An early report of adverse events related to Suboxone treatment noted that some participants showed increases in serum aminotransferase levels, but these increases could not be directly attributed to Suboxone.
What is Hep C and Suboxone?
That study was published prior to the availability of clinical testing for Hep C so the Hep C status of the subjects was not known. A subsequent study obtained liver enzyme values on patients prior to initiation of Suboxone and again after a minimum of 40 days of treatment with either 2, 4, or 8 mg/70 kg Suboxone per day.
How do Hep C and Suboxone work?
he intravenous users recovered after stopping intravenous injection, and 2 of them did not interrupt the sublingual administration of Suboxone. The HIV-positive patient also recovered after stopping Suboxone. A second series of cases from France included 7 patients who developed hepatitis while on Suboxone.
Can I develop a dependence on Suboxone?
Only 1 of these patients was injecting Suboxone. The other 6 took it as prescribed by the sublingual route. Average ALT levels were 39 times normal. All patients had serologic evidence of Hep C. Suboxone treatment was continued in all patients, although 3 had a dose reduction of 50%. All 7 patients recovered without apparent sequelae.
Is Suboxone a new drug on the market?
An in vitro study with rat hepatocytes suggested that buprenorphine is a proton donor that can interfere with mitochondrial respiration resulting in necrosis of hepatocytes. (5) It thus appears that buprenorphine may have the potential to cause elevations in transaminases and reversible hepatic injury, particularly in individuals with Hep C. The precise incidence of these types of events remains uncertain, though serious hepatic injury appears to be quite rare considering that many thousands of individuals have been treated with buprenorphine in France with only a few reported cases of hepatic injury.
What makes Hep C and Suboxone different from other treatments?
The National Institute on Drug Abuse Clinical Trials Network will be conducting a prospective study that will systematically assess changes in liver tests over time in opioid-dependent patients randomized to be treated with either buprenorphine/naloxone or methadone. Results from this trial should provide more information about the effects of buprenorphine/naloxone on the liver.
Sources cited:
- Lange WR, Fudala PJ, Dax EM, Johnson RE. Safety and side-effects of buprenorphine in the clinical management of heroin addiction. Drug Alcohol Depend 1990;26:19-28.
- Petry NM, Bickel WK, Piasecki D, Marsch LA, Badger GJ. Elevated liver enzyme levels in opioid-dependent patients with hepatitis treated with buprenorphine. Am J Addict 2000;9:265-9. 3. Berson A, Gervais A, Cazals D et al. Hepatitis after intravenous buprenorphine misuse in heroin addicts.[comment]. Journal of Hepatology. 2001;34:346-50.
- Herve S, Riachi G, Noblet C et al. Acute hepatitis due to buprenorphine administration. Eur J Gastroenterol Hepatol 2004;16:1033-7.
- Berson A, Fau D, Fornacciari R et al. Mechanisms for experimental buprenorphine hepatotoxicity: major role of mitochondrial dysfunction versus metabolic activation.[comment]. Journal of Hepatology. 2001;34:261-9.
