Formulations: Available as 2 mg buprenorphine/0.5 mg naloxone or 8 mg buprenorphine/2 mg naloxone. The naloxone is to prevent diversion.

Partial opiate agonist with very tight binding to opiate receptors. Low oral bioavailability. Sublingual absorption 30-55%. Onset at 30-60 minutes. Peak effect at 1-4 hours. Half life 37 hours. Peak effect at 12 mg/day – higher doses prolong half life.

Produces opiate like effects in opiate naïve individuals, with low risk for overdose. Apnea is uncommon, unless mixed with other respiratory depressants. Because of limited agonism, can produce withdrawal symptoms in those taking full agonists.

avoid in severe hepatic or respiratory failure

Similar to other opiates. Beware of patients taking high doses of combination acetaminophen/narcotic preparations on top of buprenorphine – risk of acetaminophen toxicity

: Initial dose to be given at least 6 hours after last dose of short acting narcotic, 12-24 after long acting narcotic or with a COWS score of at least 13. Initial dose is 2 mg buprenorphine for COWS

Patient must keep tablet under tongue until dissolved (up to 10 min). Less effective if swallowed.

For acute pain management for those on buprenorphine – ketamine, high dose hydromorphone