overdose. You may need to give another injection every 2 to 3 minutes until emergency help arrives. Follow all medication instructions carefully. Each Evzio auto-injector is for one use only. Throw away after one use, even if there is still some medicine left in it after injecting a dose.

Store naloxone at room temperature away from moisture and heat. Keep the auto- injector in its outer case until you are ready to use it. Do not use the medicine if it has changed colors or has particles in it. Call your pharmacist for new medication in case you miss a dose because you will receive naloxone in an emergency situation; you are not likely to miss a dose. Avoid leaving a person alone after giving him or her a naloxone injection. An overdose can impair a person’s thinking or reactions.

Side effects

Get emergency medical help if you have signs of an allergic reaction to naloxone: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Because naloxone reverses opioid effects, this medicine may cause sudden withdrawal symptoms such as: nausea, vomiting, diarrhea, stomach pain; fever, sweating, body aches, weakness; tremors or shivering, fast heart rate, pounding heartbeats, increased blood pressure; feeling nervous, restless, or irritable; goosebumps, shivering; runny nose, yawning; or (in babies younger than 4 weeks old) seizures, crying, stiffness, overactive reflexes.