Buprenorphine patch
BUTRANS
Pronunciation: byoo-pre-NOR-feen (BYOO-trans)
“Bup transdermal”
What it isPartial mu-opioid agonist and kappa antagonist delivered by 7-day transdermal system; continuous treatment of chronic pain.
Why this oneUnlike sublingual buprenorphine, it carries a PAIN label, not OUD; weekly delivery provides continuous analgesia.
What limits itExternal heat can accelerate absorption; respiratory depression worsens with benzodiazepines, and the patch still carries addiction risk.
FDA-approved for
- chronic pain (around-the-clock) (2010)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Severe and persistent pain requiring an around-the-clock opioid (alternatives inadequate); not for PRN use | Adults; opioid-nontolerant | 5 mcg/hr patch every 7 days | Individualized | 20 mcg/hr |
Titration Minimum titration interval 72 hours (time to steady state)
Renal Undefined
Hepatic Not evaluated in severe hepatic impairment; consider an alternate analgesic
Apply a new patch every 7 days
Instructions
- Transdermal use on intact skin; wear each patch 7 days
- Wait a minimum of 3 weeks before applying to the same site; rotate sites
- Do not cut the patch; avoid heat exposure (hot water, direct sun)
- Do not abruptly discontinue in physically dependent patients — taper
- Doses 7.5–20 mcg/hr only for patients on <=80 mg/day oral morphine equivalent for >=1 week
Available strengths
- patch 5, 7.5, 10, 15, 20 mcg/hr
- SL film 0.075, 0.15, 0.3, 0.45, 0.6, 0.75, 0.9 mg
- SL tab 2, 4, 8, 12 mg
- inj 0.3 mg/mL
Contraindications
- Significant respiratory depression
- Acute or severe bronchial asthma in an unmonitored setting or without resuscitative equipment
- Known or suspected gastrointestinal obstruction, including paralytic ileus
Cautions
- Opioid-induced hyperalgesia/allodynia
- Life-threatening respiratory depression in chronic pulmonary disease or elderly/cachectic/debilitated patients
- Adrenal insufficiency
- Severe hypotension
- Increased intracranial pressure/head injury/impaired consciousness
- QTc prolongation
- Hepatotoxicity
Adverse reactions
- Nausea
- Headache
- Application-site pruritus/erythema/rash
- Dizziness
- Constipation
- Somnolence
- Vomiting
- Dry mouth
Pregnancy Insufficient human data; prolonged use during pregnancy can cause neonatal opioid withdrawal syndrome; not recommended immediately prior to labor.
Lactation Breastfeeding not recommended (risk of excess sedation and respiratory depression); monitor infant for sedation/breathing and withdrawal.
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 5 mcg/hr | patch | per unit | $23.45/ea | not offered |
| 7.5 mcg/hr | patch | per unit | $37.68/ea | not offered |
| 10 mcg/hr | patch | per unit | $32.53/ea | not offered |
| 15 mcg/hr | patch | per unit | $53.78/ea | not offered |
| 20 mcg/hr | patch | per unit | $58.83/ea | not offered |
Other forms: Buprenorphine (SUBUTEX) · Buprenorphine buccal film (BELBUCA) · Buprenorphine ER injection (SUBLOCADE) · Buprenorphine SC (weekly/monthly) (BRIXADI)
Available combined with: Buprenorphine/ naloxone (SUBOXONE)
⚠ BOXED WARNINGS
- Addiction, abuse and misuse
- Life-threatening respiratory depression
- Risk from concomitant use with benzodiazepines
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityRespiratory depression and dependence remain possible, especially with benzodiazepines, alcohol or other sedatives.
Open Buprenorphine patch in the interactive console ↗
Memory aids: interaction avatars
