Bunavail

Buprenorphine Post
jmosby1469
Posts: 104

Postby jmosby1469 » Tue Jan 13, 2015 6:56 am

I know you have a reason for not suggesting a fractionated dose plan.

fishdoc
Posts: 111

Postby fishdoc » Tue Jan 13, 2015 6:56 am

Thank you, ckheb, I have been telling patients to chew the "gummy bear" for another 5 or sip some water and swish it in the mouth for a few seconds before spitting it out or swelling the liquid. Most of the time this is enough to make the "gummy bear" dissolve and there is no further problem.

Your analysis of the relative strength of the 3 name brands is correct. This has been mentioned in other threads.

assadi11
Posts: 5

Postby assadi11 » Tue Jan 13, 2015 6:56 am

Hi guys. I have a patient on 8/2 mg of Suboxone bid. He says he gets extremely sleepy during the day after the morning dose. There is no relation to food intake. He has tried it before after taking food and still gets so sleepy. I asked him even not to swallow the juice but no different. He is the only patient I have with such complaints. Out of frustration! I gave him Bunavail !! today. Can someone please suggest something. I appreciate it.

ckheb
Posts: 25

Postby ckheb » Tue Jan 13, 2015 6:56 am

I fear that my previous post regarding Bunavail was too nebulous or circuitous. (I suspect I was trying to sound academic...mistake) So...

Starting out with a new patient not used to Suboxone film is a great idea! Standard titration until clinically stable. No expectations from the patient or physician.

But...If changing from Sub film to Bunavail, we must remember that Suboxone film is 30% stronger than Suboxone tablets, 30% stronger than Bunavail, 30% stronger than Zubsolv, 30% stronger than the generics, and 30% stronger than Subutex generic. So it is necessary to increase the number of Bunavail film by at least 30% above the number of Suboxone film (and my experience is to bump it even a little more). And since we're physicians, let's titrate for clinical effect. One Bunavail film (4.2mg) IS NOT equivalent to one Suboxone film (8mg). And if we titrate for clinical effect, there can be no failures...needed is just a dose adjustment.

There will, of course, be lots of reasons that a patient won't like Bunavail, as with any new med. But there are many advantages, also.

But regarding the 'Gummy Bear effect,' studies of BEMA absorption dynamics suggest "After 20 - 30 minutes, the 'Gummy Bear' can be spit out or swallowed;" Or deco-art created; Or something. But I don't think it can be blamed for withdrawal due to inadequate absorption. It is simply "A shadow of its former self, to be dismissed without concern."

drpasser
Posts: 1404

Postby drpasser » Tue Jan 13, 2015 6:56 am

Thanks
I plan to "make it work " one way or another :-)

KP

deegee
Posts: 137

Postby deegee » Tue Jan 13, 2015 6:56 am

Kevin, I think that is the best way to use this medication. Patients who are completely naive to bupe. Otherwise they will have unmet expectations, are used to another med, distrust a new med, esp one with lower mg numbers.
I'll bet you find that it works well and the patients are pleased. I do believe it has advantages and will make inroads if introduced in this way.

drpasser
Posts: 1404

Postby drpasser » Tue Jan 13, 2015 6:56 am

I plan to re-try, on my first new pt who is completely naive to bupe.

deegee
Posts: 137

Postby deegee » Tue Jan 13, 2015 6:56 am

I agree that it's difficult to transition from film to bunavail, but for new patients it's not been a problem.
It also carries a lower incidence of constipation, maybe from less swallowed bup. I've had patients who got headaches from films, switch to bunavail and get no headache, perhaps because there is not an accumulation of saliva that may be swallowed with naloxone in it.
I agree that the dosing guidelines are misleading, but I don't know if there is pharmacokinetic data to compare to other than that of the tablets. (or so the reps say).
I think this new drug's greatest****et is it's apparent resistance to misuse.

drpasser
Posts: 1404

Postby drpasser » Tue Jan 13, 2015 6:56 am

All my Bunavail pts have not been neophytes to OBOT c bupe. Most had been on Film.

fishdoc
Posts: 111

Postby fishdoc » Tue Jan 13, 2015 6:56 am

Have all your Bunavail failures been new starts? I was unable to switch most patients from Suboxone film to Zubsolv, unless mandated by third party payers, but new start patients have had much less trouble and were mostly successful on Zubsolv. While I have not had a lot of Bunavail patients, all have been new starts and only a couple have disliked it.


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