Objective: The purpose of this study was to assess the changes in liver enzyme values associated with sublingual buprenorphine/naloxone combination (Suboxone®) treatment and co-medication with psychotropic agents among opioid dependent subjects aged 15–18.
Methods: Trends and changes of liver enzyme levels (ALT and AST) were evaluated among 59 adolescent subjects aged 15-18 before and following 8 weeks of Suboxone® treatment (2, 4, or 8 mg/day) and co-treatment with psychotropic medicines in an alcohol and drug dependence inpatient treatment unit.
Results: Mean levels of liver enzymes were significantly higher than baseline at weeks 2 and 4 (ALT; p<0.0001 and AST; p<0.0001; ALT; p=0.003 and AST; p=0.016 respectively). However there was no statistically significant difference in AST and ALT levels between baseline and week 8. Five patients experienced a fivefold increase in ALT levels and eight patients experienced a fivefold increase in AST levels. Transaminase levels of one patient did not return to normal limits within two weeks after the cessation of treatment. There was statistically significant difference in mean AST and ALT levels between baseline and week 8 in patients receiving risperidone (p:0.039; p:0.011 respectively).
Conclusion: Suboxone® treatment may lead mostly to asymptomatic liver function test abnormalities but there is also a possibility of marked liver function test abnormalities at therapeutic doses in adolescents. (The majority of the abnormalities seen were mild elevations, marked liver enzyme elevations were found in 8.9% of subjects.) Co-medication with some psychotropic agents was much more robustly associated with liver enzyme elevations. These results suggest that liver enzyme levels should be monitored carefully in patients treated with Suboxone®, especially in patients using additional psychotropic agents.