Login Register Cart 0
Generic placeholder image

Current Psychopharmacology

Editor-in-Chief

ISSN (Print): 2211-5560
ISSN (Online): 2211-5579

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Case Report

Rapid Metabolism of Monthly Extended-Release Buprenorphine Formulation: A Case Report

Author(s): Hossameldin Tolba, Wael Foad and Samer El Hayek*

Volume 12, 2024

Published on: 31 May, 2024

Article ID: e310524230588 Pages: 5

DOI: 10.2174/0122115560292967240527072922

Price: $65

Open Access Journals Promotions 2
conference banner
Abstract

Background: Medication-assisted treatment constitutes the gold standard management for patients with opioid use disorder. Many factors can alter the response to medications, including genetic variations. In this case report, we discuss the presentation of a patient maintained on subcutaneous extended-release buprenorphine formulation who repeatedly presented objective and subjective signs of opioid withdrawal when he was switched from weekly to monthly formulation. We particularly highlight the role of metabolic pharmacogenes in this presentation.

Case Presentation: Mr. Y, a 31-year-old single man, presented to our rehabilitation center seeking assistance for his polysubstance dependence, mainly opioid use disorder. As part of his multidisciplinary treatment plan, he was started on weekly extended-release buprenorphine. After maintenance for several months, he was transitioned to the monthly equivalent formulation. Since the transition, he began to develop severe withdrawal symptoms 1-2 weeks before his next due injection. This was paralleled by a noted decrease in buprenorphine level on his urine drug screening test. As soon as the patient was placed back on the weekly formulation, his symptoms resolved.

Conclusion: This is a novel case highlighting the potential role of pharmacogenomics in clinical presentation and response to medications. Switching patients from weekly to monthly extendedrelease buprenorphine formulation might make rapid or ultra-rapid metabolizers at risk of earlyonset withdrawal symptoms. In such a case, earlier provision of the injection or switching to another formulation or medication can be considered.

Keywords: Buprenorphine, extended-release, medication-assisted treatment, rapid metabolism, opioid use disorder, case report.

