High-dose tramadol conversion to buprenorphine-naloxone

Julienne K. Kirk, PharmD, BCPS; Charlotte T. Boyd, MA, CHES; Lisa Cassidy-Vu, MD; Linda P. McRae, PsyD; Heather E. Strickland, NP-C; Ernest Blake Fagan, MD

doi:10.5055/jom.2023.0774

Authors

Julienne K. Kirk, PharmD, BCPS https://orcid.org/0000-0002-5144-7780
Charlotte T. Boyd, MA, CHES
Lisa Cassidy-Vu, MD
Linda P. McRae, PsyD
Heather E. Strickland, NP-C
Ernest Blake Fagan, MD

DOI:

https://doi.org/10.5055/jom.2023.0774

Keywords:

tramadol, withdrawal, buprenorphine-naloxone

Abstract

Buprenorphine-naloxone is a combination medication of an opioid partial agonist and opioid antagonist that is proven to be effective in outpatient management of opioid use disorder (OUD). Tramadol is a centrally acting analgesic. This commonly used pain medication inhibits serotonin and noradrenaline reuptake by acting as a selective agonist on opioid μ receptors. Transition and tapering high-dose tramadol to buprenorphine-naloxone is not well described in the literature. We report a case of a patient who was taking 1,000-1,250 mg of tramadol daily upon presentation to the clinic. She was originally prescribed 150 mg daily with escalation in dose and frequency over a 10-year period. The patient was converted to buprenorphine-naloxone and has been successful in treatment of OUD for 1 year.

Author Biographies

Julienne K. Kirk, PharmD, BCPS

Professor, Department of Family & Community Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina

Charlotte T. Boyd, MA, CHES

Department of Family & Community Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina

Lisa Cassidy-Vu, MD

Department of Family & Community Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina

Linda P. McRae, PsyD

Department of Family & Community Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina

Heather E. Strickland, NP-C

Department of Family & Community Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina

Ernest Blake Fagan, MD

Family Medicine, UNC Health Sciences at Mountain Area Health Education Center, Asheville, North Carolina

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