buprenorphine and Dizziness

Buprenorphine appears to have a ceiling effect on respiratory depression, but not analgesia in healthy young patients. However, the efficacy and side-effects of buprenorphine in the setting of acute pain are poorly characterized. The aim of this study was to characterize the analgesic efficacy and adverse effects of buprenorphine compared with morphine in the acute pain setting. A systematic review of five databases was performed. Randomised controlled trials (RCTs) comparing buprenorphine with morphine in acute pain management were included. Studies performed outside of the hospital setting were excluded. The a priori primary outcomes included pain, respiratory depression, and sedation. Secondary outcomes included requirement for rescue analgesia, time to rescue analgesia, nausea, vomiting, dizziness, hypotension, and pruritus. Twenty-eight RCTs with 2210 patients met the inclusion criteria. There was no difference in pain [visual analogue scale weighted mean difference (WMD)=-0.29; 95% confidence interval (CI)=-0.62 to 0.03; I

Topics: Acute Pain; Analgesics, Opioid; Buprenorphine; Dizziness; Humans; Hypotension; Nausea; Pain Management; Pruritus; Randomized Controlled Trials as Topic; Respiration; Treatment Outcome; Vomiting

Buprenorphine has low oral bioavailability. Regardless of sublingual administration, a notable part of buprenorphine is exposed to extensive first-pass metabolism by the cytochrome P450 (CYP) 3A4. As drug interaction studies with buprenorphine are limited, we wanted to investigate the effect of voriconazole, a strong CYP3A4 inhibitor, on the pharmacokinetics and pharmacodynamics of oral buprenorphine.. Twelve healthy volunteers were given either placebo or voriconazole (orally, 400 mg twice on day 1 and 200 mg twice on days 2-5) for 5 days in a randomized, cross-over study. On day 5, they ingested 0.2 mg (3.6 mg during placebo phase) oral buprenorphine. We measured plasma and urine concentrations of buprenorphine and norbuprenorphine and monitored their pharmacological effects. Pharmacokinetic parameters were normalized for a buprenorphine dose of 1.0 mg.. Voriconazole greatly increased the mean area under the plasma concentration-time curve (AUC. Voriconazole greatly increases exposure to oral buprenorphine, mainly by inhibiting intestinal and liver CYP3A4. Effect on some transporters may explain elevated norbuprenorphine concentrations. Although oral buprenorphine is not commonly used, this interaction may become relevant in patients receiving sublingual buprenorphine together with voriconazole or other CYP3A4 or transporter inhibitors.

Topics: Adolescent; Adult; Analgesics, Opioid; Antifungal Agents; Area Under Curve; Biotransformation; Buprenorphine; Cross-Over Studies; Cytochrome P-450 CYP3A; Dizziness; Drug Interactions; Female; Half-Life; Healthy Volunteers; Humans; Male; Voriconazole; Young Adult

An on demand intramuscular analgesic system using the Cardiff Palliator was tested. Forty consenting patients were studied after cholecystectomy in a double blind trial using increments of buprenorphine (0.15 mg), meptazinol (50 mg), morphine (5 mg), and pethidine (50 mg). Most patients attained good levels of pain relief (mean analogue pain score 36.5), comparable to intravenous on demand analgesia. There were no technical complications. Significant differences were found between drugs in dizziness (pethidine produced the worst score) but not with other side effects. Buprenorphine produced longer lasting analgesia than meptazinol or pethidine and also gave the lowest pain scores. Patterns of analgesic consumption were the same as with intravenous on demand systems, but larger amounts of drug were generally used. Relative analgesic potencies derived from drug consumption rates were also consistent with those from intravenous on demand studies. An on demand intramuscular analgesic system offers a simple but effective means of relieving severe postoperative pain.

Topics: Adolescent; Adult; Aged; Analgesics; Buprenorphine; Cholecystectomy; Clinical Trials as Topic; Dizziness; Double-Blind Method; Female; Humans; Injections, Intramuscular; Male; Meperidine; Meptazinol; Middle Aged; Morphine; Pain, Postoperative

This study examined analgesic efficacy and adverse effects of buprenorphine and fentanyl for the postoperative pain relief by continuous epidural infusion. Fifty patients after upper or lower abdominal surgeries were assigned to two groups and buprenorphine and fentanyl were epidurally administered postoperatively. Buprenorphine (B) group received bolus injection of B 0.1mg + saline 8 ml and continuous infusion of B 0.8 mg+saline 92 ml (2 ml.h-1). Fentanyl group received bolus injection of F 0.1 mg+saline 6 ml and continuous infusion of F 0.6 mg+saline 84 ml (2 ml.h-1). There was no significant difference between the two groups in the analgesic efficacy, which became lower from 2 to 12 hours postoperatively. However, compared with buprenorphine group, the incidence of nausea or vomiting and dizziness was significantly less in the fentanyl group (11 vs. 4 cases and 7 vs. 1 cases). These results imply that the major site of action of epidurally administered fentanyl is the spinal cord. In contrast, analgesic effect of epidural buprenorphine appears to be enhanced by the supraspinal action. We conclude that fentanyl is superior to buprenorphine for postoperative pain relief by continuous epidural infusion.

Topics: Abdomen; Aged; Buprenorphine; Dizziness; Female; Fentanyl; Humans; Injections, Epidural; Male; Middle Aged; Nausea; Pain, Postoperative; Vomiting