Patients who have Hepatitis C
The rate of hepatitis C virus (HCV) among injection drug users is extremely high. There is some evidence that buprenorphine may elevate serum aminotransferase levels among people with HCV. Thus, you should maintain these patients on the lowest effective dose of buprenorphine and monitor them closely for liver-related problems.
Follow these guidelines when treating HCV patients with buprenorphine:
- Obtain baseline liver function tests (LFTs) prior to buprenorphine induction.
- Continue to run LFTs periodically during buprenorphine treatment (there is no guideline for how often - up to the clinician's judgment). Testing should be done more frequently in patients with baseline elevations or advanced HCV.
- Educate patients about the symptoms of hepatotoxicity and have them contact you or go to the ER immediately if they experience these symptoms.
- Caution patients that they must never inject buprenorphine, since this can lead to severe cytolytic hepatitis in some cases.
- In patients with abnormal LFTs or evidence of hepatotoxicity, follow LFTs more closely. If the elevation is related to the buprenorphine, decreasing the dose will often also decrease the LFTs.
- If LFT levels increase to more than three times normal you may want to consider stopping buprenorphine. You may also want to consult a gastroenterologist or hepatologist.
Additionally, prior to starting buprenorphine, you should run hepatitis B and C panels in patients whose disease status is unknown or who are at risk. You may also want to vaccinate all HCV patients for Hepatitis A and B.
Related Resources:
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Center for Substance Abuse Treatment (CSAT) (3 votes)
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Physician Clinical Support System (PCSS) (3 votes)
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This chapter of TIP 43 is aimed to help treatment providers identify co-occurring medical problems in patients who are addicted to opioids.
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Substance Abuse and Mental Health Association (SAMHSA) (3 votes)
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