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Posted: Fri Oct 14, 2016 7:20 am
by drpasser
I do not agree c the 2 mgs q 45 mins. It take two full hours for each dose's effects.
Dosing should be q 2 hrs for inductions.
I usually limit the pt's first day's dose to no lore than 6-8 mgs.
Starting low and going slow is the way to go.
Pts end up on lower doses that way and still do just fine
However much pts end up on during induction, that's the more that their going to need to come off of, the more the fetus will be exposed to and the more of an expense.


Posted: Fri Oct 14, 2016 7:20 am
by NoDrugs4u
We don't have any special procedures in my clinic for pregnant patient inductions other than using plain buprenorphine instead of the combination products. All inductions are in-clinic (outpatient). Logic is that any complications from the bup are still better than the patient using heroin.

Posted: Fri Oct 14, 2016 7:20 am
by robertsonjon
Make sure the patient is told to be in at least mild withdrawal for their first visit. Make sure they are, COWS score of at least 6. Give them 2mg q45 minutes (until withdrawal symptoms are controlled) up to 16mg on day one. If that doesn't work, on day 2, you can go up to 24mg. I use the same method whether they are pregnant or not. Call the obstetrician and inform them (after getting patient consent) and see if OB wants to check the patient over after induction.

Posted: Fri Oct 14, 2016 7:20 am
by kcairns
protocols abound including asam national practice guide but bottom line is it is a very simple thing - mild/mod wdrl and start, many like to start w small doses and will so tell you, I start usually w 8 and next day 12 problem free and allow woman enjoy fully the anticipation of happy events and me of another coming happy mom and beautiful baby

Posted: Fri Oct 14, 2016 7:20 am
by medic2109
Myself, personally, have done them in the office. But I don't wait for a high COWS score. I will accpet a 5-8 if their symptoms they experience are the typical they get when they first start to get dope sick. If you are able to get buprenex in your office, you can give a small IM test dose to see if they precipitate. If not then it is in my opinion same. The alternative is to get a 2 mg subutex and give 1/2 and see if they have any symptoms of precipitate withdrawal. If so stop and wait. I have induced about 20 women of varying gestation along with recommendations and acknowledgement of the high risk ob/gyn I make them see.

I see nothing in the law that prevents me from using buprenex as a test dose. I just cant use it as a long term treatment for SUD