Buprenorphin comes in a sublingual and transdermal formulation. In October 2002, the Food and Drug Administration (FDA) approved buprenorphine monotherapy product, Subutex®, and a buprenorphine/naloxone combination product, Suboxone®, for use in opioid addiction treatment. The combination product is designed to decrease the potential for abuse by injection.
The transdermal form is well-established for treatment of chronic cancer pain and. It was recommended for addiction purpose by a consensus conference(Pergolizzin et al). The sublingual form is much less studied in this setting. Notably, it was studied as long ago as 1979 by Robbie. He concluded that this sublingual preparation seems worthy of addition to the commercially available range of analgesics in clinical practice. Other publications appeared occasionally over the next 20 years and have been generally supportive. in 2005, Malinoff found it to be well tolerated and safe and appeared to be effective in the treatment of chronic pain patients refractory to other pain medications. It continued to be mildly recommended in more recent reviews.
Pergolizzi JV Jr, Mercadante S, Echaburu AV, Van den Eynden B, Fragoso RM, Mordarski S, Lybaert W, Beniak J, Orońska A, Slama O; Euromed Communications meeting.Curr Med Res Opin. 2009 Jun;25(6):1517-28.
D. S. Robbie A trial of sublingual buprenorphine in cancer pain. Br J Clin Pharmacol. 1979; 7(Suppl 3): 315S–317S.
Hotz G. Oral and maxillofacial cancer pain therapy with sublingual buprenorphine.Schmerz. 1988 Mar;2(1):38-41.
Malinoff HL, Barkin RL, Wilson G. Sublingual buprenorphine is effective in the treatment of chronic pain syndrome.Am J Ther. 2005 Sep-Oct;12(5):379-84.
Yokell MA, Zaller ND, Green TC, Rich JD. Buprenorphine and buprenorphine/naloxone diversion, misuse, and illicit use: an international review.Curr Drug Abuse Rev. 2011 Mar 1;4(1):28-41.
Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract. 2008 Jul-Aug;8(4):287-313.
Pergolizzi J, Böger RH, Budd K, Dahan A, Erdine S, Hans G, Kress HG, Langford R, Likar R, Raffa RB, Sacerdote P. The role of transdermal buprenorphine in the treatment of cancer pain: an expert panel consensus.Pain Pract. 2008 Jul-Aug;8(4):287-313.
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