Indications for BUPRENEX:
Management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate.
Use lowest effective dose for shortest duration. Individualize. >12yrs: initially 0.3mg (1mL) by deep IM or slow IV (over ≥2mins) inj at up to 6hr intervals, as needed. May repeat once (up to 0.3mg), 30–60mins after initial dose. Max single dose: 0.6mg (IM only). Concomitant use or discontinuation of CYP3A4 inhibitors or inducers: monitor closely and consider dose adjustments (see full labeling).
<2yrs: not recommended. 2–12yrs: 2–6micrograms/kg every 4–6hrs, depending on clinical response. Concomitant use or discontinuation of CYP3A4 inhibitors or inducers: monitor closely and consider dose adjustments (see full labeling).
Significant respiratory depression. Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment. Known or suspected GI obstruction, including paralytic ileus.
Addiction, abuse, and misuse. Life-threatening respiratory depression. Neonatal opioid withdrawal syndrome. Risks from concomitant use with benzodiazepines or other CNS depressants.
Abuse potential (monitor). Life-threatening respiratory depression; monitor within first 24–72hrs of initiating therapy and following dose increases. Sleep-related breathing disorders (including central sleep apnea (CSA), sleep-related hypoxemia); consider dose reduction if CSA develops. COPD, cor pulmonale, decreased respiratory reserve, hypoxia, hypercapnia, or pre-existing respiratory depression; monitor and consider non-opioid analgesics. History of long QT syndrome; avoid. Hypokalemia, hypomagnesemia, unstable cardiac disease (eg, unstable atrial fibrillation, symptomatic bradycardia, unstable CHF, active MI); monitor ECG periodically. Adrenal insufficiency. Head injury. Increased intracranial pressure, brain tumors; monitor. Seizure disorders. CNS depression. Impaired consciousness, coma, shock; avoid. Biliary tract disease. Acute pancreatitis. Myxedema or hypothyroidism. Toxic psychoses. Prostatic hypertrophy. Urethral stricture. Delirium tremens. Kyphoscoliosis. Drug or alcohol abusers. Severe pulmonary, hepatic, or renal impairment. Reevaluate periodically. Avoid abrupt cessation. Children. Elderly. Cachectic. Debilitated. Labor & delivery. Pregnancy; potential neonatal opioid withdrawal syndrome during prolonged use. Nursing mothers: not recommended.
Opioid (partial agonist-antagonist).
Increased risk of hypotension, respiratory depression, sedation with benzodiazepines or other CNS depressants (eg, non-benzodiazepine sedatives/hypnotics, anxiolytics, general anesthetics, phenothiazines, tranquilizers, muscle relaxants, antipsychotics, alcohol, other opioids); reserve concomitant use in those for whom alternative options are inadequate; limit dosages/durations to minimum required; monitor. Avoid concomitant Class 1A (eg, quinidine, procainamide, disopyramide) or Class III antiarrhythmics (eg, sotalol, amiodarone, dofetilide). During or within 14 days of MAOIs: not recommended. Risk of serotonin syndrome with serotonergic drugs (eg, SSRIs, SNRIs, TCAs, triptans, 5-HT3 antagonists, mirtazapine, trazodone, tramadol, cyclobenzaprine, metaxalone, MAOIs, linezolid, IV methylene blue); monitor and discontinue if suspected. Avoid concomitant mixed agonist/antagonist and partial agonist opioids (eg, butorphanol, nalbuphine, pentazocine); may reduce effects and/or precipitate withdrawal symptoms. Potentiated by CYP3A4 inhibitors (eg, macrolides, azole antifungals, protease inhibitors). Antagonized by CYP3A4 inducers (eg, rifampin, carbamazepine, phenytoin). May antagonize diuretics; monitor. Paralytic ileus may occur with anticholinergics. Chronic Buprenex treatment with concomitant NNRTIs (eg, efavirenz, nevirapine, etravirine, delavirdine); monitor. Concomitant atazanavir ± ritonavir: may need to reduce Buprenex dose.
Sedation, dizziness/vertigo, nausea, vomiting, hypotension, miosis, headache, sweating, hypoventilation; respiratory depression, severe hypotension, syncope, hypersensitivity reactions.