Pharmacy

Buprenorphine isn’t available at my institution, how can I get it on formulary?

Most institutions allow for requests for formulary additions by providers within the system. This generally requires a provider on record to either develop or work with a member of the pharmacy staff to develop a drug monograph and presentation at a Pharmacy and Therapeutics (P&T) committee. We provide a template monograph for buprenorphine that can be adjusted to the specifications of your hospital system.

I’m caring for a patient taking buprenorphine/naloxone, but we only have the buprenorphine mono product (or vice-versa) at my institution, can I substitute?

Yes. Naloxone is added to deter injection of the buprenorphine. While these products are not considered “A” rated (therapeutically bioequivalent) by the FDA and cannot be interchanged by an outpatient pharmacy without a prescriber order, they can be considered clinically similar at equivalent dosages and frequencies. Continuation of a patient’s buprenorphine therapy should not be withheld due to lack of availability of a specific product as long as an equivalent dose is available.

How does a clinician give buprenorphine?

Buprenorphine tablets or films should be administered sublingually. IV formulations can also be used in some situations. If buprenorphine tablets or films are swallowed, very little medicine gets absorbed. No observation is required. Transdermal buprenorphine will generally be too weak to prevent withdrawal symptoms and is best used for patients with chronic pain.

What buprenorphine formulations are available for the treatment of opioid use disorder?