Buprenorphine Microdosing for the Pain and Palliative Care Clinician
Journal of Palliative Medicine December 20, 2021 Kyle Quirk, Maximillian H. Stevenson
Microdosing induction of buprenorphine, in which the drug is gradually titrated while full agonist opioids are continued, offers a viable alternative to traditional inductions that require an opioid-free interval or withdrawal. This review of 34 publications found that the most common strategy involved administering divided doses of sublingual products marketed for opioid use disorder, with 73.5% of articles using partial tablets or films ranging from 1/8 to 1/2 of a 2 mg product. Transdermal patches, low-dose sublingual buprenorphine available in Europe, intravenous buprenorphine, and buccal buprenorphine have also been used. The speed of induction, setting, final dosing, and management of concomitant full agonists varied widely.