Buprenorphine Transdermal Patch : Uses, Side Effects, Interactions & More
Buprenorphine patches can be habit-forming, especially with long-term use. Use buprenorphine patches exactly as directed. Do not apply more patches, apply patches more often, or use patches in a different way than prescribed by your doctor. While using buprenorphine patches, talk with your healthcare provider about your pain management goals, the length of treatment, and other ways to manage your pain. Tell your doctor if you or anyone in your family drinks or has ever had large amounts of alcohol, uses or has ever used illegal drugs, or has overused prescription drugs, or if you have or have ever had depression or other Mental illness. There is an increased risk that you will abuse buprenorphine if you have or have ever had any of these conditions. Talk to your healthcare provider immediately and seek guidance if you think you have an opioid addiction or call the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP.
Buprenorphine patches can cause serious or life-threatening breathing problems, especially during the first 24 to 72 hours of your treatment and each time your dose is increased. Your doctor will monitor you carefully during your treatment. Tell your doctor if you have or have ever had trouble breathing, asthma, chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways), or other lung disease. Your doctor may tell you not to use buprenorphine patches.
Taking certain medications with buprenorphine patches can increase the risk of serious or life-threatening breathing problems, sedation, or coma. Tell your doctor and pharmacist if you are taking atazanavir (Reyataz); benzodiazepines such as alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Diastat, Valium), estazolam, flurazepam, lorazepam (Ativan), oxazepam, temazepam (Restoril), triazolam; medications for mental illness and nausea; other pain medications; muscle relaxants; sedative sleeping pills; and tranquilizers. Your doctor may need to change the doses of your medications and will monitor you carefully. If you use transdermal buprenorphine with any of these medications and experience any of the following symptoms, call your doctor immediately or seek emergency medical attention: unusual dizziness, lightheadedness, extreme drowsiness, slow or difficult breathing, or unresponsiveness. Make sure your doctor or family members know what symptoms may be serious so they can call a doctor or emergency medical attention if you are unable to seek treatment on your own.
Drinking alcohol or using street drugs during your treatment with transdermal buprenorphine also increases the risk that you will experience these serious and life-threatening side effects. Do not drink alcohol, take prescription or over-the-counter medications that contain alcohol, or use illegal drugs during your treatment.
Do not let anyone else use your medicine. Accidental exposure, especially to children, can cause serious injury or death. Store buprenorphine patches in a safe place so that no one else can use them accidentally or on purpose. Take special care to keep buprenorphine patches out of the reach of children. Keep track of how many patches are left to see if any are missing.
Tell your doctor if you are pregnant or plan to become pregnant. If you use buprenorphine patches regularly during your pregnancy, your baby may experience life-threatening withdrawal symptoms after birth. Tell your baby’s doctor right away if your baby experiences any of the following symptoms: irritability, hyperactivity, abnormal sleep, high-pitched crying, uncontrollable shaking of part of the body, vomiting, diarrhea, or lack of weight gain.
Your doctor or pharmacist will give you the manufacturer’s patient information sheet (Medication Guide) when you start buprenorphine patch treatment and each time you get a refill. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer’s website to obtain the Medication Guide.
Talk to your doctor about the risks of using this medication.
Why is this medication prescribed?
Buprenorphine patches are used to relieve severe pain in people who are expected to need pain relievers 24 hours a day for a long time and who cannot be treated with other medications. It belongs to a class of medications called opioid (narcotic) pain relievers. It works by changing the way the brain and nervous system respond to pain.
How should this medicine be used?
Transdermal buprenorphine comes as a patch to apply to the skin. The patch is usually applied to the skin once every 7 days. Change your patch at around the same time of day each time you change it. Follow the directions on your prescription label carefully and ask your doctor or pharmacist to explain any parts you do not understand. Apply buprenorphine patches exactly as directed.
Your doctor may start you on a low-dose buprenorphine patch and gradually increase your dose, no more than once every 3 days. If this increase involves the use of two patches, remove the current patch and, at the same time, place the two new patches next to each other in a new place. If your doctor tells you to use two patches, you should always change them and apply them at the same time. Your doctor may lower your dose if you experience side effects. Contact your doctor if the dose you are taking does not control your pain. Talk to your doctor about how you feel during your treatment with buprenorphine patches.
