Case Report: Buprenorphine-precipitated fentanyl withdrawal treated with high-dose buprenorphine [version 2; peer review: 2 approved]
Background: Buprenorphine, a partial agonist of the mu-opioid receptor, is an increasingly prescribed medication for maintenance treatment of opioid use disorder. When this medication is taken in the context of active opioid use, precipitated withdrawal can occur, leading to acute onset of opioid wi...
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| Format: | Article |
| Language: | English |
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F1000 Research Ltd
2023-08-01
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| Series: | F1000Research |
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| Online Access: | https://f1000research.com/articles/11-487/v2 |
| _version_ | 1797690262674210816 |
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| author | Alison Lynch Antony Gout Vicki Kijewski Nicholas L. Bormann |
| author_facet | Alison Lynch Antony Gout Vicki Kijewski Nicholas L. Bormann |
| author_sort | Alison Lynch |
| collection | DOAJ |
| description | Background: Buprenorphine, a partial agonist of the mu-opioid receptor, is an increasingly prescribed medication for maintenance treatment of opioid use disorder. When this medication is taken in the context of active opioid use, precipitated withdrawal can occur, leading to acute onset of opioid withdrawal symptoms. Fentanyl complicates use of buprenorphine, as it slowly releases from body stores and can lead to higher risk of precipitated withdrawal. Objectives: Describe the successful management of buprenorphine precipitated opioid withdrawal from fentanyl with high doses of buprenorphine. We seek to highlight how no adverse effects occurred in this patient and illustrate his stable transition to outpatient treatment. Case report: We present the case of a patient with severe opioid use disorder who presented in moderately severe opioid withdrawal after taking non-prescribed buprenorphine-naloxone which precipitated opioid withdrawal from daily fentanyl use. He was treated with high doses of buprenorphine, 148 mg over the first 48 hours, averaging 63 mg per day over four days. The patient reported rapid improvement in withdrawal symptoms without noted side effects and was able to successfully taper to 16 mg twice daily by discharge. Conclusions: This case demonstrates the safety and effectiveness of buprenorphine at high doses for treatment of precipitated withdrawal. While other options include symptomatic withdrawal management, initiating methadone or less researched options like ketamine, utilizing buprenorphine can preserve or re-establish confidence in this life-saving medication. This case also increases the previously documented upper boundary on buprenorphine dosing for withdrawal and should provide additional confidence in its use. |
| first_indexed | 2024-03-12T01:57:02Z |
| format | Article |
| id | doaj.art-40e602309cb546d694e2d5c31eedc4a0 |
| institution | Directory Open Access Journal |
| issn | 2046-1402 |
| language | English |
| last_indexed | 2024-03-12T01:57:02Z |
| publishDate | 2023-08-01 |
| publisher | F1000 Research Ltd |
| record_format | Article |
| series | F1000Research |
| spelling | doaj.art-40e602309cb546d694e2d5c31eedc4a02023-09-08T00:00:00ZengF1000 Research LtdF1000Research2046-14022023-08-0111154251Case Report: Buprenorphine-precipitated fentanyl withdrawal treated with high-dose buprenorphine [version 2; peer review: 2 approved]Alison Lynch0https://orcid.org/0000-0002-0966-6605Antony Gout1Vicki Kijewski2https://orcid.org/0000-0002-2295-7335Nicholas L. Bormann3https://orcid.org/0000-0001-8847-8727Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USAPsychiatry, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USAPsychiatry, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USAPsychiatry, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USABackground: Buprenorphine, a partial agonist of the mu-opioid receptor, is an increasingly prescribed medication for maintenance treatment of opioid use disorder. When this medication is taken in the context of active opioid use, precipitated withdrawal can occur, leading to acute onset of opioid withdrawal symptoms. Fentanyl complicates use of buprenorphine, as it slowly releases from body stores and can lead to higher risk of precipitated withdrawal. Objectives: Describe the successful management of buprenorphine precipitated opioid withdrawal from fentanyl with high doses of buprenorphine. We seek to highlight how no adverse effects occurred in this patient and illustrate his stable transition to outpatient treatment. Case report: We present the case of a patient with severe opioid use disorder who presented in moderately severe opioid withdrawal after taking non-prescribed buprenorphine-naloxone which precipitated opioid withdrawal from daily fentanyl use. He was treated with high doses of buprenorphine, 148 mg over the first 48 hours, averaging 63 mg per day over four days. The patient reported rapid improvement in withdrawal symptoms without noted side effects and was able to successfully taper to 16 mg twice daily by discharge. Conclusions: This case demonstrates the safety and effectiveness of buprenorphine at high doses for treatment of precipitated withdrawal. While other options include symptomatic withdrawal management, initiating methadone or less researched options like ketamine, utilizing buprenorphine can preserve or re-establish confidence in this life-saving medication. This case also increases the previously documented upper boundary on buprenorphine dosing for withdrawal and should provide additional confidence in its use.https://f1000research.com/articles/11-487/v2Buprenorphine fentanyl Opioid-Related Disorders case reporteng |
| spellingShingle | Alison Lynch Antony Gout Vicki Kijewski Nicholas L. Bormann Case Report: Buprenorphine-precipitated fentanyl withdrawal treated with high-dose buprenorphine [version 2; peer review: 2 approved] F1000Research Buprenorphine fentanyl Opioid-Related Disorders case report eng |
| title | Case Report: Buprenorphine-precipitated fentanyl withdrawal treated with high-dose buprenorphine [version 2; peer review: 2 approved] |
| title_full | Case Report: Buprenorphine-precipitated fentanyl withdrawal treated with high-dose buprenorphine [version 2; peer review: 2 approved] |
| title_fullStr | Case Report: Buprenorphine-precipitated fentanyl withdrawal treated with high-dose buprenorphine [version 2; peer review: 2 approved] |
| title_full_unstemmed | Case Report: Buprenorphine-precipitated fentanyl withdrawal treated with high-dose buprenorphine [version 2; peer review: 2 approved] |
| title_short | Case Report: Buprenorphine-precipitated fentanyl withdrawal treated with high-dose buprenorphine [version 2; peer review: 2 approved] |
| title_sort | case report buprenorphine precipitated fentanyl withdrawal treated with high dose buprenorphine version 2 peer review 2 approved |
| topic | Buprenorphine fentanyl Opioid-Related Disorders case report eng |
| url | https://f1000research.com/articles/11-487/v2 |
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