Seguridad del uso de la buprenorfina-naloxona en comparación con la metadona en pacientes con síndrome de abstinencia para el tratamiento del dolor agudo. Revisión sistemática

Abstract

Title: Safety of Buprenorphine-Naloxone Compared to Methadone in Patients with Withdrawal Syndrome for the Treatment of Acute Pain: A Systematic Review. Objectives: To assess the safety of buprenorphine-naloxone compared to methadone in patients with withdrawal syndromes to treat acute pain. Methodology: Articles published within the last decade in English or Spanish were included. Eligible studies comprised clinical trials, observational studies, or narrative reviews involving human participants over 18 years of age. Systematic reviews and meta-analyses were excluded. The databases consulted were PubMed, Taylor & Francis, Scopus, Springer, Web of Science, and Google Scholar. The risk of bias was assessed with RoB 2 and JBI tools, depending on the study design. Results were analyzed narratively and classified into safety, efficacy, and adverse effects. Results: Buprenorphine-naloxone (BUP/NX) showed lower risk of abuse, overdose, adverse effects, as well as reduction in drug craving. Methadone presented higher risks due to its pharmacokinetic profile. Discussion: BUP/NX is considered a safer alternative than methadone for the treatment of acute pain in patients with opioid withdrawal syndrome, as it is associated with a lower risk of abuse and serious adverse effects. Broader use of BUP/NX and further comparative studies are recommended. Conclusions: BUP/NX offers a superior safety profile compared to methadone in managing acute pain in patients with withdrawal syndrome, with a lower risk of severe adverse effects.