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Contrary to previous concerns, however, no analgesic ceiling effect and no antagonism of combined pure \u03bc\u2010opioid receptor agonists is seen within the therapeutic dose range. In recent studies, buprenorphine could be effectively and safely combined with full \u03bc\u2010agonists, and switching between buprenorphine and another opioid provided comparable pain relief based on equianalgesic doses. Moreover, buprenorphine exerts an antihyperalgesic effect, which is due\u2014at least in part\u2014to antagonistic activity at \u03ba\u2010opioid receptors.<\/jats:p>\n                  <jats:p>Buprenorphine pharmacokinetics are not altered by advanced age or renal dysfunction. In addition, the risk of respiratory depression is lower than with other opioids including morphine, hydromorphone, methadone and fentanyl. Unlike morphine and fentanyl, there is no immunosuppressive activity with buprenorphine at therapeutic analgesic doses. Transdermal buprenorphine has significantly improved the clinical use of the drug, providing continuous buprenorphine release for up to 96h. In clinical trials, patients receiving transdermal buprenorphine experienced significantly greater pain relief, better sleep, and a reduced need for rescue therapy, compared to placebo. Large\u2010scale post\u2010marketing studies have confirmed the effectiveness of transdermal buprenorphine in treating moderate\u2010to\u2010severe cancer and non\u2010cancer pain including neuropathic syndromes. Finally, the comparably low incidence of CNS adverse events and constipation, and the possibility of use in severe renal dysfunction without a need for dose adjustment make buprenorphine well suited for chronic pain management in at\u2010risk patients, such as diabetics, elderly or renally impaired individuals including those requiring haemodialysis.<\/jats:p>","DOI":"10.1016\/j.ejpain.2008.04.011","type":"journal-article","created":{"date-parts":[[2008,6,25]],"date-time":"2008-06-25T06:09:43Z","timestamp":1214374183000},"page":"219-230","source":"Crossref","is-referenced-by-count":184,"title":["Clinical update on the pharmacology, efficacy and safety of transdermal buprenorphine"],"prefix":"10.1002","volume":"13","author":[{"given":"Hans G.","family":"Kress","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,1,9]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"81","volume-title":"Opioids in the treatment of cancer pain Royal Society of Medicine Services, International Congress and Symposium Series","author":"Atkinson R.E.","year":"1990"},{"key":"e_1_2_6_3_1","first-page":"87","article-title":"Buprenorphine and sustained\u2010release morphine \u2013 effect and side\u2010effects in chronic use","volume":"4","author":"Bach V.","year":"1991","journal-title":"Pain Clinic"},{"key":"e_1_2_6_4_1","first-page":"31","article-title":"The Opioid Study Group of the Spanish Pain Society. 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