Buprenorphine belongs to the class of medications called opioid analgesics (pain relievers). Buprenorphine sustained release is only intended to treat persistent severe chronic (long-term) pain, where pain relief is needed around the clock. For acute pain or "breakthrough" pain, the doctor will prescribe another pain medication such as acetaminophen, ibuprofen, or a narcotic-containing medication.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The usual dose of buprenorphine patch varies according to the needs of the individual. The most common starting dose of buprenorphine sustained release patch is 5 µg per hour, and it may be slowly increased as required. The maximum dose of buprenorphine patch is 20 µg per hour. Each patch should be worn for 7 days, then removed before applying a new patch. This medication should not be used by people who weigh less than 40 kg.

Apply this medication to a hairless or nearly hairless skin site. The patch may be applied to any convenient skin area – recommended sites include the upper outer arm, upper chest, upper back, or the side of the chest. Change the skin site where you apply the patch each week, making sure that at least 3 weeks (21 days) pass before you reuse the same skin site. If the application site must be cleaned, clean the site with water only and avoid using soaps, alcohol, oils, lotions, or abrasive devices. Allow the skin to dry before applying the patch.

Do not apply the patch to broken skin or to areas where there may be irritation (rashes, swelling, redness, or other skin problems). This can lead to higher than normal levels of buprenorphine in the blood stream thus increasing the risk of side effects. When handling the patch do not touch the sticky side of the patch with your fingers, and instead use the protective liner as a handle. Press the entire patch firmly into place with the palm of your hand over the patch for about 30 seconds – do not rub the patch. Wash your hands thoroughly after the application. Following use, fold the patch in half, so the adhesive side sticks to itself. Discard the patch in a manner that prevents accidental application or ingestion by curious pets or children.

The buprenorphine patch is to be applied to the skin only. It is not intended to be chewed or swallowed. Doing so may cause choking and death.

This medication may be habit-forming if taken for long periods of time. You may experience withdrawal effects if you stop using this medication suddenly after extended use. If you plan on stopping the medication, your doctor may want you to reduce the dose gradually to reduce the severity of withdrawal effects.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to use this medication exactly as prescribed by your doctor. If the patch falls off, do not reapply the patch. Discard the medication safely and apply a new patch to a different site. If the edges of the patch start to loosen, apply first aid tape or special see-through adhesive dressings only to the edges of the patch. If you leave the patch on for more than 7 days, remove the patch and apply a new patch as soon as you remember. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

5 µg/hour
Each rectangular or square, beige patch consisting of a protective liner, functional layers, and an active surface area of 6.25 cm² delivers 5 µg/hour of buprenorphine. Nonmedicinal ingredients: beige backing layer of polyethylene terephthalate; an adhesive matrix rim without buprenorphine; a separating foil over the adhesive matrix; the buprenorphine-containing adhesive matrix with inactive ingredients including aluminum acetylacetonate, levulinic acid, oleyl oleate, polyacrylate (dry solids), and povidone; and a release liner (before use, the release liner covering the adhesive layer is removed and discarded).

10 µg/hour
Each rectangular or square, beige patch consisting of a protective liner, functional layers, and an active surface area of 12.5 cm² delivers 10 µg/hour of buprenorphine. Nonmedicinal ingredients: beige backing layer of polyethylene terephthalate; an adhesive matrix rim without buprenorphine; a separating foil over the adhesive matrix; the buprenorphine-containing adhesive matrix with inactive ingredients including aluminum acetylacetonate, levulinic acid, oleyl oleate, polyacrylate (dry solids), and povidone; and a release liner (before use, the release liner covering the adhesive layer is removed and discarded).

15 µg/hour
Each rectangular or square, beige patch consisting of a protective liner, functional layers, and an active surface area of 18.5 cm² delivers 15 µg/hour of buprenorphine. Nonmedicinal ingredients: beige backing layer of polyethylene terephthalate; an adhesive matrix rim without buprenorphine; a separating foil over the adhesive matrix; the buprenorphine-containing adhesive matrix with inactive ingredients including aluminum acetylacetonate, levulinic acid, oleyl oleate, polyacrylate (dry solids), and povidone; and a release liner (before use, the release liner covering the adhesive layer is removed and discarded).

