Combination of buprenorphine and naloxone may be safe for those hospitalized with acute hepatitis A

1. This quantitative study found that buprenorphine/naloxone can be safely administered to patients with acute hepatitis A without increased risk of liver problems such as hepatic encephalopathy.

2. Buprenorphine/naloxone should not be withheld from hospitalized patients with acute hepatitis A.

Evidence Rating Level: 2 (Good)

The combination of buprenorphine and naloxone (bup/nx) is a highly effective rescue medication for opioid overdoses; however, it is not known whether those with acute hepatitis A (HAV) can tolerate the medication well. HAV infections have risen dramatically since 2017, especially among the homeless and those who use opioid drugs. Currently, it is unknown whether liver function will be affected by bup/nx administration and how best to care for those with both acute HAV and opioid use disorder.

This retrospective quantitative study analyzed data from 31 patients hospitalized for acute HAV from the University of Kentucky (October 2018-July 2019) who also had an addiction problem. Inclusion criteria included age > 18 and acute HAV, which was defined by symptoms and a positive anti-HAV IgM titer. Measured outcomes assessed liver function tests (aspartate aminotransferase, alanine aminotransferase, total bilirubin, and INR) as well as patient tolerability of bup/nx induction in patients.

No significant differences were found in any liver function test between those who received bup/nx and those who did not, indicating that bup/nx may be safe for these patients. However, those who received bup/nx were more likely to report nausea. This study did have several limitations including its reliance on physician documentation, which might not have included mild or moderate symptoms. Additionally, this was an observational study, so other differences between the two groups may exist. Finally, there was limited follow-up data, so long-term liver function could not be determined. Despite these limitations, this study expands our understanding of bup/nx and shows that bup/nx may be used for patients with HAV.

Click to read the study in Journal of Addiction Medicine

Image: PD

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