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Dear Sir, Buprenorphine is a narcotic analgesic which is typically used in patients with opioid dependence [1]. The use of low potency opioid analgesics as a second-line treatment may have advantages in elderly osteoarthritis patients [2, 3]. In this context, the ready availability of transdermal patches of buprenorphine would make it an attractive treatment option, especially in elderly patients. The recently published work of Al-Tawil et al. [4] has explored the pharmacokinetics (PK) of buprenorphine and its metabolite norbuprenorphine in two groups of individuals: elderly (≥75 years) and young (50–60 years). The age-related influence on the elimination pathway of drugs provided the basis for this interesting comparative PK/safety study. The sample size chosen in this study had 80 % power to obtain the 90 % confidence interval of the AUC tau ratio (elderly:young) to be contained within 80–125 %. Due to higher variability in the data sets, bioequivalence was not concluded between the two groups; however, similarity in the point estimate of buprenorphine exposure led to the recommendation that dosage adjustment was not necessary in the use of buprenorphine transdermal patches in the elderly subjects [4]. My intention in this letter is to further evaluate the data and provide additional perspectives, taking into consideration both the parent and metabolite data which were generated in this study [4]. For the purpose of this assessment, the mean values and the maximum values reported for AUC tau , C maxss and C minss of buprenorphine and norbuprenorphine were utilized [4]. In total, there were six paired sets of parent and metabolite data in the elderly and young subjects. The data were evaluated in two steps. In step 1, for each PK parameter (AUC tau , C maxss , C minss), the norbuprenorphine/buprenorphine ratio was computed separately for the young and elderly groups; in step 2, the relative change observed for elderly was computed as a quotient of elderly/young metabolic ratios. As evidenced in Table 1, examination of the relative change for the various parameters appears to suggest that there was a somewhat higher presence of metabolite in the elderly group. This finding was quite pronounced in the maximum values reported for AUC tau , C maxss and C minss in the study [4]. Due to the availability of a large data set of buprenorphine and norbuprenorphine in this study [4], it was possible to tease out a qualitative evidence of a higher circulatory …

Transdermal buprenorphine—interesting observations on the metabolite norbuprenorphine levels in elderly subjects