Brand names: Buprenex®Suboxone®Subutex®

Chemical formula:

• Drug Forms:
• Buprenorphine injection (below)
• buprenorphine-sublingual-tablets
• buprenorphine-hydrochloride-solution-for-injection
• buprenorphine-hydrochloride-sublingual-tablet

• Español:
• inyecci-n-de-buprenorfina-1
• tabletas-sublinguales-de-buprenorfina-1
• clorhidrato-de-buprenorfina-soluci-n-para-inyecci-n
• clorhidrato-de-buprenorfina-tableta-sublingual

Buprenorphine injection

What is Buprenorphine injection?

BUPRENORPHINE (Buprenex®) is used to treat moderate to severe pain, usually during or after surgery. Generic buprenorphine injection is available.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

• abnormal bladder function, difficulty urinating

• constipation

• enlarged prostate

• gallbladder disease

• if you frequently have alcohol-containing drinks

• intestinal disease, such as inflammatory bowel disease

• kidney disease

• liver disease

• lung disease, such as asthma or COPD

• an unusual reaction to buprenorphine, morphine, codeine, other medicines, foods, dyes, or preservatives

• pregnant or trying to get pregnant

• breast-feeding

How should this medicine be used?

Buprenorphine injection is usually given as injection into your vein or large muscle by a trained healthcare professional.

Contact your pediatrician or health care professional regarding the use of this medicine in children. Special care may be needed.

What if I miss a dose?

This does not apply. You will receive doses of buprenorphine from your health care professional as you need them for pain.

What drug(s) may interact with Buprenorphine?

• amiodarone

• bosentan

• butorphanol

• clarithromycin

• entacapone

• erythromycin-1

• fluoxetine

• fluvoxamine-luvox

• levomethadyl

• medicines for fungal infections (examples: fluconazole, itraconazole, ketoconazole, voriconazole)

• medicines for seizures

• methadone

• mifepristone-1

• nalbuphine

• naltrexone

• nefazodone

• pentazocine

• rifampicin

• some medicines for the treatment of HIV infection or AIDS

• St. John's wort

Because buprenorphine can cause drowsiness, other medicines that also cause drowsiness may increase this effect of buprenorphine. Some medicines that cause drowsiness are:

• alcohol-containing medicines

• barbiturates such as phenobarbital

• certain antidepressants or tranquilizers

• certain antihistamines used in cold medicines

• muscle relaxants

• other strong pain medicines such as morphine, propoxyphene, hydrocodone

Ask your prescriber or health care professional about other medicines that may increase the effect of buprenorphine.

Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.

What should I watch for while taking Buprenorphine?

Do not drive, use machinery, or do anything that needs mental alertness until you know how buprenorphine affects you. Stand or sit up slowly; this reduces the risk of dizzy or fainting spells. These effects may be worse if you are an older patient. The drowsiness should decrease after taking buprenorphine for a couple of days.

Be careful taking other medicines that may also make you tired. This effect may be worse when taking other medicines that cause drowsiness along with buprenorphine. Alcohol can also increase possible drowsiness, dizziness, confusion and affect your breathing. Avoid alcohol while taking buprenorphine.

What side effects may I notice from receiving Buprenorphine?

Side effects that you should report to your prescriber or health care professional as soon as possible:

• breathing difficulties

• cold, clammy skin

• confusion

• a decrease or difficulty in passing urine

• hives, itching

• lightheadedness or fainting spells

• nervousness or restlessness

• rash

• swelling of ankles

• unusually slow breathing

• yellow skin or eyes

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):

• anxiety

• blurred vision or any change in vision

• confusion

• constipation

• dizziness

• drowsiness

• headache

• insomnia

• nausea

• sweating

• vomiting

Where can I keep my medicine?

This does not apply. You will not be given buprenorphine injection to use at home.

Secondary parkinsonism is similar to Parkinson's disease, but it is caused by certain medicines, a different nervous system disorder, or another illness.

Parkinsonism - secondary

Parkinson's disease is one of the most common nervous system (neurologic) disorders of the elderly. "Parkinsonism" refers to any condition that causes Parkinson's-type abnormal movements. These movements are caused by changes in or destruction of the nerve cells (neurons) that produce the chemical dopamine in a certain area of the brain.

