title: Buprenorphine dosing choices in specific populations: review of expert opinion.
abstract: BACKGROUND
  Treatment of opioid dependence with buprenorphine improves outcomes. Typical dosing ranges for all patients from clinical evidence and as defined in the product information are wide. For specific groups with complex clinical scenarios, there is no clear consensus on dosing choices to achieve best possible outcomes.
  
  
  METHODS
  The doses of buprenorphine used in 6 European countries was reviewed. A review of published evidence supported rapid induction with buprenorphine and the benefits of higher doses but did not identify clearly useful guidance on dosing choices for groups with complex clinical scenarios. An expert group of physicians with experience in addiction care participated in a discussion meeting to share clinical practice experience and develop a consensus on dosing choices.
  
  
  CONCLUSIONS
  There was general agreement that treatment outcomes can be improved by optimising buprenorphine doses in specific subgroups. Specific groups in whom buprenorphine doses may be too low and who could have better outcomes with optimised dosing were identified on the basis of clinical practice experience. These groups include people with severe addiction, high tolerance to opioids, and psychiatric comorbidities. In these groups it is recommended to review dosing choices to ensure buprenorphine dosing is sufficient.
authors.affiliation: a Department of Neurosciences, Santa Chiara University Hospital , University of Pisa , Pisa , Italy.
authors.forename: Icro
authors.initials: I
authors.lastname: Maremmani
authors.affiliation: b Departments of Addiction Medicine and Pharmacology, INSERM , University Hospital of Lille , Lille , France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Rolland
authors.affiliation: c Addiction Treatment Centre , Biella , Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Somaini
authors.affiliation: d Addiction and Dual Diagnosis Unit, Department of Psychiatry , Vall d'Hebron Hospital , Barcelona , Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Roncero
authors.affiliation: e Director at Centre for Interdisciplinary Addiction Research , University Medical Centre Hamburg-Eppendorf, Martini Strasse , Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Reimer
authors.affiliation: f Spectrum Community Health CIC , Wakefield , UK.
authors.forename: Nat
authors.initials: N
authors.lastname: Wright
authors.affiliation: g Applied Strategic , London , UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Littlewood
authors.affiliation: h Division of Mental Health and Addiction, Department of Substance Use Disorder Treatment , Oslo University Hospital , Oslo , Norway.
authors.forename: Peter
authors.initials: P
authors.lastname: Krajci
authors.affiliation: i HA, Clinicum, University of Helsinki and University Hospital , Helsinki , Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Alho
authors.affiliation: j Faculty of Medical and Human Sciences, Institute of Brain Behaviour and Mental Health , University of Manchester , Manchester , UK.
authors.forename: Oscar
authors.initials: O
authors.lastname: D'Agnone
authors.affiliation: k Service de Pharmacologie Clinique, Sainte Marguerite Hospital , Marseille , France.|l Department of Clinical Pharmacology , Medical School of Marseilles , Marseille , France.|m Aix Marseille University, INSERM, UMR 912 IRD, SESSTIM , Marseille , France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Simon
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D002047:Buprenorphine / Q000008:administration & dosage*; D005060:Europe; D006801:Humans; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D002047:Buprenorphine
keywords: Buprenorphine; dosing; opioid dependence; special groups