The official journal of
EUROPAD - European Opiate Addiction Treatment Association
WFTOD - World Federation for the Treatment of Opioid Dependence
Editor: Icro Maremmani, MD - Pisa, Italy, EU
Associate Editors:
Thomas Clausen, MD - Oslo, Norway
Pier Paolo Pani, MD - Cagliari, Italy, EU
Marta Torrens, MD - Barcelona, Spain, EU
Statistical Editor:
Mario Miccoli, PhD - Pisa, Italy, EU

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Heroin Addiction and Related Clinical Problems: 2024, 26, 20

Maternal Buprenorphine split dosing

Cindy Flores, Usman Riaz, Peter Tenore, and Nazar Muhammad

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Summary: Background: Buprenorphine treatment is rapidly emerging as the preferred standard of care for opioid-dependence disorders due to its safety profile. In pregnant patient populations, buprenorphine serum concentrations have been shown to decrease due to physiological changes during gestation. Current dosing protocols do not address the elevated predisposition of pregnant patients to developing early withdrawal symptoms that maladaptively affect mother and child. Aim: To explore the safety and efficacy of buprenorphine split-dosing as a medical intervention for managing opioid dependence for pregnant mothers and children. Materials/Methods: An online search was performed on Medline/PubMed to find relevant studies on the safety and effectiveness of buprenorphine split-dosing for maternal and fetal health. Results: Buprenorphine is a potential opioid-replacement therapy for pregnant women. However, pregnancy decreases plasma protein levels and increases fats and cytochrome p450 and glucuronosyltransferase enzyme activities, which lower buprenorphine blood concentrations. Split-dosing maintains higher plasma levels of buprenorphine, improves the doctor-patient relationship, encourages greater compliance for urine toxicology, and does not increase the severity of neonatal abstinence syndrome (NAS). Split doses are recommended for pregnant women suffering from over-medication or withdrawal symptoms before the next dose. Conclusion: Buprenorphine split-dosing promises to maintain therapeutic plasm levels, improve doctor-patient relationships and support healthier maternal/fetal heart rate and variability.

Keywords: Maternal dosing; Buprenorphine; Opioid use disorder


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