buprenorphine needs dose adjustment in liver dysfunction but not in renal dysfunction

Buprenorphine (and buprenorphine-naloxone formulations) are primarily metabolized in the liver by CYP3A4 and excreted by the gastrointestinal system. For patients with moderate to severe hepatic dysfunction, dose reduction and/or avoiding buprenorphine should be considered. Because the kidneys have little role in the metabolism and excretion of buprenorphine, the medication dose does not need to be adjusted for either acute or chronic kidney dysfunction. The medication is also not significantly dialyzed because it has a large volume of distribution and is highly protein bound, so doses do not need to be adjusted for patients receiving renal replacement therapy.12345

Footnotes

  1. SEEK Questionnaires ↩

  2. Buresh M, Ratner J, Zgierska A, et al. Treating perioperative and acute pain in patients on buprenorphine: narrative literature review and practice recommendations. J Gen Intern Med. 2020;35(12):3635-3643. PubMed ↩

  3. Erstad BL, Glenn MJ. Management of critically ill patients receiving medications for opioid use disorder. Chest. 2024;165(2):356-367. PubMed ↩

  4. Smith K, Wang M, Abdukalikov R, et al. Pain management considerations in patients with opioid use disorder requiring critical care. J Clin Pharmacol. 2022;62(4):449-462. PubMed ↩

  5. The ASAM national practice guideline for the treatment of opioid use disorder: 2020 focused update. J Addict Med. 2020;14(2S suppl 1):1-91. PubMed ↩