Brief Clinical ObservationAcute liver and renal failure during treatment with buprenorphine at therapeutic dose
Introduction
Buprenorphine (BPN), a semi-synthetic opioid derivative acting on morphine receptors, is currently prescribed for analgesic purposes and, more recently, for the maintenance treatment of heroin addiction [1]. Doses as high as 32 mg/day given sublingually are considered effective and safe for prolonged treatments [2]. However, acute hepatitis occurrence has been reported following misuse [3], massive overdose [4], and also therapeutic doses [5]. However, in the latter cases, no signs of renal involvement were observed and no liver histology provided. We herein describe the first known case of acute liver and renal failure secondary to BPN at recommended sublingual regimen and we investigate the possible pharmacogenomic bases.
Section snippets
Case report
A 33-year-old man with a history of heroin addiction, alcohol abuse, and hepatitis C virus (HCV) infection was admitted to our Unit for severe acute hepatitis and renal failure. The patient had been abstinent from alcohol for over 6 months and undergoing a detoxification program for 3 months with methadone until switching to BPN 20 mg/day sublingually 3 weeks prior to our observation. Importantly, renal function was repeatedly normal at any of the previous medical evaluations. At admission, the
Conflict of interest statement
None declared.
References (18)
- et al.
Maintenance buprenorphine for opioid users
Lancet
(2003) - et al.
The clinical pharmacology of buprenorphine: extrapolating from the laboratory to the clinic
Drug Alcohol Depend
(2003) - et al.
Mechanisms for experimental buprenorphine hepatotoxicity: major role of mitochondrial dysfunction versus metabolic activation
J Hepatol
(2001) Mitochondria: important target for drug toxicity?
J Hepatol
(2001)- et al.
Liver enzyme abnormalities during buprenorphine versus methadone maintenance
Drug Alcohol Depend
(2002) - et al.
Acute hepatitis due to buprenorphine administration
Eur J Gastroenterol Hepatol
(2004) Enzyme induction and inhibition by new antiepileptic drugs: a review of human studies
Fundam Clin Pharmacol
(2000)Clinical efficacy and safety of gabapentin
Neurology
(1994)- et al.
In vivo induction and in vitro inhibition of hepatic cytochrome P450 activity by the benzodiazepine anticonvulsants clonazepam and diazepam
Drug Metab Dispos
(1997)
Cited by (40)
Which Opioids Are Safest and Most Effective in Patients With Renal or Hepatic Failure?
2023, Evidence-Based Practice of Palliative Medicine, Second EditionBuprenorphine
2019, Journal of Exotic Pet MedicineCitation Excerpt :Patients with severe hepatic dysfunction may also eliminate the drug more slowly than normal patients therefore should be used cautiously in animals with this disease condition. There has been a case report in human medicine of acute renal and liver failure from buprenorphine due to a latent chronic hepatitis C infection.9 There have also been reports in human medicine of opiates causing suppression of the hypothalamic-pituitary-adrenal axis, causing decreased cortisol secretion, and should therefore be avoided in patients will poorly controlled hypoadrenocorticism (Addison's disease).10
A relative study on sonochemically synthesized mesoporous WS<inf>2</inf> nanorods & hydrothermally synthesized WS<inf>2</inf> nanoballs towards electrochemical sensing of psychoactive drug (Clonazepam)
2019, Ultrasonics SonochemistryCitation Excerpt :Mainly, CNP is one of the illegally used drugs with side effects such as poor coordination, sleepiness, agitation and increases the risk of suicides [16,17]. In perverse, the over dosage of CNP can cause undesired side effects such as liver toxicity and hepatotoxicity [18–24]. Hepatotoxicity is implies chemical-driven liver damage and it’s a cause of acute and chronic liver disease with cancer based tumors [25–27].
Hepatic Safety of Buprenorphine in HIV-Infected and Uninfected Patients With Opioid Use Disorder: The Role of HCV-Infection
2016, Journal of Substance Abuse TreatmentCitation Excerpt :In addition to patients with active HCV infection, a case report described acute symptomatic liver and kidney failure in a patient with positive HCV antibody but non-detectable HCV viral load treated with standard doses of BUP. Discontinuation of BUP led to resolution of both kidney and liver dysfunction in this patient (Zuin et al., 2009). Additionally, a case report of acute, clinically significant liver enzyme elevation has been reported in an adolescent receiving high dose BUP without any evidence of underlying liver disease, including viral hepatitis (Upadhyay & Xueming, 2010).
Hepatotoxicity in a 52-week randomized trial of short-term versus long-term treatment with buprenorphine/naloxone in HIV-negative injection opioid users in China and Thailand
2014, Drug and Alcohol DependenceCitation Excerpt :In a separate model, the risk of ALT events was not significantly increased at visits where the urine drug test was positive for opiates compared to negative for opiates (OR 0.72, 95% CI 0.44, 1.16). While BUP/NX is an effective therapy for opioid dependence, this preparation and buprenorphine mono-product have been associated with cytolytic hepatitis in case reports and with ALT increases in longitudinal, non-comparative studies (Berson et al., 2001b; Herve et al., 2004; Houdret et al., 1999; Lucas et al., 2011; Petry et al., 2000; Zuin et al., 2009). However, opioid dependent individuals are at increased risk of hepatoxicity from multiple causes, particularly viral hepatitis and drug or alcohol use.
Buprenorphine/Naloxone and methadone effects on laboratory indices of liver health: A randomized trial
2013, Drug and Alcohol Dependence