Buprenorphine Initiation for the Uninitiated
1) WAIT ...
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Description

Buprenorphine Initiation for the Uninitiated

1) WAIT FOR MODERATE WITHDRAWAL SYMPTOMS

 - Precipitated withdrawal can be caused by buprenorphine displacing a full opioid agonist. To avoid precipitated withdrawal, begin initiation during moderate withdrawal.

 - Moderate withdrawal symptoms: e.g. COWS Score 6-10 or substantial patient discomfort.

 - Consider the BUP Home Induction app for guidance.

2) START LOW DOSE BUPRENORPHINE

 - Begin with a first dose of 4mg for patients in moderate withdrawal.

 - Consider starting with 2mg for patients at higher risk of precipitated withdrawal.

 - Pro tip: Rx 8mg BID, then have the patient cut the film in half for the first day's doses.

3) WAIT 4 HOURS, GIVE 4MG

 - If the first dose is well tolerated, the patient can take a second 4mg dose later that day.

4) UPTITRATE & REASSESS

 - The following day, start 8mg BID

 - reassess adequacy after 7 days.

 - A majority of patients do well on a total dose of 16mg buprenorphine daily for maintenance therapy.



#Buprenorphine #Initiation #Prescribing #Addiction #Management
Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief πŸ‡΅πŸ‡­ πŸ‡ΊπŸ‡Έ - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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