Buprenorphine Poisonings

This is from the most recent Maryland Poison Control ToxTidbits Newsletter. You can subscribe by email here.

Author Bryan Hayes was interviewed on the Nursing Show last month.

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Buprenorphine ingestions in pediatric patients are usually well tolerated, but can cause serious toxicity. The few published cases show conflicting outcomes.

In one case report a 4-year-old girl who ingested 4 mg of buprenorphine experienced only miosis. In another published report, a 2-year-old boy experienced 1 episode of spontaneous emesis and became drowsy en route to the emergency department (ED) 30 minutes after an ingestion of up to 8 mg. He was observed in the ED, no interventions were necessary, and the child was discharged asymptomatic and stable 6 hours post ingestion.

More serious toxicity developed in a small case series in which 5 children <2 years of age ingested buprenorphine doses estimated to be between 4 and 10 mg. All of them developed respiratory and CNS depression. Naloxone was administered in 4 patients, and the fifth patient required intubation with mechanical ventilation.

This month, a much larger case series out of the Maryland Poison Center was published (Hayes BD, Klein-Schwartz W, Doyon S. Toxicity of buprenorphine overdoses in children. Pediatrics. 2008;121(4):e782-6).

This retrospective analysis of national poison center cases reported on 86 patients <6 years of age who unintentionally ingested buprenorphine. Thirty-two patients (37%) remained asymptomatic, 48 patients (56%) had a minor effect, and 6 patients (7%) developed severe effects (respiratory depression and significant CNS depression). There were no fatalities.

The most common clinical effects in patients who developed toxicity were drowsiness/lethargy (55%), vomiting (21%), and miosis (21%). The study analyzed dose data and concluded that any child ingesting >2 mg (in the form of Suboxone® or Subutex®) or an unknown amount should be referred to the ED. Additionally, children <2 years of age ingesting more than a lick or taste should be referred to the ED.

Pediatric patients with a suspected buprenorphine exposure should be monitored in an ED setting for a minimum of 6 hours. Naloxone can be used to reverse respiratory depression, although more than one dose may be required.

The Maryland Poison Center is available 24-7 to answer all questions and assist in the management of all poisoned patients. Please call 1-800-222-1222 to reach one of our certified specialists in poison information.

Bryan D. Hayes, PharmD, Clinical Toxicology Fellow

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See Also – these poisoning and overdose segments on the Nursing Show:

Insecticide Poisonings

Household Cleaner Poisonings

Dextromethorphan OD

Snakebites and Venom (pt 1)

Snakebites (pt 2)

Phenytoin OD (Dilantin)

Poison Control Centers

Poison Center Nursing Careers