Transitioning From Intrathecal Hydromorphone to Sublingual Buprenorphine-Naloxone Through Microdosing: A Case Report

Isaiah T. Crum; Va Kara M. Meyer Karre; Alëna A. Balasanova

doi:10.1213/XAA.0000000000001316

Transitioning From Intrathecal Hydromorphone to Sublingual Buprenorphine-Naloxone Through Microdosing: A Case Report

Isaiah T. Crum, Va Kara M. Meyer Karre, Alëna A. Balasanova

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

Abstract

A 76-year-old woman with chronic noncancer pain and an intrathecal hydromorphone-bupivacaine pump was admitted for acute exacerbation of heart failure. Her pump was unable to be replaced due to medical comorbidities. She was unable to tolerate oral opioids due to ventilatory depression. Tapering hydromorphone resulted in opioid withdrawal due to physiological dependence. Microdosing of sublingual buprenorphine-naloxone was initiated while decreasing intrathecal hydromorphone. This successfully weaned the patient off intrathecal hydromorphone with adequate pain relief and prevented both opioid withdrawal and ventilatory depression. To our knowledge, microdosing buprenorphine-naloxone to assist with discontinuing intrathecal opioids has not been previously reported in the literature.

Original language	English (US)
Pages (from-to)	e01316
Journal	A&A practice
Volume	14
Issue number	11
DOIs	https://doi.org/10.1213/XAA.0000000000001316
State	Published - Sep 1 2020

ASJC Scopus subject areas

General Medicine

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10.1213/XAA.0000000000001316

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abstract = "A 76-year-old woman with chronic noncancer pain and an intrathecal hydromorphone-bupivacaine pump was admitted for acute exacerbation of heart failure. Her pump was unable to be replaced due to medical comorbidities. She was unable to tolerate oral opioids due to ventilatory depression. Tapering hydromorphone resulted in opioid withdrawal due to physiological dependence. Microdosing of sublingual buprenorphine-naloxone was initiated while decreasing intrathecal hydromorphone. This successfully weaned the patient off intrathecal hydromorphone with adequate pain relief and prevented both opioid withdrawal and ventilatory depression. To our knowledge, microdosing buprenorphine-naloxone to assist with discontinuing intrathecal opioids has not been previously reported in the literature.",

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Transitioning From Intrathecal Hydromorphone to Sublingual Buprenorphine-Naloxone Through Microdosing: A Case Report

Abstract

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