{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T08:06:20Z","timestamp":1771488380286,"version":"3.50.1"},"reference-count":15,"publisher":"American Association of Psychiatric Pharmacists (AAPP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n        <jats:p>\n          <jats:bold>Introduction: <\/jats:bold>Sublingual buprenorphine is indicated for opioid dependence. It comes in 2 formulations: a mono buprenorphine product (BUP) and a combination product containing naloxone (BUP-NAL), which functions as an abuse deterrent. Sublingual naloxone does not reach clinically significant levels except in cases of hepatic impairment, where its metabolism can be impaired. Substantial naloxone accumulation could block the therapeutic effects of buprenorphine. The risk of hepatic impairment is elevated in the opioid dependence population, and our case highlights the need for careful evaluation of hepatic function and consideration of BUP.<\/jats:p>\n        <jats:p>\n          <jats:bold>Case\/Results: <\/jats:bold>We report a patient with end-stage liver disease who began BUP-NAL induction with modest improvement on treatment day 1 followed by sustained withdrawal after receiving an observed dose on day 2. He returned to the clinic 2 days after his second successive day of BUP-NAL, vomiting and complaining of persistent withdrawal. To avoid potential accumulation of naloxone, the patient was eventually switched to and stabilized on BUP with good response.<\/jats:p>\n        <jats:p>\n          <jats:bold>Discussion\/Conclusion: <\/jats:bold>The clinical course this patient experienced during induction makes a case that naloxone can accumulate and interfere with the effectiveness of buprenorphine in the presence of liver dysfunction. Our case highlights the need for consideration of BUP in circumstances where patient safety and effective treatment outweigh the risks of prescribing a product with abuse deterrent properties.<\/jats:p>","DOI":"10.9740\/mhc.2016.05.131","type":"journal-article","created":{"date-parts":[[2016,5,2]],"date-time":"2016-05-02T20:32:41Z","timestamp":1462221161000},"page":"131-133","source":"Crossref","is-referenced-by-count":4,"title":["Intolerance of sublingual buprenorphine-naloxone during induction in a patient with end-stage liver disease: A case report"],"prefix":"10.9740","volume":"6","author":[{"given":"Jennifer","family":"Behan","sequence":"first","affiliation":[{"name":"(Corresponding author) City and County Department of Public Health Pharmacist, Behavioral Health Services, San Francisco Health Network, San Francisco, California, jonesbehan@gmail.com;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Geier","sequence":"additional","affiliation":[{"name":"City and County Department of Public Health Pharmacist, Behavioral Health Services, San Francisco Health Network, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4719","reference":[{"key":"i2168-9709-6-3-131-b01","series-title":"Clinical guidelines for the use of buprenorphine in the treatment of opioid addiction: a treatment improvement protocol (TIP) series 40 [Internet]","unstructured":"Center for Substance Abuse Treatment. Clinical guidelines for the use of buprenorphine in the treatment of opioid addiction: a treatment improvement protocol (TIP) series 40 [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration(SAMHSA); 2004 [cited 2015 Sept 20]. Available from: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK64245\/pdf\/Bookshelf_NBK64245.pdf"},{"key":"i2168-9709-6-3-131-b02","article-title":"Buprenorphine and buprenorphine-naloxone preparations","unstructured":"Author. Buprenorphine and buprenorphine-naloxone preparations [Internet]. Hudson(OH): Lexicomp; 2015 [cited 2015 Oct 28]. Available from: http:\/\/online.lexi.com"},{"issue":"Suppl 2","key":"i2168-9709-6-3-131-b03","series-title":"Drug Alcohol Depend","first-page":"S39","article-title":"Pharmacokinetics of the combination tablet of buprenorphine and naloxone","volume":"70","author":"Chiang \n              CN,","year":"2003","unstructured":"Chiang \n              CN, \n            \n            \n              Hawks \n              RL. \n            \n          \n          Pharmacokinetics of the combination tablet of buprenorphine and naloxone. Drug Alcohol Depend. 2003;70Suppl 2:S39-47. 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