Buprenorphine skin patches are for use on the skin only. Do not put patches in your mouth or chew or swallow the patches.
Do not stop using buprenorphine patches without checking with your doctor. Your doctor will likely reduce your dose gradually. If you stop using buprenorphine patches suddenly, you may have withdrawal symptoms. Call your doctor if you experience any of these withdrawal symptoms: restlessness, watery eyes, runny nose, yawning, sweating, chills, standing hair, muscle aches, large pupils (black circles in the center of the eyes), irritability, diarrhea, nausea, vomiting, anxiety, joint pain, weakness, fast heartbeat, or fast breathing.
Do not use a buprenorphine patch that is cut, damaged, or changed in any way. If you use cut or damaged patches, you may receive most or all of the medicine at once, instead of slowly over 7 days. This can cause serious problems, including an overdose and death.
If your buprenorphine patch is exposed to extreme heat, it can release too much medicine into your body at one time. This can cause serious or life-threatening symptoms. Do not expose the patch or the skin around it to direct heat such as heating pads, electric blankets, heat lamps, saunas, hot tubs, and heated waterbeds. Do not take long hot baths or sunbathe while wearing the patch.
You can bathe or shower while you are wearing a buprenorphine patch. If the patch falls off during these activities, please dispose of it properly. Then dry your skin completely and apply a new patch. Leave the new patch in place for 7 days after applying it.
You can apply a patch of buprenorphine to the outer upper arms, upper chest, upper back, or side of the chest. Choose an area of flat, hairless skin. Do not apply the patch to parts of the body that have been irritated, torn, cut, damaged, or changed in any way. If there is hair on the skin, use scissors to cut the hair as close to the skin as possible. Don’t shave the area. Wait at least 3 weeks before applying a new patch to the same site.
To apply the patch, follow these steps:
- Clean the area where you plan to apply the patch with clean water and dry completely. Do not use soaps, lotions, alcohols, or oils.
- Use scissors to open the bag containing the buprenorphine patch along the dotted line. Remove the patch from the bag and remove the protective liner from the back of the patch. Try not to touch the sticky side of the patch.
- Immediately press the sticky side of the patch onto the chosen skin area with the palm of your hand.
- Press the patch firmly for at least 15 seconds. Make sure the patch sticks well to your skin, especially around the edges. Do not rub the patch.
- If the patch does not adhere well or comes loose after application, tape only the edges to your skin with first aid tape. If the patch still does not adhere well, you can cover it with Bioclusive or Tegaderm clear dressings. Do not cover the patch with any other type of bandage or tape. Talk to your doctor or pharmacist if your patch continues to have trouble sticking to your skin.
- If a patch falls off before it is time to remove it, dispose of it properly and apply a new patch to a different area of skin. Leave the new patch in place for 7 days.
- When you have finished applying the patch, wash your hands with only clean water right away.
- Write down the date and time the patch is applied.
- When it is time to change your patch, remove the old patch and apply a new patch to a different area of your skin.
- After removing the patch, use the patch disposal unit provided by the manufacturer to safely dispose of the used patch in the trash. Close the patch removal unit by folding the adhesive sides together, then press firmly and gently on the entire unit so that the patch is sealed inside. Do not put used patches in the trash without first sealing them in the patch disposal unit. Alternatively, you can also fold the sticky sides of a used patch and flush it down the toilet. Used patches may still contain some medications and can be dangerous to children, pets, or adults who have not been prescribed buprenorphine patches.
Other uses for this medicine
Buprenorphine should not be used to treat mild or moderate pain, short-term pain, or pain that can be controlled with medications taken as needed.
This medicine may be prescribed for other uses; ask your doctor or pharmacist for more information.
What special precautions should I follow?
Before using buprenorphine patch,
- Tell your doctor and pharmacist if you are allergic to buprenorphine, any other medications, or any of the ingredients in a buprenorphine patch. Ask your doctor or pharmacist or see the Medication Guide for a list of the ingredients.
- Tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take or use. Be sure to mention the medications listed in the IMPORTANT WARNING and any of the following medications: anticholinergics (atropine, belladonna, benztropine, dicyclomine, diphenhydramine, isopropamide, procyclidine, and scopolamine); cyclobenzaprine (Amrix); dextromethorphan (found in many cough medicines; in Nuedexta); diuretics (‘water pills’); certain medications for irregular heartbeats, such as amiodarone (Cordarone, Nexterone, Pacerone), disopyramide (Norpace), dofetilide (Tikosyn), procainamide (Procanbid), quinidine (in Nuedexta), and sotalol (Betapace, Betapace AF, Sorine, Sotylize, others) ; lithium (Lithobid); medications for migraines such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex, in Treximet), and zolmitriptan (Zomig); mirtazapine (Remeron); certain medications for seizures, such as carbamazepine (Tegretol, Teril, others), phenobarbital, phenytoin (Dilantin, Phenytek); rifampicin (Rifadin, Rimactane, in Rifamate, in Rifater); 5HT3 serotonin blockers such as alosetron (Lotronex), dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran, Zuplenz), or palonosetron (Aloxi); selective serotonin reuptake inhibitors such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Prozac, Pexeva), and sertraline (Zoloft); serotonin and norepinephrine reuptake inhibitors such as duloxetine (Cymbalta), desvenlafaxine (Khedezla, Pristiq), milnacipran (Savella), and venlafaxine (Effexor); trazodone; or tricyclic antidepressants (‘mood elevators’) such as amitriptyline, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine. Also tell your doctor or pharmacist if you are taking or receiving the following monoamine oxidase (MAO) inhibitors or if you have stopped taking them in the last two weeks: isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine ( Nardil). , selegiline (Eldepryl, Emsam, Zelapar) or tranylcypromine (Parnate). Many other medications can also interact with buprenorphine, so be sure to tell your doctor about all medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you closely for side effects.
- Tell your doctor what herbal products you are taking, especially St. John’s wort and tryptophan.
- Tell your doctor if you have or have ever had the conditions mentioned in the IMPORTANT WARNING section or a paralytic ileus (condition in which digested food does not move through the intestines). Your doctor may tell you not to use buprenorphine patches.
- Tell your doctor if you or a member of your immediate family have or have ever had long QT syndrome (a condition that increases the risk of developing an irregular heartbeat that can cause loss of consciousness or sudden death); or if you have or have ever had atrial fibrillation; heart failure; seizures a head injury, brain tumor, stroke, or any other condition that has caused high pressure inside your skull; biliary tract disease; slower heartbeat; low blood pressure; low levels of potassium in the blood; trouble urinating; or disease of the pancreas, thyroid, heart, kidney, or liver.
- Tell your doctor if you are breastfeeding.
- You should know that this medicine can decrease fertility in men and women. Talk to your doctor about the risks of using buprenorphine patches.
- If you are having surgery, including dental surgery, tell the doctor or dentist that you are using a buprenorphine patch.
- You should know that this medicine may make you drowsy. Do not drive a car, operate machinery, or do other possibly dangerous activities until you know how this drug affects you.
- You should know that buprenorphine patches can cause dizziness, lightheadedness, and fainting when you get up too quickly after lying down. This is more common when you start using a buprenorphine patch. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.
- You should know that buprenorphine patches can cause constipation. Talk to your doctor about changing your diet or using other medications to prevent or treat constipation while using buprenorphine patches.
- You should know that if you have a fever or are very hot after physical activity, the amount of buprenorphine you receive from the patch can increase and possibly cause a drug overdose. Avoid physical activity that can make you very hot. Call your doctor right away if you have a fever. Your doctor may need to adjust your dose.
What special dietary instructions should I follow?
Unless your doctor tells you otherwise, continue your normal diet.
What should I do if I forget a dose?
If you forget to apply or change a buprenorphine patch, apply the patch as soon as you remember. Be sure to remove the old patch before applying a new patch. Wear the new patch for the period of time prescribed by your doctor (usually 7 days) and then replace it. Do not use two patches at the same time unless your doctor tells you to.
What side effects can this medication cause?
