Can Belbuca replace Dilaudid at higher dose

QuestionsCategory: Opioid DosingCan Belbuca replace Dilaudid at higher dose
Jeffrey asked 4 weeks ago

Hello Dr. Fudin,
My pain doctor prescribed Dilaudid 4mg every 4 hours about four weeks ago. This is the latest increase from lower levels of opioid pain medication as the pain has gotten worse. This dose does manage the pain to a tolerable level.
My doctor wants me to transition to Belbuca. He directed me to take 300mcg, now 450mcg 12 hours apart, while continuing with the Dilaudid at the same dose, 4mg every four hours.
I am feeling more pain since I’ve started the Belbuca a few days ago, so I am concerned. (I just called dr. office. they say ok to stop taking Belbuca. But I’m still concerned because pain is increasing.)
Do you think the Belbuca can reduce how well the Dilaudid works? Can Belbuca ever replace the 96 mme I’m at of Dilaudid?

1 Answers
Jeffrey FudinJeffrey Fudin Staff answered 4 weeks ago

Thank you for your questions.  
Do you think the Belbuca can reduce how well the Dilaudid works? YES.  Once buprenorphine combines with an opioid receptor, it prevents hydromorphone from combining with that receptor for two reasons – 1st, bupe has a higher binding to that receptor, so hydromorphone can no longer work there and 2nd, bupe lasts longer (has a longer half-life) that hydromorphone. There will always be some unoccupied receptors with these doses of bupe.
Can Belbuca ever replace the 96 mme I’m at of Dilaudid? YES.  It may be more advantageous to slowly decrease the previously medication while gradually increasing the new medication – this strategy should be discussed with your prescriber. In this way, you get maximum benefit from both medications during the titration process.