20 µg/hour
Each rectangular or square, beige patch consisting of a protective liner, functional layers, and an active surface area of 25 cm² delivers 20 µg/hour of buprenorphine. Nonmedicinal ingredients: beige backing layer of polyethylene terephthalate; an adhesive matrix rim without buprenorphine; a separating foil over the adhesive matrix; the buprenorphine-containing adhesive matrix with inactive ingredients including aluminum acetylacetonate, levulinic acid, oleyl oleate, polyacrylate (dry solids), and povidone; and a release liner (before use, the release liner covering the adhesive layer is removed and discarded).

Do not use this medication if you:

• are allergic to buprenorphine or any ingredients of this medication
• are dependent on opioids or experiencing narcotic withdrawal symptoms
• are experiencing severe breathing difficulties
• are pregnant, planning to become pregnant, in labor, or breast-feeding
• have or recently had a head injury
• have acute or severe asthma or another airway disease
• have ileus (narrowing of intestines or a blockage in intestines)
• have mild, irregular, or temporary pain
• have myasthenia gravis
• have severe drowsiness
• have severe liver disease
• have taken MAO inhibitors (e.g., phenelzine, tranylcypromine, moclobemide or selegiline) within 14 days
• may require abdominal surgery (e.g. people with inflamed pancreas or appendix)
• require pain relief before or after surgery
• suffer from alcohol addiction or dependence, or have convulsions

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• constipation
• decreased interest or ability for sexual activity
• diarrhea
• dizziness
• drowsiness
• dry mouth
• headache
• inability to fall asleep or remain asleep
• increased sweating
• loss of appetite
• nausea
• redness and itching at the site of application
• vomiting
• weakness or loss of strength

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• fast, slow or irregular heartbeat
• low blood pressure (dizziness or lightheadedness when rising from a sitting or lying position)
• symptoms of a bowel blockage (e.g., abdominal pain, nausea, severe constipation)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• seizures
• severe breathing problems, shortness of breath, slow breathing, or shallow breathing
• symptoms of an allergic reaction (e.g., difficulty breathing or swallowing, hives, swelling of the face or throat)
• symptoms of serotonin syndrome (e.g., confusion, fast heartbeat, hallucinations, restlessness, shaking, shivering, sudden jerking of muscles, sweating)
• symptoms of too much medication (overdose: hallucinations, confusion, inability to walk normally, slow or weak breathing, extreme sleepiness, sedation, or dizziness, floppy muscles/poor muscle tone, cold and clammy skin)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Abdominal conditions: Buprenorphine may make the diagnosis of abdominal conditions more difficult, or it may worsen these conditions. If you have an abdominal condition such as inflammatory or obstructive bowel disease, acute cholecystitis, or pancreatitis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Accidental exposure: Accidental exposure to this medication may lead to serious complications or death, especially in children. Accidental exposure can occur when a patch is transferred to someone else through hugging or moving them in bed. If this happens, immediately remove the patch from the person, wash the area with water, and seek immediate medical attention. If you are applying the patch for someone, wash your hands with water only immediately after applying or removing the patch.

Adrenal gland problems: Adrenal glands produce chemical messengers that are responsible for the normal function of the body's organs, including how your body responds to injury or stress. On rare occasions, buprenorphine may cause your adrenal gland to function improperly. Your doctor may monitor your adrenal gland condition especially if you have experienced stress such as surgery, injury, or severe infection.

Alcohol and other medications that cause drowsiness: Do not consume alcohol while taking this medication, as this may lead to dangerous and even fatal side effects. Other medications that cause drowsiness or slow down your breathing (e.g., antidepressants, sleeping pills, anxiety medications) should be avoided if possible as additive side effects may occur and can be dangerous and possibly fatal.

