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Opioids can cross both the placental and blood-brain barriers, which poses risks to fetuses and newborns exposed to these drugs before birth. This exposure to opioids during pregnancy can lead to potential obstetric complications, including spontaneous abortion, abruption of the placenta, pre-eclampsia, prelabor rupture of membranes, and fetal death.
Buprenorphine/naloxone, sold under the brand name Suboxone among others, is a fixed-dose combination medication that includes buprenorphine and naloxone. [3] It is used to treat opioid use disorder , and reduces the mortality of opioid use disorder by 50% (by reducing the risk of overdose on full-agonist opioids such as heroin or fentanyl ).
Mixed agonist-antagonist opioids, such as nalbuphine, serve as a classic example of the ceiling effect; increasing the dose of a narcotic frequently leads to smaller and smaller gains in relief of pain. In many cases, the severity of side effects from a medication increases as the dose increases, long after its therapeutic ceiling has been reached.
A single administration of naloxone at a relatively high dose of 2 mg by intravenous injection has been found to produce brain MOR blockade of 80% at 5 minutes, 47% at 2 hours, 44% at 4 hours, and 8% at 8 hours. [72] A low dose (2 μg/kg) produced brain MOR blockade of 42% at 5 minutes, 36% at 2 hours, 33% at 4 hours, and 10% at 8 hours. [72]
Buprenorphine appears to be associated with more favorable outcomes compared to methadone for treating opioid use disorder (OUD) in pregnancy. Studies show that buprenorphine is linked to lower risks of preterm birth, greater birth weight, and larger head circumference without increased harm. [155]
Women should speak to their doctor or healthcare professional before starting or stopping any medications while pregnant. [1] Drugs taken in pregnancy including over-the counter-medications, prescription medications, nutritional supplements, recreational drugs, and illicit drugs may cause harm to the mother or the unborn child.
[29] [38] [39] According to the AAP 2020 Guidelines, it is recommended to use opioids with a longer half-life like buprenorphine and methadone, but it is important to take caution if the preparation has a high alcohol content.
Therapeutic dose dependence is the largest category of people dependent on benzodiazepines. These individuals typically do not escalate their doses to high levels and generally use their medication as intended by their prescriber. Smaller groups include patients escalating their dosage to higher levels and drug misusers as well.