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Buprenorfin

Klassificering: A

Preparat: Buprefarm, Bupremyl, Buprenorfin Actavis, Buprenorfin Evolan, Buprenorphine Bluefish, Buprenorphine Ethypharm, Buprenorphine G.L. Pharma, Buprenorphine Glenmark, Buprenorphine Orifarm, Buprenorphine Sandoz, Buprenorphine STADA, Buprenorphine Teva, Buvidal, Espranor, Norspan, Norspan®, Sublocade, Subutex, Subutex®, Temgesic, Temgesic®, Transtec

ATC kod: N02AE01, N07BC01

Substanser: buprenorfin, buprenorfinhydroklorid

Sammanfattning

Buprenorfin används både som opiat vid smärtbehandling och vid opioidberoende. Både kvinnor och män har nytta av behandling med buprenorfin vid opioidberoende.

Det finns med nuvarande kunskapsunderlag inget skäl att generellt differentiera i behandling mellan kvinnor och män. Som med andra opiater skall buprenorfin titreras för att hitta lägsta effektiva dos.

Additional information

The literature indicates that women and men differ in pain behavior. This could be influenced by differences in pharmacokinetics, sex hormones, differences in stress response, or type of pain test. Also, many variables other than a person’s sex/gender account for individual differences in pain sensitivity. The prevalence of several clinical pain conditions are higher in women than men suggests that either different clinical pain mechanisms may operate in men vs. women, or different or additional risk factors are relevant in one sex, or a combination of differences [1].

Pharmacokinetics and dosing

In a retrospective study, men and women received the same daily dose of sublingual buprenorphine/naloxone 16/4 mg. Women had higher AUC and Cmax for buprenorphine and the metabolites norbuprenorphine and norbuprenorphine-3-glucuronide. When the results were adjusted for lean body mass, there were no sex differences in AUCs [2].Pooled data from pharmacokinetic studies conducted by the sponsor showed no sex differences in Cmax and AUC. NONMEM analysis showed that increasing age and sex contributed to a 20% lower clearance. Since buprenorphine sublingual tablet (Subutex®) is a titratable drug and the predicted decrease in clearance is only 20%, no dosage adjustments are recommended [3].The effect of sex on transdermal buprenorphine pharmacokinetics has been investigated by the original manufacturer using analysis of pooled clinical pharmacology studies. No significant effect of sex was observed in Cmax and AUC [4].

Buprenorphine is dosed according to effect and thus individualized. Pharmacokinetic studies show no difference between men and women when correlated for bodyweight and age and thus, if these factors are considered similar doses should be used.

Effects

A randomized controlled study (104 men, 61 women) evaluating the impact of sex on opioid agonist treatment found both men and women to benefit from buprenorphine treatment (dosing 16-32 mg) [5].

Adverse effects

A randomized controlled trial found that no patients taking buprenorphine (36 men, 18 women) experienced a QT prolongation even though buprenorphine in vitro blocks the human hERG channel which is strongly associated with QT prolongation and a risk of Torsades de pointes ventricular tachycardia [6]. Among the known risk factors of drug-induced ventricular arrhythmias are female sex, hypokalemia, bradycardia, and base line QT-prolongation [7].

Reproductive health issues

Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).

Other information

One study on buprenorphine in patients with former drug abuse reported that women receiving buprenorphine had fewer illegitimate opioid-positive urine samples than men [8]. However, another study reported that women receiving buprenorphine showed greater rates of illegitimate opioid use than men [8]. These different results could be explained by different study designs and different durations of treatment, but also by differences in pharmacodynamics [9].

Försäljning på recept

Fler kvinnor än män hämtade ut läkemedel innehållande buprenorfin (ATC-kod N02AE01) på recept i Sverige år 2015, totalt 34 134 kvinnor och 13 448 män. Det motsvarar 7,0 respektive 2,8 personer per tusen invånare. Andelen som hämtat ut läkemedel var högst i åldersgruppen 85 år och äldre hos båda könen. I genomsnitt var läkemedel innehållande buprenorfin 2,1 gånger vanligare hos kvinnor [10]. Prevalens för kronisk smärta är högre hos kvinnor [11, 12].

Fler män än kvinnor hämtade ut sublinguala resoribletter innehållande buprenorfin (ATC-kod N07BC01) på recept i Sverige år 2015, totalt 899 män och 447 kvinnor [10].

Uppdaterat: 2019-02-26

Litteratursökningsdatum: 2015-02-12

Referenser

  1. Greenspan JD, Craft RM, LeResche L, Arendt-Nielsen L, Berkley KJ, Fillingim RB et al. Studying sex and gender differences in pain and analgesia: a consensus report. Pain. 2007;132 Suppl 1:S26-45. PubMed
  2. Moody DE, Fang WB, Morrison J, McCance-Katz E. Gender differences in pharmacokinetics of maintenance dosed buprenorphine. Drug Alcohol Depend. 2011;118:479-83. PubMed
  3. Food and Drug Administration (FDA). Clinical Pharmacology and Biopharmaceutics Review - SUBUTEX (buprenorphine) [updated 2002-10-08]. länk
  4. Food and Drug Administration (FDA). Clinical Pharmacology and Biopharmaceutics Review - BUTRANS (buprenorphine) [updated 2010-06-30]. länk
  5. Jones HE, Fitzgerald H, Johnson RE. Males and females differ in response to opioid agonist medications. Am J Addict. 2005;14:223-33. PubMed
  6. Wedam EF, Bigelow GE, Johnson RE, Nuzzo PA, Haigney MC. QT-interval effects of methadone, levomethadyl, and buprenorphine in a randomized trial. Arch Intern Med. 2007;167:2469-75. PubMed
  7. Roden DM. Drug-induced prolongation of the QT interval. N Engl J Med. 2004;350:1013-22. PubMed
  8. Johnson RE, Eissenberg T, Stitzer ML, Strain EC, Liebson IA, Bigelow GE. Buprenorphine treatment of opioid dependence: clinical trial of daily versus alternate-day dosing. Drug Alcohol Depend. 1995;40:27-35. PubMed
  9. Unger A, Jung E, Winklbaur B, Fischer G. Gender issues in the pharmacotherapy of opioid-addicted women: buprenorphine. J Addict Dis. 2010;29:217-30. PubMed
  10. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2015 [cited 2016-04-30.] länk
  11. Wändell P, Carlsson AC, Wettermark B, Lord G, Cars T, Ljunggren G. Most common diseases diagnosed in primary care in Stockholm, Sweden, in 2011. Fam Pract. 2013;30:506-13. PubMed
  12. Shega JW, Tiedt AD, Grant K, Dale W. Pain measurement in the National Social Life, Health, and Aging Project: presence, intensity, and location. J Gerontol B Psychol Sci Soc Sci. 2014;69 Suppl 2:S191-7. PubMed

Författare: Linnéa Karlsson Lind, Desirée Loikas

Faktagranskat av: Mia von Euler

Godkänt av: Karin Schenck-Gustafsson