have heard of doctors using this combination with the bupe at low doses so it can keep some pain relief going long lasting, but at not a high enough dose to block full agonist opioids. Is this a myth or does it really work
how low would the doses of bupe have to be to not block a full agonist? how about .5 mg?
this study says "
Combination and rotation with opioids
Recent studies indicate that buprenorphine could be effectively and safely combined with full μ-agonists, and switching between buprenorphine and another opioid provides comparable pain relief using equianalgesic doses.
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12 The results indicate that adding opioids to patients currently receiving buprenorphine therapy is safe and effective, while the addition of buprenorphine to patients receiving other opioid therapy should be used more cautiously. Buprenorphine has been combined with other opioids (morphine, tramadol) and has demonstrated additivity. In one study, supra-additive analgesia has been reported in combination study of buprenorphine with oxycodone or hydromorphone. Although buprenorphine has demonstrated very high affinity for μ-receptors, it occupies fewer receptors for analgesia, which leads to a significant receptor reserve for other μ-agonists. Buprenorphine increases μ-receptor expression, which allows other μ-agonists to interact with receptors.
Supplemental dosing with an opioid is the main treatment suggested to manage breakthrough pain in cancer patients. Combination of immediate release or iv morphine and a basal analgesic regime of transdermal buprenorphine has been used as an effective and safe treatment. Clinically, the treatment shows an additive analgesic effect, without any safety relevant issues.
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88 No cross tolerance was observed during rotation between buprenorphine and fentanyl.
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89 Future studies will need to confirm combination therapy and the role of buprenorphine in opioid rotation."