Application of heat: Heat applied to or around the area of the patch can cause an unpredictable release and absorption of this medication. Avoid applying external heat such as heating pads or electric blankets, or soaking in hot tubs while wearing the buprenorphine patch.

Application site skin reactions: In rare cases, there have been severe skin reactions at the site of application. If you experience signs of inflammation, including a burning feeling, discharge, or raised bumps, stop using the medication and talk to your doctor as soon as possible.

Blood pressure: Buprenorphine can cause decreases in blood pressure, especially when a person rises from a lying or sitting position (orthostatic hypotension). To minimize the feeling of dizziness or lightheadedness upon standing, get up slowly from a lying or sitting position. If you have a condition that increases your risk of low blood pressure (hypotension) such as certain heart conditions, cerebrovascular disease (e.g., strokes), are prone to dehydration, or are being treated with blood pressure medications, discuss with your doctor how this medication may affect your medical condition or medications you are taking and whether any special monitoring is needed.

Central nervous system: The effects of buprenorphine on the brain are increased when taken with other medications with similar effects, such as opioids (codeine, morphine, oxycodone), anesthetic agents, haloperidol, promethazine, or phenobarbital. Taking any of these medications at the same time as using buprenorphine may cause an increase in drowsiness, dizziness, breathing difficulty, and awareness of surroundings. Tell your doctor if you are using any of these other medications.

Dependence and withdrawal: Physical dependence, psychological dependence, and abuse have occurred with the use of buprenorphine. Talk to your doctor about the risks and benefits of taking this medication. It is important to keep this medication in a safe place to prevent theft. It is against the law to sell or give this medication to other people.

Drowsiness/reduced alertness: Buprenorphine may impair the mental or physical abilities needed for certain potentially hazardous activities such as driving a car or operating machinery. Avoid driving or operating heavy machinery until you have determined how this medication affects you.

Drug addiction: Buprenorphine patches have not been studied for use by people who have an addiction to narcotics. This medication is not intended to treat narcotic addiction, and people with a history of past or current substance use problems may be at greater risk of abusing or developing an addiction to buprenorphine.

If you have a history of substance abuse, discuss the risks and benefits of using this medication with your doctor.

Head injury: People with head injuries or increased pressure in the brain may have a higher risk of experiencing side effects (breathing problems) or worsening of their condition while taking this medication. These people should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Heart conditions: At high doses, buprenorphine may cause an abnormal heart rhythm. If you have certain heart rhythm problems (especially long QT syndrome, congenital QT interval prolongation, and low heart rate), irregular heart rhythms caused by other medications in the past, low blood potassium or magnesium levels, or are taking certain medications used to treat irregular heart rhythms (e.g., quinidine, procainamide, amiodarone, sotalol), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

Medical conditions: If you have Addison's disease, blood pressure problems, enlarged prostate, problems urinating, mental health problems (e.g., depression or hallucinations), reduced pituitary function, or reduced thyroid function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Medication transfer to others: People using this medication should be careful while hugging or sharing a bed to ensure that the buprenorphine patch does not get transferred to others. If the patch comes loose and accidentally sticks to the skin of another person, take the patch off the person's skin immediately and call a doctor. This applies to both fresh and used patches (some drug remains in the patch even after it has been used).

Respiratory conditions: This medication affects breathing and may cause respiratory depression. If you experience difficulty breathing, including slow, shallow breathing, seek medical attention immediately. If you have breathing difficulties (e.g., asthma, chronic obstructive pulmonary disease [COPD], sleep apnea), are severely overweight, are taking medications that may affect breathing (e.g., codeine, morphine, oxycodone, anesthetic agents, haloperidol, phenobarbital), or are a senior, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Seizures: This medication may cause seizures, especially when higher doses are used or when taken with other medications that may increase the risk of seizures, or by people who have epilepsy, a history of seizures, or a risk of seizures (e.g., people with head trauma).

Serotonin Syndrome: Severe reactions are possible when buprenorphine is combined with other medications that act on serotonin, such as tricyclic antidepressants and serotonin reuptake inhibitors, medications used to treat depression. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, and changes in mental state including delirium and agitation. Coma and death are possible.

