Tuesday, September 7, 2010

Pain Updates: Butrans - Buprenorphine patch

  • is a transdermal system (buprenorphine) indicated for moderate-to-severe chronic pain in patients requiring an around-the-clock opioid analgesic for an extended period of time.
  • exerts its analgesic effect via high affinity binding to μ opiate receptors in the CNS; displays partial mu agonist and weak kappa antagonist activity
  • intended to be used for the continual release of buprenorphine transdermally over a 7-day period per patch, for the management of persistent pain of moderate intensity. BuTrans can be used in either opioid naïve patients or patients previously treated with PRN (as needed) analgesics when the analgesic requirement has progressed to a need for continuous opioid analgesia.
  • Pallimed article:
  • From:
    • Its release is controlled by the physical characteristics of the matrix and is proportional to the surface area of the patch. Absorption of the buprenorphine through the skin and into the systemic circulation is influenced by the stratum corneum and blood flow.
    • There are few practical differences in the use of the buprenorphine or fentanyl matrix patches.
    • Compared with fentanyl, TD buprenorphine adheres better. However, after patch removal, it is associated with more persistent erythema (± localized pruritus), and sometimes a more definite dermatitis.
    • Retrospective analysis suggests that, compared with TD fentanyl, patients receiving TD buprenorphine (as Transtec®) have a slower rate of dose increase and longer periods of dose stability.
    • Buprenorphine does slow intestinal transit, but possibly less so than morphine. Constipation may be less severe.
    • In contrast to other opioids, buprenorphine does not suppress the gonadal axis or testosterone levels.
    • Compared with morphine and other opioids, buprenorphine has little or no immunosuppressive effect.
    • With typical clinical doses, it is possible to use morphine (or other μ-opioid receptor agonist) for break-through (episodic) pain and to switch either way between buprenorphine and morphine (or other μ-opioid receptor agonist) without loss of analgesia.
    • Despite concerns that antagonism could occur, this is likely only with a very large dose; even with buprenorphine 32mg SL, only 84% of μ-opioid receptors are occupied.
    • A recent study in volunteers suggests that buprenorphine may have an antihyperalgesic effect as well as an analgesic effect.
    • Animal studies and case reports also suggest that buprenorphine may be of particular benefit in neuropathic pain. The implications for the clinical management of neuropathic pain, if any, need to be determined by controlled studies.



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Pharmacy History

"The earliest known compilation of medicinal substances was ARIANA the Sushruta Samhita, an Indian Ayurvedic treatise attributed to Sushruta in the 6th century BC. However, the earliest text as preserved dates to the 3rd or 4th century AD.
Many Sumerian (late 6th millennium BC - early 2nd millennium BC) cuneiform clay tablets record prescriptions for medicine.[3]

Ancient Egyptian pharmacological knowledge was recorded in various papyri such as the Ebers Papyrus of 1550 BC, and the Edwin Smith Papyrus of the 16th century BC.

The earliest known Chinese manual on materia medica is the Shennong Bencao Jing (The Divine Farmer's Herb-Root Classic), dating back to the 1st century AD. It was compiled during the Han dynasty and was attributed to the mythical Shennong. Earlier literature included lists of prescriptions for specific ailments, exemplified by a manuscript "Recipes for 52 Ailments", found in the Mawangdui tomb, sealed in 168 BC. Further details on Chinese pharmacy can be found in the Pharmacy in China article."

From Wikipedia:

Journal of Palliative Medicine - Table of Contents

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