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Buprenorphine is a partial opioid agonist and also an opioid antagonist. It came out as an analgesic in the 1980s, but is nowadays used also for the treatment of opioid addiction. It is sold under trade names such as Temgesic, Buprenex, Subutex and Suboxone (combined with naloxone).
Mode of action
Buprenorphine is a thebaine derivative, and its analgesic effect is due to agonism of μ subtype of opioid receptor. Buprenorphine is also a κ- antagonist. Unlike other opiods, naloxone can only partially revert the effects of buprenorphine. Buprenophine has quite a long effect, 48 hours, due to its slow dissociation from the opiod receptors. Patients build tolerance towards buprenorphine fairly quickly.
Pharmacokinetics
Buprenorphine is administered as hydrochloride as either intramuscular or intravenous injection or as sublingual tablets. It is not administered orally, due to very high first-pass metabolism. Burenorphine is metabolised in the liver into an active metabolite, norbuprenorphine by N-dealkylation via CYP-3A4. The metabolites are further conjugated with glucoronic acid and eliminated mainly through excretion into the bile.
Side effects
Most common side effects are drowsiness, nausea, sweating and dizziness. High doses can also cause respiratory depression, which can be dangerous, for there is no depandable antagonist. Buprenorphine causes addiction, but mainly psychological dependence.
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