A member of DOCS Education writes:
I have a 39-year-old, 140lbs female patient coming in for a procedure later this week. The patient has a medical history which includes gastric bypass surgery in 2004. Her daily medications are comprised of three doses of Suboxone®, 65mg of Iron, and one dose of Prevacid®. My main concern is the Suboxone®. How long should the patient cease taking the Suboxone® before and after a procedure that involves Triazolam?
Dr. Jerome Wellbrock, DOCS Education faculty, responds:
I would like to know more about this patient before I make a full recommendation. How long has she and for what reason is she on the Suboxone®? It is also important to determine if the patient is in any kind of rehab. I am also interested to know more about her airway. Does your patient suffer from apnea or sleep disorders? The patient does not necessarily need to stop the Suboxone®, but please keep in mind you are adding Triazolam which is a CNS depressant on top of another potent CNS depressant. Your patient may be a hypo-responder, requiring more sedative than the calculated TOP dose. She is probably a better candidate for IV sedation, especially since she is at risk for a possible relapse if she is, in fact, in recovery.
The DOCS Member responds to Dr. Welbrock’s query
Our patient is taking Soboxone® due to a narcotic pain addiction. The patient was taking 200 plus tabs of Norco monthly prompting treatment at a rehab facility for four months and is now under the care of a primary physician. Patient was prescribed and has been taking Suboxone® for three to four years to help with herniated disc pain. She has no history of sleep disorders or apnea, and has re-assessed her weight at 160 pounds.
Dr. Anthony Feck, Dean of DOCS Education Faculty, weighs in:
I would like to echo my colleague Dr. Welbrock's advice of recommending IV sedation. Suboxone® has a [D] interaction with all of the DOCS sedation medications. Ergo, I would not use any of the DOCS OCS protocols in combination with Suboxone®. Ceasing the Suboxone® would most likely result in pain and withdrawal symptoms and therefore instructing the patient to discontinue use, even for a brief period, is not recommended. As both I and Dr. Welbrock have stated, consider IV sedation for this patient.
