How far have we come baby? The current knowledge about exposure to buprenorphine during pregnancy and lactation
Buprenorphine, a partial mu-opioid agonist, is the most recent opioid
maintenance pharmacotherapy approved by the United Sates Food & Drug
Administration for non-pregnant patients. Given buprenorphine's
availability in both office-based practice and traditional opioid
treatment settings (i.e., methadone clinics), fetal exposures to this
medication will occur. Thus, physicians treating a pregnant
opioid-dependent patient entering treatment will have several options:
commence buprenorphine treatment (category C), commence methadone
treatment (category B and the only recommended medication), or provide a
closely monitored taper following stabilization on an opioid agonist.
Physicians treating a pregnant patient already maintained on buprenorphine
will also have several options: discontinuing buprenorphine, transferring
to methadone or continuing to buprenorphine. Current literature of
buprenorphine exposure during pregnancy suggests that buprenorphine can be
safely continued through antenatal period (c.f., Johnson et al., 2003).
Buprenorphine appears to provide similar benefits (i.e., suppression of
opioid withdrawal symptoms, decreased illicit opioid use, stabliization of
the intrauterine environment) to the mother as methadone but may be
associated with a qualitatively and quantitatively different neonatal
abstinence syndrome (NAS) form that observed with mu-opioid agonists
(Auricombe et al., 1999). This, well-controlled studies are needed to
address critical questions regarding fetal and neonatal exposure to
buprenorphine and its metabolities to determine the impact of prenatal
This symposium provided the latest laboratory and clinical data regarding
prenatal exposure to buprenorphine. Specifically, Dr Ahmed reviews the
placental transfer and metabolism of buprenorphine compared to LAAM
(another opioid agonist medication) and discusses the effect of
buprenorphine and LAAM on placental viability and functional parameters.
Dr Fischer reviewed case reports and prospective studies describing
clinical outcomes of neonates following prenatal exposure to
buprenorphine. She provided data from two women who were maintained on
buprenorphine at conception and were prospectively followed. She reported
preliminary data from double-blind, double dummy methadone versus
buprenorphine comparison. Dr. Finnegan discussed perinatal addiction with
special attention given to prenatal opioid exposure and outcomes of
treatment with methadone versus buprenorphine. Suggestions for future
research needs were outlined.
Placenta Transfer and Metabolism of Buprenorphine - M S Ahmed
Neonatal Outcome After Buprenorphine Treatment: Clinical and
Pharmacokinetic Features - G Fischer.