BELBUCA 150 MCG PATCH

Alternative to Home Buprenorphine Induction Dosing, for those not currently in Opioid Withdrawal.Iphone Application (BUP Home) created by Yale Clinicians.Offer Opioid Withdrawal symptomatic management (e.g.Requires patient to withstand abstaining from Opioids long enough at home to precipitate withdrawal.Consider for those not currently in Opioid Withdrawal.By day 7: Maximum of 32 mg/day (no benefit above 24-32 mg daily).Adjusted based on physician evaluation, withdrawal.Re-evaluation in 24 hours (no more than 7 days).May repeat 2-4 mg every 1-2 hours up to 8-16 mg/day.Lower Dose Protocol: Start with Buprenorphine 2 mg SL.May repeat 4-8 mg every 30-60 minutes until adequate effect (up to 16 mg).Higher Dose Protocol: Start with Buprenorphine 4-8 mg SL.Monitor at 60 min intervals after first dose, titrating to dose that reduces withdrawal symptoms.Initiation Dosing on Day 1 (provider observed).Started >24 hours after last long acting Narcotic.Started >12 hours after last short acting Narcotic.Buprenorphine will precipitate withdrawal if not already present.Avoid starting Buprenorphine in patients without active withdrawal symptoms.Clinical Opiate Withdrawal Scale or COWS >8 (or other withdrawal scale).Patient should be at least 12 hours from last short-acting or 24 hours from last long-acting Opioid.Indicated for patients on stable dose of Buprenorphine SL at 8-24 mg/day for at least 1 week.Buprenorphine monthly injection (Sublocade).Indicated for patients on stable dose of Buprenorphine SL at 8 mg/day for at least 3 months.Implanted subdermal rods with duration of 6 months (may be replaced once in opposite arm).Maximum effective dose: 32 mg Buprenorphine (no benefit above 24-32 mg daily).Goal: 16 mg Buprenorphine and 4mg Naloxone.Titrate: Over 2 days (see dosing protocol for Buprenorphine below).Start: 4 mg Buprenorphine and 1mg Naloxone.Prevents snorting (but has still been misused via injection).May not appear on routine Urine Drug Screen.Drug Abusers crush and snort the sublingual tabs.Abused despite combination with Naloxone.Buprenorphine with Naloxone (Suboxone, Zubsolv, generic).Same dosing as with Buprenorphine with Naloxone.On switching from other Opioid, wean to no more than equivalant to Morphine 30 mg/day.Buccal film used twice daily (dosed in mcg).

BELBUCA 150 MCG PATCH

Patch applied once weekly (dosed in mcg).Stop other Opioid in evening, and start Butrans or Belbuca the next morning.Taper current Opioid before switching OR.Switching to Butrans or Belbuca from other Opioid.Intended for lower chronic doses or in Opioid naive patients.

Belbuca 150 mcg