Secondary parkinsonism may be caused by disorders such as:

• Encephalitis
• Meningitis
• Stroke

Other disorders can also damage the dopamine neurons and produce this condition, including:

• Corticobasal degeneration
• Diffuse Lewy body disease
• Multiple system atrophy
• Progressive supranuclear palsy

Another common cause of secondary parkinsonism is medication, such as:

• Antipsychotics (haloperidol)
• Metoclopramide
• Phenothiazine medications

If they damage the area of the brain that contains the dopamine neurons, the following may cause secondary parkinsonism:

• Brain damage caused by anesthesia drugs (such as during surgery)
• Carbon monoxide poisoning
• Exposure to toxins
• Overdoses of narcotics

There have been cases of secondary parkinsonism among intravenous drug users who injected a substance called MPTP, which can be produced when making a form of heroin. These cases are rare and have mostly affected long-term drug users.

Secondary parkinsonism caused by antipsychotics or other medications is usually reversible if identified soon enough. However, it may not be reversible if it is caused by:

• Drug-related brain damage
• Infections
• Toxins

Symptoms of parkinsonism may include:

• Decrease in facial expressions
• Difficulty starting and controlling movement
• Soft voice
• Some types of paralysis
• Stiffness of the trunk, arms, or legs
• Tremor

Although cognitive problems are not as common in Parkinson's disease, they may be more likely in secondary parkinsonism. This is because the diseases that cause secondary parkinsonism often lead to dementia.

For a more detailed description of symptoms, see Parkinson's disease.

The health care provider may be able to diagnose secondary parkinsonism based on your history, symptoms, and a physical examination. However, the symptoms may be difficult to assess, particularly in the elderly.

Examination may show:

• Difficulty starting or stopping voluntary movements
• Increased muscle tone
• Problems with posture
• Slow, shuffling walk (gait)
• Tremors of the Parkinson's type

Reflexes are usually normal.

Tests are not usually specific for secondary parkinsonism. However, they may be used to confirm or rule out other disorders that can cause similar symptoms.

Treatment is aimed at controlling symptoms. If the symptoms are mild, no treatment may be needed.

If the condition is caused by a medication, the benefits of the medication should be weighed against the severity of symptoms. Medications should be stopped or changed if the risks outweigh the benefits.

Treating underlying conditions such as stroke or infections can reduce symptoms.

Medications may be used if symptoms interfere with the ability to perform daily activities. The medication, dose, timing, or combination of medications may need to be adjusted as symptoms change.

Many of the medications used to treat this condition can cause severe side effects. Monitoring and follow-up by the health care provider are important. Secondary parkinsonism tends to be less responsive to medical therapy than Parkinson's disease. However, medications are worth trying if the cause of the condition is not treatable.

Medications used to treat symptoms of Parkinson's disease are:

• Levodopa (L-dopa), Sinemet, levodopa and carbidopa (Altamet)
• Pramipexole (Mirapex), ropinirole (Requip), bromocriptine (Parlodel)
• Selegiline (Eldepryl, Deprenyl), rasagiline (Azilect)
• Amantadine or anticholinergic medications (to reduce early or mild tremors)
• Entacapone (to prevent the breakdown of levodopa)

For a more detailed description of treatment, see Parkinson's disease.

See: Parkinson's disease - support group

What will happen varies and depends on the cause of the disorder. If the disorder is caused by medications, it may be treatable. All other causes are not reversible and tend to get worse over time.

• Difficulty performing daily activities
• Difficulty swallowing (eating)
• Disability (varying degrees)
• Injuries from falls
• Side effects of medications

Side effects from loss of strength (debilitation):

• Aspiration
• Deep vein thrombosis
• Malnutrition

Call your health care provider if:

• Symptoms of secondary parkinsonism develop, come back, or get worse
• New symptoms appear, including:
  • Changes in alertness, behavior, or mood
  • Delusional behavior
  • Dizziness
  • Hallucinations
  • Involuntary movements
  • Loss of mental functions
  • Nausea or vomiting
  • Possible side effects of medications
  • Severe confusion or disorientation

Discuss the situation with your health care provider if you are unable to care for the person at home (after treatment begins).

Treating conditions that cause secondary parkinsonism may decrease the risk.

Only use medications under a health care provider's supervision. People with conditions (such as schizophrenia) that require long-term use of antipsychotics should be carefully monitored to prevent the development of secondary parkinsonism. Newer antipsychotic medications are less likely to cause secondary parkinsonism.

Lang A. Parkinsonism. In: Goldman L, Ausiello D. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 433.

Lang AE. When and how should treatment be started in Parkinson disease? Neurology. 2009;72(7 Suppl):S39-43.

Lewitt PA. Levodopa for the treatment of Parkinson's disease. N Engl J Med. 2008;359(23):2468-76.