Suboxone (buprenorphine): one pill can kill
November 15, 2012, 1:10 am
Buprenorphine May Not Be as Safe as You Think: A Pediatric Fatality From Unintentional Exposure. Kim HK et al. Pediatrics 2012 Nov 5 [Epub ahead of print]
Buprenorphine — a partial agonist at the opioid μ receptors as well as a κ receptor antagonist — is used to treat pain and opiate addiction as an alternative to methadone. Although it is thought to exhibit a “ceiling effect” on respiratory depression and thus be safer than methadone, deaths associated with buphenorphine have been reported in adults.
This case report, from the New York City Poison Control Center, describes a 13-month-old, 10.2 kg boy who was discovered with a single sublingual buphenorphine/naloxone (8 mg/2 mg) in his mouth. This was removed and he was put to bed. Eight hours later he was found unresponsive in cardiopulmonary arrest that did not respond to standard resuscitation measures, including administration of naloxone. Post-mortem toxicology studies revealed blood buphenorphine levels more than 5-10 times those associated with case reports of death in adults.
The authors note that buprenorphine has approximately a 1000-fold greater affinity for the μ receptor than does morphine. They conclude that:
The duration of buprenorphine toxicity in children ca be prolonged or the onset can be delayed up to 6 hours. Thus, it may be prudent to admit children for 24 hours of observation after buprenorphine exposure.
It seems that buprenorphine should be added to the list of medications of which “one pill can kill” a small child. This list includes:
- tricyclic antidepressants
- calcium channel blockers
- methadone and other opioids
- oral hypoglycemics