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PostPosted: Mon Nov 21, 2011 5:22 am 
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I've been doing a bit of research about this recently. I've had my own issues regarding metabolism of buprenorphine over the years, and recently they've come up again. They seem especially linked to certain other medications.

It seems buprenorphine and norbuprenorphine are metabolised primarily by the CYP2D6 and CYP3A4 enzymes in our liver. These are two very important enzymes in the metabolism of pharmaceuticals, and as such, there are many possible medications that may induce delayed or rapid metabolism of buprenorphine.

While buprenorphine is metabolised by (also known as a substrate of) CYP2D6 & CYP3A4, it also seems to act as an inhibitor on these enzymes as well. This means that there's potential for buprenorphine to slow the metabolism of other medications broken down by these enzymes.

I'll quickly go through some definitions:

Substrate: Any medication that is broken down by a certain enzyme. ie: Buprenorphine is a substrate of CYP2D6.
Inhibitor: Any medication that inhibits an enzyme. This inhibits the metabolism of other medications broken down by the enzyme, thus making them "last longer" and potentially stronger.
Inducer: Any medication that induces an enzyme, thus making it more active. This can cause rapid metabolism of other medications metabolised by the same enzyme


CYP2D6 drugs:

Buprenorphine may increase your absorbtion of the medications:

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These medications may increase your absorbtion of buprenorphine:

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CYP3A4 drugs:

Here's all the potential interactions:

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There is a PDF of all the CYP interactions available here.

**note** There are many medications that are lacking from this list. In the year or so that I've started paying attention to this stuff, I've noticed that more and more medications are being added, and moved around. It's a fairly new field of research.

It's also important to know that we are all unique in how we metabolise drugs. The amounts of the various enzymes is often determined by genetics, especially with CYP2D6. Race seems to play a role as well.

I just have to add, that the appearance of some of your medications on these lists is absolutely no need to fret. I've only become interested in this stuff to try and isolate why I seem to metabolise buprenorphine quicker when I'm on certain medications.

If ever someone is put on a new medication regime, and notices a need to increase their Suboxone dose, it may be worthwhile checking the list to observe for interactions.


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PostPosted: Mon Nov 21, 2011 9:21 am 
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Thanks for sharing that Tear, it is very useful information.


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PostPosted: Mon Nov 21, 2011 10:04 am 
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Also, it turns out bergamottin, the bitter stuff in grapefruit juice, can actually slow our metabolism of buprenorphine. This may be useful to know for people who are tapering. It's also in earl grey tea. It's actually a CYP3A4 inhibitor, and can slow the metabolism of many drugs, so it's wise to be careful.


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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