If you are taking antidepressants, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Sleep Apnea: Sleep apnea is a condition where you stop breathing for short periods of time while asleep. This can be caused or made worse by medications that slow breathing, such as buprenorphine. If you or your partner notice episodes where you are not breathing then suddenly start to breathe again, contact your doctor as soon as possible.

Stopping the medication: Stopping this medication suddenly may lead to withdrawal symptoms such as anxiety, sweating, difficulty sleeping, rigors, pain, nausea, tremors, diarrhea, difficulty breathing, goose bumps, or, rarely, hallucinations. If you are thinking of stopping the medication, check with your doctor first. This medication should be stopped gradually as recommended by your doctor.

Pregnancy: Using this medication during pregnancy can harm the developing baby and cause a withdrawal syndrome in the baby after birth. Buprenorphine should not be used during pregnancy. If you become pregnant while using this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are using buprenorphine patches, it may affect your baby. Women using this medication should not breast-feed.

Children: The safety and effectiveness of using this medication have not been established for children less than 18 years of age.

Seniors: Seniors may be more sensitive to the effects of buprenorphine and may require a lower dose and monitoring by their doctor as a result.

There may be an interaction between buprenorphine sustained release patches and any of the following:

• acetazolamide
• aclidinium
• alcohol
• amiodarone
• amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
• antihistamines (e.g., azelastine, bilastine, cetirizine, dimenhydrinate, diphenhydramine, rupatadine)
• antipsychotics (e.g., cariprazine, chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
• apalutamide
• aprepitant
• atropine
• "azole" antifungals (e.g., fluconazole, itraconazole, ketoconazole, voriconazole)
• barbiturates (e.g., butalbital, phenobarbital)
• benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
• benztropine
• bosentan
• brimonidine
• butorphanol
• cannabis
• chloral hydrate
• clidinium
• clonidine
• cobicistat
• conivaptan
• darifenacin
• desmopressin
• diltiazem
• diphenoxylate
• disopyramide
• diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
• domperidone
• dronedarone
• entacapone
• enzalutamide
• eplerenone
• esketamine
• fesoterodine
• flecainide
• flibanserin
• general anesthetics (medications used to put people to sleep before surgery)
• glycopyrrolate
• grapefruit juice
• hepatitis C antiviral medications (e.g., ledipasvir, letermovir, sofosbuvir)
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., efavirenz, etravirine, nevirapine)
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• ipratropium
• kava kava
• ketotifen
• lemborexant
• linezolid
• lithium
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• methadone
• methotrimeprazine
• metoclopramide
• mifepristone
• mirtazapine
• mitotane
• modafinil
• monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
• muscle relaxants (e.g., baclofen, cyclobenzaprine, methocarbamol, orphenadrine, tizanidine)
• nabilone
• naltrexone
• narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone, tapentadol, tramadol)
• oxybutynin
• pegvisomant
• pramipexole
• pregabalin
• procainamide
• quinidine
• quinine
• rifabutin
• rifampin
• ropinirole
• rotigotine
• St. John's wort
• scopolamine
• seizure medications (e.g., clobazam, carbamazepine, gabapentin, levetiracetam, phenobarbital, phenytoin, primidone, rufinamide, topiramate, valproic acid, zonisamide)
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, sertraline)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., desvenlafaxine, duloxetine, venlafaxine)
• somatostatin-like medications (e.g., lanreotide, octreotide, pasireotide)
• sotalol
• stiripentol
• tetrabenazine
• tiotropium
• tolterodine
• trazodone
• tricyclic antidepressants (e.g., amitriptyline, clomipramine, nortriptyline)
• trihexylphenidyl
• trospium
• tryptophan
• tyrosine kinase inhibitors (e.g., dasatinib, imatinib, nilotinib, ribociclib, vandetanib)
• umeclidinium
• valerian
• verapamil
• zolpidem
• zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.