Pharmacy Telehealth Visit

Reason for visit: 24 hour follow up after initiation of Suboxone (buprenorphine 4 mg/naloxone 1mg) at the Substance Use Disorder Clinic.

Drug: buprenorphine/naloxone (Suboxone)

Current dose: 4mg/1mg sublingual tablet once daily

Indication: Opioid Use Disorder

Dosing: Patient took an induction dose in the clinic yesterday. He did not take any additional doses at home because he didn’t want to “replace one medication with another" despite having withdrawal symptoms

Any prior dose modifications: N/A

Food requirements: none

Monitoring: Patient is encouraged to track his withdrawal symptoms and suboxone usage on the Subjective Opioid Withdrawl Scale.

Warnings: Keep medication out of reach from children. Rinse mouth out with water after taking the medication. Brush teeth 1 hour after medication dissolves

Withdrawal symptoms: Mr. Sodo complained of GI cramping, diarrhea, muscle aches, restlessness, anxiety, worsening limb pain and insomnia.

Available dosage forms:

2mg/0.5mg

4mg/1mg

8mg/2mg

12mg/3mg

Medication list: 

Gabapentin 600 mg by mouth once daily.

Narcan nasal 1 spray nasally prn respiratory depression 

Efficacy: The single induction dose of 4mg/1mg SL was insufficient to control the patient’s withdrawal symptoms.

Adverse effects: Patient did not report adverse effects after the induction dose. He was provided a complete list of potential adverse reactions to the medication.

Drug Interactions: gabapentin may enhance the CNS depressant effect of buprenorphine.. Patient has been informed to monitor for this closely; we will continue to monitor and discuss it in follow-up visits. For now, the risks of untreated opioid dependence are higher than this drug-drug interaction with low dose gabapentin