Supplementing Transdermal Buprenorphine with Immediate-Release Opioids Acceptable

LAS VEGAS, NV — At PAINWeek 2012, investigators reported that immediate-release opioids are acceptable for supplemental analgesia when transdermal buprenorphine is being used to manage moderate-to-severe chronic pain.

Buprenorphine is a partial mu-opioid receptor agonist that has a high affinity for, and slow dissociation from, the mu-opioid receptor. Transdermal buprenorphine is approved to treat moderate-to-severe chronic pain. Because buprenorphine may displace or prevent competing mu-opioid agonists from binding, confusion arose regarding whether immediate-release, full mu-opioid receptor agonists could be used concomitantly for supplemental analgesia.

This study reviewed current buprenorphine pharmacology literature. Additionally, the researchers performed an analysis on the concomitant use of immediate-release opioids (e.g., hydrocodone/acetaminophen, oxycodone/acetaminophen, codeine/acetaminophen) for supplemental analgesia during an open-label, long-term clinical trial of transdermal buprenorphine for moderate-to-severe chronic pain.

The study also searched published literature to identify other clinical trials of transdermal buprenorphine that reported on using immediate-release opioids for supplemental analgesia. This search identified several published clinical studies with the higher dose formulations of transdermal buprenorphine that are available in Europe, and these studies allowed the use of immediate-release opioids (e.g., oral morphine, tramadol) as supplemental analgesia for pain.

Dr. Marc Cataldo, PharmD, from Purdue Pharma, Stamford, CT, and colleagues concluded that immediate-release opioids are an acceptable choice for supplemental analgesia while managing moderate-to-severe chronic pain with transdermal buprenorphine. Their basis for this treatment option included transdermal buprenorphine clinical trial experience, the U.S .Prescribing Information for transdermal buprenorphine, and published clinical studies.