Transitioning from bup to methadone in pregnancy

Buprenorphine Post
Posts: 84

Postby DrBallester » Tue Sep 10, 2013 8:34 am

I would perform a witnessed comprehensive and quantitative urine toxicology

At the Ohio State Medical Center, they use Suboxone during pregnancy

Posts: 1404

Postby drpasser » Tue Sep 10, 2013 8:34 am

I know this might be a stupid question, but, is there any chance that she is not absorbing all of the bupe, from the sublingual administration, for one reason or another? Can she try keeping it under her tongue longer? I ask my pts on tablets, to keep swishing the juices around under their tongue, for 20 minutes. Then, I have my pts spit out the juices, as there is no real reason to swallow that stuff.

With the film, I recommend half that time, just 5-10 minutes before spitting. Could this be an issue?

That is one of the main reasons that I always try and have the pt take the first dose in my office, so I can help to better insure that they are properly using the product.

I would not increase her past 32 mgs/day.

It's not a big deal to go from bupe to methadone, it's just a challenge to go from methadone to bupe. In my opinion, bupe (even though not indicated for pregnancy), is generally superior to methadone, and much safer.

I also think, higher doses are often needed for pts with a lot of underlying emotional problems, esp. with Depression and Anxiety.

Any reason to think, that she is diverting and selling some of your prescriptions? Anyway to have family monitor stuff? If she wants the FILM, I would not have a problem with that. Suboxone Film may have a higher street value.


Posts: 571

Postby kcairns » Tue Sep 10, 2013 8:34 am

What is the objective evidence of withdrawal?. Are you with an OTP for issue of methadone or would refer to an OTP and if so would they be inclined to so change? She needs advance plan re out of state as that will be most major issue. As you know most guidance is not to change unless very necessary. It does not seem very clear as to why she would need more bup or methadone at this time. Sticking w bup would not make it harder to transition to methadone and I think your patient is safest by not switching or increasing and so are you.

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