Quick Guide: Buprenorphine Initiation Algorithm Adjunctive meds: The following can be prescribed PRN for symptoms of withdrawal • Acetaminophen 650 mg PO q 6 hours daily PRN pain • Clonidine 0.1-0.3 mg PO q 6-8 hours PRN w/d symptoms (NTE 1.2 mg/day, hold if BP < 100/70) • Diphenhydramine 25-50 mg, PO q 8 hours PRN insomnia/anxiety • Loperamide 4 mg PO initially, then 2 mg PRN each additional loose stool (NTE 16 mg/24 hours) • Ondansetron 4 mg PO q 6 hours PRN nausea • Trazodone 50 mg PO qhs PRN insomnia • Melatonin 3 mg PO qhs PRN insomnia Patients started in the ED: ● If given total dose of <16 mg in ED, continue to follow day 1 algorithm ● If given total dose 16 mg in ED, hold additional doses on day 1, then day 2 start 16 mg qday ● If given total dose > 16 mg in ED, hold additional dosing until return of cravings/withdrawal, then start 16 mg qday ● If patient is experiencing pain may split dose TID Subsequent days: ● Administer total daily dose from previous day as single dose in am – split TID if ongoing pain ● Increase dose prn cravings/withdrawal/pain ● Decrease dose prn sedation, insomnia, adverse effects ● Typical max dose 24 mg Support for Hospital Opioid Use Treatment (SHOUT) #Buprenorphine #Initiation #Algorithm #Treatment #Management #Addiction #Opiate #Start #Prescribing #Inpatient
