TREATMENT DURING PREGNANCY

Outcomes of Methadone and Buprenorphine Treatment during Pregnancy



Outcomes of Methadone and Buprenorphine Treatment during Pregnancy

Introduction

Buprenorphine is already used for years in many countries including France, the United States, the United Kingdom and Australia. Originally used as an analgesic cal, this drug has proven useful and safe in the treatment of addiction opioids. Buprenorphine is now offering an alternative to methadone for opioid dependent patients. Indeed, forty years methadone was the only authorized medicine effective in the treatment of opioid dependence. Some patients cannot tolerate methadone nor have significant adverse effects that sometimes encourage them to abandon their treatment (Savage, 2008). Buprenorphine may be useful but will not replace methadone. Patients "stabilized" on methadone with a response satisfactory clinical treatment should continue/

Outcomes of Methadone and Buprenorphine Treatment during Pregnancy

Substitution treatment of heroin addicts in coaching began to spread in US there are now fifteen years. The methadone was long the only known product prescribed and within this framework. The high dose buprenorphine (Subutex ), marketed in US since the end of 2002, began to be known. The medical literature about it is enriched by new contributions. In addition, the recent appearance in June 2008 of buprenorphine combined with naloxone (Suboxone ) presented a spotlight on this alternative to methadone.

This has led the movement to revise the ALTO and the relative use of these various treatment options. In terms of addiction, drug treatment is obviously well-conducted a prerequisite for a possible follow-up success. The quality of the therapeutic relationship and coaching, that is to be often multidisciplinary, is essential and crucial.

Effectiveness of Methadone and Buprenorphine

Methadone (methadone hydrochloride, or 6-dimethylamino-4 ,4-diphenyl-3-hepatone hydrochloride) is a synthetic opioid agonist that produces an effect on humans similar to that observed for morphine. Methadone is well absorbed by the gastrointestinal system, regardless of type of presentation (eg. syrup or tablets). It has excellent bioavailability of 80 to 95% (Leggate, 2008). The half-life of methadone was estimated between 24 and 36 hours, with considerable variation among individuals (10 to 80 hours). The body primarily responsible for the metabolism of methadone is the liver. Methadone is eliminated from the body as metabolites resulting from its biotransformation and excretion of the product itself in the urine and feces. This pharmacological profile makes methadone a drug OST useful because it allows oral administration, a dose once daily and the maintenance of stable plasma levels after administration repeated without opiate withdrawal syndrome in the range of a dose of one day. The rate of metabolism of methadone by the CYP3A4 enzyme determines the clearance of methadone in the body. The expression of the CYP enzyme is influenced by genetic and environmental factors and certain medications. It is very variable, which can cause toxicity of methadone and unlike a withdrawal syndrome of opiates. Some drugs interact with the level of concentration of methadone in the blood and should be particularly attentive to other people who use drugs such as HIV drugs, antibiotics, anticonvulsants and some treatments against tuberculosis (Pritham, ...