Select a medication above to begin.
buprenorphine
generic
Black Box Warnings .
Appropriate Use
should only be prescribed by healthcare professionals knowledgeable about opioid use and how to mitigate assoc. risks; reserve opioid analgesics for pts w/ inadequate tx alternatives; proper dosing and titration essential to decr. resp. depression risk
Addiction, Abuse, and Misuse
Schedule III controlled substance w/ risk of addiction, abuse, and misuse, which can lead to overdose and death; assess opioid abuse or addiction risk prior to prescribing; regularly reassess all pts for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even w/ recommended use, esp. during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately
Risks from Concomitant Use w/ Benzodiazepines, CNS Depressants
concomitant opioid use w/ benzodiazepines or other CNS depressants, incl. alcohol, may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for pts w/ inadequate alternative tx options
Neonatal Opioid Withdrawal Syndrome
extended use in pregnant pts can lead to potentially life-threatening neonatal opioid withdrawal syndrome; advise pregnant pts of risks and ensure tx by neonatology experts avail. at delivery if extended opioid use required
Adult Dosing .
Dosage forms: SL TAB: 2 mg, 8 mg; INJ: 300 mcg per mL
Special Note
- [prescribing info]
- Info: strongly consider prescribing naloxone if risk of opioid overdose or accidental ingestion
opioid dependence
- [induction tx]
- Dose: 2-4 mg SL x1, may incr. by 2-4 mg SL q1-2h prn up to 8 mg/day on day 1, then give equivalent total daily dose from day 1 on day 2, may incr. by 2-4 mg SL q1-2h prn up to 16 mg/day on day 2, then may incr. by 2-4 mg/day prn until sx stabilization; Start: when mild-moderate withdrawal sx present and >6h after last short-acting opioid use or >24h after last long-acting opioid use; Info: do not cut/chew/swallow SL tab
- [maintenance tx]
- Dose: 4-24 mg SL qd; Start: equivalent total daily dose on last day of induction tx, then may adjust by 2-4 mg/day prn; Info: single-ingredient buprenorphine products not preferred for maintenance tx except in select pts; do not cut/chew/swallow SL tab; doses >24 mg/day rarely more effective; dose adjustment may be needed during pregnancy and/or postpartum; taper dose gradually over several months to D/C
pain, mod-severe
- [300 mcg IM/IV q6-8h prn]
- Start: 300 mcg IM/IV x1, may repeat dose x1 after 30-60min, then 300 mcg IM/IV q6-8h prn; Max: 300 mcg/dose IV; 600 mcg/dose IM; Info: use lowest effective dose, shortest effective tx duration; titrate slowly in pts 65 yo and older; taper dose gradually to D/C if prolonged or long-term use
renal dosing
- [see below]
- renal impairment: no adjustment
- HD: no adjustment; no supplement; PD: not defined
hepatic dosing
- [SL route]
- mild impairment: no adjustment; moderate impairment: not defined, caution advised; severe impairment: consider decr. usual dose by 50%
- [IM/IV route]
- mild-moderate impairment: not defined; severe impairment: not defined, caution advised
Peds Dosing .
- Dosage forms: SL TAB: 2 mg, 8 mg; INJ: 300 mcg per mL
Special Note
- [prescribing info]
- Info: strongly consider prescribing naloxone in pts w/ opioid use disorder
pain, mod-severe
- [2-12 yo]
- Dose: 2-6 mcg/kg/dose IM/IV q4-8h prn; Max: 6 mcg/kg/dose; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if prolonged or long-term use
- [13 yo and older]
- Dose: 300 mcg IM/IV q6-8h prn; Start: 300 mcg IM/IV x1, may repeat dose x1 after 30-60min, then 300 mcg IM/IV q6-8h prn; Max: 300 mcg/dose; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if prolonged or long-term use
opioid dependence (off-label)
- [induction tx, adolescents]
- Dose: 2-4 mg SL x1, may incr. by 2-4 mg SL q1-2h prn up to 8 mg/day on day 1, then give equivalent total daily dose from day 1 on day 2, may incr. by 2-4 mg SL q1-2h prn up to 16 mg/day on day 2, then may incr. by 2-4 mg/day prn until sx stabilization; Start: when mild-moderate withdrawal sx present and >6h after last short-acting opioid use or >24h after last long-acting opioid use; Info: do not cut/chew/swallow SL tab
- [maintenance tx, adolescents]
- Dose: 4-24 mg SL qd; Start: equivalent total daily dose on last day of induction tx, then may adjust by 2-4 mg/day prn; Info: single-ingredient buprenorphine products not preferred for maintenance tx except in select pts; do not cut/chew/swallow SL tab; doses >24 mg/day rarely more effective; dose adjustment may be needed during pregnancy and/or postpartum; taper dose gradually over several months to D/C
renal dosing
- [not defined]
- renal impairment: consider adult renal dosing for guidance
- HD/PD: consider adult renal dosing for guidance
hepatic dosing
- [IM/IV route]
- mild-moderate impairment: not defined; severe impairment: not defined, caution advised
- [SL route]
- hepatic impairment: consider adult hepatic dosing for guidance