Unlike research suggestive of a ‘ceiling effect’ for respiratory depression after higher doses of buprenorphine in adults, pediatric exposures to buprenorphine result in respiratory depression not insignificantly. What is one proposed mechanism for this?
P-Glycoprotein (P-gp). P-gp plays an important role against toxicity by allowing the efflux of norbuprenorphine at the blood-brain barrier. The development of P-gp occurs in a time dependent manner with very limited P-gp in newborns. It is proposed that the limited availability of P-gp in the pediatric brain may lead to an increase in CNS norbuprenorphine concentrations.
Toce MS et al. Clinical effects of unintentional pediatric buprenorphine exposures: experience at a single tertiary care center. Clin Tox 2017; 55 (1): 12-17.