Buprenorphine patches may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- difficulty falling asleep or staying asleep
- dry mouth
- stomach pain
- skin irritation, itching, swelling, or redness in the area where you wore the patch
Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately or get emergency medical treatment:
- difficulty breathing or swallowing
- shortness of breath
- changes in heartbeat
- agitation, hallucinations (seeing things or hearing voices that do not exist), fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, nausea, vomiting, or diarrhea
- nausea, vomiting, loss of appetite, weakness, or dizziness
- inability to get or keep an erection
- irregular menstruation
- decreased sexual desire
- chest pain
- swelling of your face, tongue or throat
Buprenorphine patches can cause other side effects. Call your doctor if you have any unusual problems while using this medicine.
If you experience a serious side effect, you or your doctor can submit a report online to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).
What should I know about storage and disposal of this medication?
Keep this medicine out of the reach of children. Store at room temperature and away from excess heat and moisture (not in the bathroom).
Discard patches that are out of date or as soon as they are no longer needed. Use a patch removal unit provided by the manufacturer to safely dispose of unnecessary or obsolete patches in the trash. Do not put obsolete or unnecessary buprenorphine patches in a trash can without first sealing them in a patch disposal unit. Alternatively, you can get rid of the patches by carefully removing the adhesive backing, folding the adhesive sides of each patch so that they adhere to itself, and flushing the patches down the toilet. Talk to your pharmacist about the correct way to dispose of your medicine.
It is important to keep all medicines out of the sight and reach of children, since many containers (such as those containing weekly pills and those for eye drops, creams, patches and inhalers) are not resistant to children and small children can easily open them. To protect young children from poisoning, always close the safety caps and immediately place the medicine in a safe place, one that is upright and out of their sight and reach. http://www.upandaway.org
In case of emergency/overdose
In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help.
If the victim collapsed, had a seizure, has trouble breathing, or cannot wake up, immediately call 911 for emergency services.
While you are using buprenorphine patches, you may be told to always have a rescue medicine called naloxone available (for example, at home, in the office). Naloxone is used to reverse the life-threatening effects of an overdose. It works by blocking the effects of opioids to relieve dangerous symptoms caused by high levels of opiates in the blood. You will probably not be able to treat yourself if you experience an opioid overdose. You should make sure that your family members, caregivers, or the people who spend time with you know how to know if you are experiencing an overdose, how to use naloxone, and what to do until emergency medical help arrives. Your doctor or pharmacist will teach you and your family members how to use the medicine. Ask your pharmacist for instructions or visit the manufacturer’s website for instructions. If someone sees that you are experiencing symptoms of an overdose, they should give you your first dose of naloxone, call 911 immediately, stay with you, and monitor you closely until emergency medical help arrives. Your symptoms may return within minutes after receiving naloxone. If their symptoms return, the person should give them another dose of naloxone. Additional doses may be given every 2 to 3 minutes, if symptoms reappear before medical help arrives.
Symptoms of overdose may include the following:
- small, pinpoint pupils (black circles in the center of the eye)
- extreme sleepiness or drowsiness
- slowed or difficulty breathing
- coma (loss of consciousness for a period of time)
What other information should I know?
Keep all appointments with your doctor and laboratory. Your doctor will order certain laboratory tests to check your body’s response to buprenorphine.
Before having any laboratory test (especially those that involve methylene blue), tell your doctor and the laboratory personnel that you are using buprenorphine.
Don’t let anyone else use your medication. Buprenorphine is a controlled substance. Prescriptions can be refilled only a limited number of times; ask your pharmacist if you have any questions.
It is important that you keep a written list of all prescription and over-the-counter (over-the-counter) medications you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should take this list with you each time you visit a doctor or if you go into hospital. It is also important information to take with you in case of emergencies.
Disclaimer: DrLinex has made every effort to ensure that all information is factually accurate, comprehensive and up-to-date. However, this article should not be used as a licensed health care professional’s choice of knowledge and expertise. You should always consult your doctor or other health care professional before taking any medication. The information given here is subject to change and it has not been used to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions or adverse effects. The lack of warning or other information for any drug does not indicate that the combination of medicine or medication is safe, effective or appropriate for all patients or all specific uses.