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Year: 2013 Publisher: Bruxelles: UCL,
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Methadone and buprenorphine are the two most commonly used molecules in the treatment of heroin withdrawal. The aim of this project was to compare these two molecules in terms of effectiveness and security and to make an opinion on the best treatment modality to consider when facing a heroin addict patient. Methadone is a full agonist for opiate receptors while buprenorphine is a partial agonist. In both cases, the effectiveness of treatment with one of these molecules has been demonstrated with a slight advantage for methadone. It is therefore in terms of safety and ease of use that buprenorphine appears to have some advantages compared to methadone. Indeed, although methadone and buprenorphine share a majority of their adverse effects, namely those of opioids, buprenorphine, as a partial agonist, reaches a ceiling effect. Increasing the dose is therefore not responsible for increased pharmacological and adverse effects beyond a certain threshold. Furthermore, buprenorphine seems safer than methadone in the context of heroin withdrawal in pregnant women because a neonatal withdrawal syndrome appears less frequently with this molecule. Besides, prolongation of the QT interval is observed with methadone but not with buprenorphine, which is a selection criterion for at-risk patients for this adverse effect. Despite these advantages, methadone is often the first choice because of the greater knowledge we have of this molecule. Anyway, the management of a heroin addict patient should always be examined case by case and also depends on the preference and experience of the patient and physicians for one of the two modalities of care. Finally, monitoring and psychological assistance should be placed at the forefront to potentiate chances of success of such treatment. La méthadone et le buprénorphine sont les deux molécules les plus utilisées dans le sevrage à l’héroïne. Le but poursuivi dans ce projet était donc de comparer ces deux molécules en termes d’efficacité, de sécurité d’emploi ainsi que de se forger un avis sur la meilleure modalité de traitement à envisager face à un patient héroïnomane. La méthadone est un agoniste complet des récepteurs aux opiacés tandis que la buprénorphine est un agoniste partiel pour ces récepteurs. Dans les deux cas, l’efficacité d’un traitement par une de ces molécules a été prouvée avec un léger avantage pour la méthadone. C’est donc en termes de sécurité et de facilité d’emploi que la buprénorphine semble présenter quelques avantages par rapport à la méthadone. En effet, malgré une majorité d’effets indésirables communs à la méthadone et à la buprénorphine, à savoir ceux des morphiniques, la buprénorphine, de par son statut d’agoniste partiel permet d’atteindre un effet plafond. Une augmentation de la dose ne sera donc pas responsable d’une augmentation des effets pharmacologiques et indésirables au-delà d’un certain seuil. De plus, la buprénorphine semble plus sûre que la méthadone dans le sevrage à l’héroïne chez la femme enceinte puisqu’un syndrome de sevrage du nouveau-né est moins fréquent avec cette molécule. En outre, un allongement de l’intervalle QT est observé avec la méthadone mais pas avec la buprénorphine, ce qui représente un critère de choix pour sevrer les patients à risque pour cet effet indésirable. Malgré ces avantages, la méthadone reste souvent le premier choix car il y a une plus grande connaissance de cette molécule. Quoi qu’il en soit, la prise en charge d’un patient héroïnomane devra toujours se faire au cas par cas et selon la préférence et l’expérience du patient et du médecin face à une des deux modalités de prise en charge. Enfin, un suivi et une aide psychologiques sont à mettre au premier plan afin de potentialiser les chances de succès d’un tel traitement.
Methadone --- Buprenorphine --- Substance-Related Disorders --- Heroin
Book
ISBN: 1493901818 1461469732 1461469740 Year: 2013 Publisher: New York : Springer,
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Methadone and buprenorphine are the only two opioids that are indicated for the management of both pain and opioid-related drug addiction. Both present unique challenges to the general practitioner and pain specialist, requiring a separate analysis from the rest of the drugs in the same family. Handbook of Methadone Prescribing and Buprenorphine Therapy is an invaluable guide to the safe use of these opioids. Authored by clinical and academic leaders from a variety of settings and backgrounds, this book includes chapters on pharmacology, adverse effects, safe rotation from other opioids, cardiac toxicity, prescribing, pharmacokinetics, equianalgesic dose, and replacement therapy. This comprehensive text provides clinicians, researchers, policy-makers and academicians a resource for all the relevant points in methadone prescribing and buprenorphine therapy.
Buprenorphine -- Handbooks, manuals, etc. --- Drugs -- Prescribing -- Handbooks, manuals, etc. --- Methadone maintenance -- Handbooks, manuals, etc. --- Methadone maintenance --- Ketones --- Substance-Related Disorders --- Therapeutics --- Morphinans --- Neurologic Manifestations --- Analgesics --- Diseases --- Nervous System Diseases --- Opiate Alkaloids --- Analytical, Diagnostic and Therapeutic Techniques and Equipment --- Sensory System Agents --- Organic Chemicals --- Alkaloids --- Chemicals and Drugs --- Peripheral Nervous System Agents --- Heterocyclic Compounds --- Physiological Effects of Drugs --- Pharmacologic Actions --- Chemical Actions and Uses --- Buprenorphine --- Pain --- Drug Therapy --- Analgesics, Opioid --- Opiate Substitution Treatment --- Methadone --- Opioid-Related Disorders --- Medicine --- Surgery & Anesthesiology --- Health & Biological Sciences --- Pathology --- Anesthesiology --- Methadone maintenance. --- Buprenorphine. --- Methadone hydrochloride --- Methadone treatment programs --- Therapeutic use --- Medicine. --- Anesthesiology. --- Internal medicine. --- Oncology. --- Neurology. --- Pain medicine. --- Rehabilitation medicine. --- Medicine & Public Health. --- Pain Medicine. --- Rehabilitation Medicine. --- Internal Medicine. --- Morphine --- Narcotic antagonists --- Drug abuse --- Derivatives --- Treatment --- Rehabilitation. --- Oncology . --- Tumors --- Medicine, Internal --- Anaesthesiology --- Surgery --- Nervous system --- Neuropsychiatry --- Algiatry --- Neurology . --- Medicine, Rehabilitation --- Rehabilitation medicine --- Rehabilitation --- Medicine, Physical
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