Excess salivation

Buprenorphine Post
MichaelWShoreMD
Posts: 370

Postby MichaelWShoreMD » Tue Jul 26, 2005 5:51 pm

Two issues: First, the transition from methadone to Bup is invariably difficult. I also want my patients to be free of any methadone for 72 hours, but it is usually too difficult for them to accomplish this over the last 24 to 36 hours without assistance. I have used some Darvocet, one Q 4 - 6 up until 15 hours before induction, clonidine .1 up to TID and valium 5 to 10 mg TID over the last 24 to 36 hours before induction to help ease the distress from methadone abstinence. Even with 72 hours, my patients switching from methadone do not feel better for two to three days after initiating Bup, but they usually don't feel much worse. As far as the excessive salivation, I have usually not had it interfere with sublingual administration, but certainly individual patient variability is expected. Either using higher doses initially (expecting some medication to be lost and making up for it) or an anticholinergic agent for the first few days is reasonable. Mike

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