title: Breakthrough Pain Associated with a Reduction in Serum Buprenorphine Concentration during Dialysis.
abstract: OBJECTIVE
  To describe a case of breakthrough pain associated with a reduction in serum buprenorphine concentration during dialysis.
  
  
  METHODS
  Pharmacokinetic sampling of total and free buprenorphine and norbuprenorphine in an 80 year old male undergoing haemodialysis three times per week who received 5760 µg oral and transdermal buprenorphine daily was performed. The patient's serum albumin concentration was 23g/l (reference range: 35-52 g/l).
  
  
  RESULTS
  Pharmacokinetic sampling revealed a free buprenorphine fraction of 32% (consistent with the hypoalbuminaemia), which was markedly reduced at the end of dialysis (free buprenorphine concentration 2.4 µg/l before vs. <0.1 µg/l after dialysis).
  
  
  CONCLUSIONS
  Clinicians should be aware that some patients may require extra buprenorphine doses during dialysis to prevent significant falls in the concentration of active drug.
authors.affiliation: Department of Clinical Pharmacology and Toxicology, University and University Hospital Basel, Basel, Switzerland; Medical University Department of the University of Basel, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Ali Reza
authors.initials: AR
authors.lastname: Salili
authors.affiliation: Institute of Clinical Chemistry, University Hospital Zürich, Zurich, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Müller
authors.affiliation: Institute of Clinical Chemistry, University Hospital Basel, Basel, Switzerland.
authors.forename: Roswitha
authors.initials: R
authors.lastname: Skendaj
authors.affiliation: Clinic for Transplantation Immunology & Nephrology, University Hospital Basel, Basel, Switzerland.
authors.forename: Andreas W
authors.initials: AW
authors.lastname: Jehle
authors.affiliation: Department of Clinical Pharmacology and Toxicology, University and University Hospital Basel, Basel, Switzerland. Electronic address: anne.taegtmeyer@usb.ch.
authors.forename: Anne B
authors.initials: AB
authors.lastname: Taegtmeyer
mesh_terms: D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use; D059390:Breakthrough Pain / Q000209:etiology*; D002047:Buprenorphine / Q000031:analogs & derivatives* / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine; C043585:norbuprenorphine
keywords: Breakthrough pain; buprenorphine; haemodialysis; pharmacokinetics