NR 546 Week Addiction Medications Table 2024

NR 546 Week Addiction Medications Table 2024. Drug Name Indication (Bold is FDA approved) Neurotransmitter(s) Affected Target Symptoms Half-life (T1/2), Metabolism (CYP 450 enzyme) Notable Side Effects (link to NT or affected brain circuit) Initial Dosing Considerations Specific lifespan considerations (age, pregnancy, breastfeeding) Buprenorphine (Subutex) Indication:  Maintenance treatment of opioid dependence (sublingual)  Maintenance treatment of opioid dependence in patients who have achieved and sustained prolonged clinical stability on low-to-moderate doses (no more than 8 mg) of a transmucosal buprenorphine- containing product (implant)  Moderate to severe opioid use disorder in patients who have initiated treatment with a transmucosal buprenorphine-containing product, followed by dose adjustment for a minimum of 7 days (injection) Affected Neurotransmitters:  Partial agonist at mu opiate receptors  Antagonist at the kappa opioid receptor  Agonist at delta opioid receptors  Partial agonist at nociceptin Half-life: Sublingual buprenorphine: 24–42 hours Naloxone: 2–12 hours Implant: Tmax is 12 hours; time to steady state is 4 weeks Metabolism: CYP450 3A4 Notable Side Effects:  Headache, constipation, nausea  Oral hypoesthesia, glossodynia  Orthostatic hypotension  Implant specific: insertion site pain, pruritis, erythema Side Effect Pathways:  Binding at mu opioid receptors Initial Dosing Considerations:  Patients must be in a mild withdrawal state prior to starting buprenorphine  Day 1 – 8 mg  Day 2 – 12 or 16 mg  Days 3-7 – Increase in increments of 4 mg to max dose of 32 MG  Observe patient for at least 2 hours with initial dose, then have 1–2 visits in first week  Achieve the lowest dose that eliminates withdrawal symptoms and illicit opioid use  During stabilization patients should be seen once per week  During maintenance patients should be seen biweekly or monthly Specific lifespan considerations Age:  Elderly - Use with caution  Children and adolescents - Safety and efficacy have not been established Pregnancy:  Controlled studies have not been conducted in pregnant women  Buprenorphine may be Addiction Medications opioid peptide receptors Target Symptoms:  Opioid dependence preferable to methadone in pregnant women  Neonatal withdrawal has been reported following use of buprenorphine during pregnancy  Not generally recommended for use during pregnancy, especially during first trimester  Effective June 30, 2015, the US FDA requires changes to the content and format of pregnancy and lactation information in prescription drug labels, including the elimination of the pregnancy letter categories; the Pregnancy and Lactation Labeling Rule (PLLR or final rule) applies only to prescription drugs and will be phased in gradually for drugs approved on or after June 30, 2001