[1]
Bahji A, Cheng B, Gray S, Stuart H. Mortality among people with opioid use disorder: A systematic review and meta-analysis. J Addict Med 2020; 14(4): e118-32.
[http://dx.doi.org/10.1097/ADM.0000000000000606] [PMID: 32011406]
[2]
Alawa J, Muhammad M, Kazemitabar M, et al. Medication for opioid use disorder in the Arab World: A systematic review. Int J Drug Policy 2022; 102: 103617.
[http://dx.doi.org/10.1016/j.drugpo.2022.103617] [PMID: 35182841]
[3]
Oesterle TS, Thusius NJ, Rummans TA, Gold MS. Medication-assisted treatment for opioid-use disorder. Mayo Clin Proc 2019; 94(10): 2072-86.
[http://dx.doi.org/10.1016/j.mayocp.2019.03.029] [PMID: 31543255]
[4]
Sofuoglu M, DeVito EE, Carroll KM. Pharmacological and behavioral treatment of opioid use disorder. Psychiatr Res Clin Pract 2019; 1(1): 4-15.
[http://dx.doi.org/10.1176/appi.prcp.20180006]
[5]
National Academies of Sciences, Engineering, and Medicine Medications for opioid use disorder save lives. Washington DC: The National Academies Press 2019.
[6]
Ma J, Bao YP, Wang RJ, et al. Effects of medication-assisted treatment on mortality among opioids users: A systematic review and meta-analysis. Mol Psychiatry 2019; 24(12): 1868-83.
[http://dx.doi.org/10.1038/s41380-018-0094-5] [PMID: 29934549]
[7]
Poliwoda S, Noor N, Jenkins JS, et al. Buprenorphine and its formulations: A comprehensive review. Health Psychol Res 2022; 10(3): 37517.
[http://dx.doi.org/10.52965/001c.37517] [PMID: 35999975]
[8]
Boyett B, Nadipelli VR, Solem CT, Chilcoat H, Bickel WK, Ling W. Continued posttrial benefits of buprenorphine extended release: Recover study findings. J Addict Med 2023; 17(2): 182-9.
[http://dx.doi.org/10.1097/ADM.0000000000001070] [PMID: 36111991]
[9]
Seguí H A, Melin K, Quiñones D S, Duconge J. A review of the pharmacogenomics of buprenorphine for the treatment of opioid use disorder. J translat genet genom 2020; 4: 263-77.
[10]
Pirmohamed M. Pharmacogenomics: Current status and future perspectives. Nat Rev Genet 2023; 24(6): 350-62.
[http://dx.doi.org/10.1038/s41576-022-00572-8] [PMID: 36707729]
[11]
Pardiñas AF, Owen MJ, Walters JTR. Pharmacogenomics: A road ahead for precision medicine in psychiatry. Neuron 2021; 109(24): 3914-29.
[http://dx.doi.org/10.1016/j.neuron.2021.09.011] [PMID: 34619094]
[12]
Ventola C L. Role of pharmacogenomic biomarkers in predicting and improving drug response: Part 1: The clinical significance of pharmacogenetic variants. P & T a peer-rev j formul manag 2013; 38(9): 545-60.
[13]
McDonnell AM, Dang CH. Basic review of the cytochrome p450 system. J Adv Pract Oncol 2013; 4(4): 263-8.
[PMID: 25032007]
[14]
Elarabi H, Elrasheed A, Ali A, et al. Suboxone treatment and recovery trial (STAR-T): Study protocol for a randomised controlled trial of opioid medication assisted treatment with adjunctive medication management using therapeutic drug monitoring and contingency management. J Addict 2019; 2019: 1-11.
[http://dx.doi.org/10.1155/2019/2491063] [PMID: 30956839]
[15]
European Medicines Agency. (2018). Buvidal Assessment report. Science Medicines Health.Available from: https://www.ema. europa.eu/en/documents/assessment-report/buvidal-epar-public-assessment-report_en.pdf
[16]
Tidder J. Long-acting injectable buprenorphine (Buvidal®) protocol. NHS borders clinical guidelines. Retrieved on 20/10/2023. Available from: https://rightdecisions.scot.nhs.uk/nhs-borders-clinical-guidelines/mental-health-learning-disabilities/long-acting-injectable-buprenorphine-buvidal-protocol/
[17]
Kharidia J, Howgate EM, Laffont CM, Liu Y, Young MA. Evaluation of drug‐drug interaction liability for buprenorphine extended‐release monthly injection administered by subcutaneous route. Clin Pharmacol Drug Dev 2021; 10(9): 1064-74.
[http://dx.doi.org/10.1002/cpdd.934] [PMID: 33750027]
[18]
Al-Ahmad MM, Amir N, Dhanasekaran S, et al. Genetic polymorphisms of cytochrome P450-1A2 (CYP1A2) among Emiratis. PLoS One 2017; 12(9): e0183424.
[http://dx.doi.org/10.1371/journal.pone.0183424] [PMID: 28934216]
[19]
Ettienne EB, Ofoegbu A, Maneno MK, et al. Pharmacogenomics and opioid use disorder: Clinical decision support in an african american cohort. J Natl Med Assoc 2019; 111(6): 674-81.
[http://dx.doi.org/10.1016/j.jnma.2019.09.006] [PMID: 31676110]
[20]
Lo A, Kerr T, Hayashi K, et al. Factors associated with methadone maintenance therapy discontinuation among people who inject drugs. J Subst Abuse Treat 2018; 94: 41-6.
[http://dx.doi.org/10.1016/j.jsat.2018.08.009] [PMID: 30243416]
[21]
Wong AK, Somogyi AA, Rubio J, Philip J. The role of pharmacogenomics in opioid prescribing. Curr Treat Options Oncol 2022; 23(10): 1353-69.
[http://dx.doi.org/10.1007/s11864-022-01010-x] [PMID: 36001223]
[22]
Randesi M, Rotrosen J, Nunes EV, et al. Variants of opioid genes and response to treatment of opioid use disorder with buprenorphine-naloxone versus extended-release naltrexone in Caucasians. Am J Drug Alcohol Abuse 2020; 46(6): 761-8.
[http://dx.doi.org/10.1080/00952990.2020.1797064] [PMID: 32851876]
[23]
Kranzler HR, Lynch KG, Crist RC, et al. A delta-opioid receptor gene polymorphism moderates the therapeutic response to extended-release buprenorphine in opioid use disorder. Int J Neuropsychopharmacol 2021; 24(2): 89-96.
[http://dx.doi.org/10.1093/ijnp/pyaa069] [PMID: 32920647]
[24]
Crist RC, Vickers-Smith R, Kember RL, et al. Analysis of genetic and clinical factors associated with buprenorphine response. Drug Alcohol Depend 2021; 227: 109013.
[http://dx.doi.org/10.1016/j.drugalcdep.2021.109013] [PMID: 34488071]

Rights & Permissions Print Cite
Article Metrics
30
3
Wayfinder Image
Open Access Journals Promotions
© 2024 Bentham Science Publishers | Privacy Policy