Licenciatura

Plancar te y Gutiérrez, Cancerología 1 (2006): 253-271

Buprenorfina Transdérmica en Pacientes con Dolor Oncológico
Ricardo Plancarte Sánchez 1 , Hilda Gutiérrez Velázquez 2
1 Instituto Nacional de Cancerología. Clínica del Dolor y Cuidados Paliativos 2 Gerente Médico de Grunenthal México; ni la Revista ni el Instituto Nacional de Cancerología son responsables de las opinio-

nes expresadaspor los autores

Abstract• At present opioids are pharmacological management support, particularly for moderate to severe pain. In this context it is important to have available different formulations and ways of administration, especially in oncological patients where the oral route of administration is the preferred one, but when swallowing is not preserved, subcutaneous or transdermic areusually the alternative, having the advantage of avoiding first pass metabolism. The transdermic formulation of buprenorphine overcomes pharmacokinetic problems associates with oral (short duration effect, limited bioavailability, side effects) and parenteral opioids (high plasma peaks), favoring continuous release at a constant speed into the systemic circulation, achieving effective analgesiaduring long periods of time, and reducing adverse events. Clinical studies in oncologic pain have shown the efficacy of buprenorphine without a ceiling effect for analgesia within the therapeutic doses range.It has also been shown that it can be used in combination with pure mu agonists, such as tramadol and morphine, with an additive effect for analgesia without antagonism. As opposed to fentanyl andmorphine, buprenorphine displays a ceiling effect related to respiratory depression, which undoubtedly translates into clinical safety. Additionally it has been shown that the influence on respiration can be completely reversed by an antagonist of the opioid mu receptor (naloxona). Oncologic patients experience intermittent periods of immunosuppression and the advantage of buprenorphine, in acuteor chronic use, is the lack of endocrine activity as opposed to other strong opioids, like morphine and fentanyl, which have an immunosuppressant effect. More over buprenorphine shows adequate safety and the possibility of administration to patients with renal failure without the need for dose adjustment. Clinical evidence shows excellent efficacy and safety of transdermal buprenorphine in thetreatment of moderate to severe pain in oncological patients, improving quality of life based on its favorable tolerability. Key words: oncological pain, transdermal buprenorphine, opioids, chronic pain.

Correspondencia a: Ricardo Plancarte Sánchez Instituto Nacional de Cancerología. San Fernando 22. Col. Sección XVI. C.P. 14080. Tlalpan, México, D.F. Correo electrónico: planky2b@yahoo.com.mx 253Resumen•

A

CTUALMENTE, LOS OPIOIDES son el soporte del manejo farmacológico, en particular del dolor moderado a severo. En este sentido, es importante disponer de distintas formulaciones y vías de administración, aún más en el contexto del paciente oncológico en donde las vías recomendadas para el manejo son la oral y cuando no está preservada la deglución, la vía subcutánea otransdérmica suelen ser la alternativa teniendo como ventaja en esta última, el evitar el metabolismo de primer paso. La formulación transdérmica de buprenorfina supera los problemas que plantea la farmacocinética de los opioides orales (corta duración de efecto, escasa biodisponibilidad, efectos colaterales) y parenterales (picos de concentración), favoreciendo la liberación continua a velocidad constanteen la circulación sistémica, logrando una analgesia eficaz durante largos períodos, y reduciendo eventos adversos. Estudios clínicos en dolor oncológico han señalado eficacia de la buprenorfina y ausencia de un efecto techo para la analgesia dentro del rango de dosis terapéutica. Así mismo, se ha demostrado que puede ser usado en combinación con agonistas µ puros tales como tramadol y morfina,...