Buprenorphine for pain relief

About buprenorphine

Strong opioids (sometimes called opiates) are medicines used to treat severe pain. Buprenorphine is a type of strong opioid. It works on your nervous system and brain to reduce the amount of pain you feel.

Tablet and injection forms of buprenorphine are suitable to ease short-term (acute) pain, such as the type of pain you get after an operation. The skin patches are not suitable for this type of acute pain; instead, they are used for long-term (chronic) pain. The patches release buprenorphine slowly and evenly over several days.

Buprenorphine is also used in the treatment of some drug addictions. When it is used for this purpose, different brands of buprenorphine tablets are used. There is more information about this in a separate medicine leaflet called Buprenorphine for addiction treatment.

Before using buprenorphine

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking buprenorphine it is important that your doctor knows:

• If you are pregnant, trying for a baby or breastfeeding.

• If you have liver or kidney problems.

• If you have prostate problems or any difficulties passing urine.

• If you have any breathing problems, such as asthma or chronic obstructive pulmonary disease (COPD).

• If you have been told you have low blood pressure (hypotension).

• If you have any problems with your thyroid or adrenal glands.

• If you have epilepsy.

• If you have a problem with your bile duct.

• If you have been constipated for more than a week or have an inflammatory bowel problem.

• If you have a condition causing muscle weakness, called myasthenia gravis.

• If you have recently had a severe head injury.

• If you have ever been dependent on drugs or alcohol.

• If you have ever had an allergic reaction to a medicine.

• If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines. It is particularly important that you let your doctor know if you are taking any other strong painkillers or over-the-counter painkillers containing codeine (eg, co-codamol).

How to take buprenorphine tablets

• Before you start this treatment, read the manufacturer's printed information leaflet from inside your pack. The manufacturer's leaflet will give you more information about the specific brand of buprenorphine tablets you have been prescribed, and a full list of the side-effects which you may experience from taking them.

• Take buprenorphine exactly as your doctor tells you to. Your doctor or pharmacist will tell you how many tablets to take and when to take them. Your dose will also be printed on the label of the pack to remind you. As a guide, it is usual to be prescribed 200-400 micrograms every 6-8 hours, depending upon how severe your pain is.

• Put the tablet under your tongue, and allow it to dissolve completely before you swallow - this may take several minutes. Do not chew the tablet or swallow the tablet whole.

• You can take buprenorphine tablets before or after food.

• If you forget to take a dose, take it as soon as you remember and then carry on as before. Do not take two doses together to make up for a forgotten dose.

How to use buprenorphine patches

• Before you start using the patches, read the manufacturer's printed information leaflet from inside your pack. The manufacturer's leaflet will give you more information about the specific brand of patch you have been prescribed, and a full list of the side-effects which you may experience from using them.

• Different brands of buprenorphine patches are changed at different time intervals. Check the pharmacy label and the manufacturer's information for the specific brand of patch you are using. If you are unsure how often to change your patch ask the pharmacist for advice.

• If you are using a seven-day patch (eg, BuTrans® patches): apply one patch to a dry, non-irritated, non-hairy area of your skin on your upper body (such as your chest, upper back, or the outside of your arms). Leave it in place for seven days and then remove it and replace it with a new patch. Apply the replacement patch to a different area of skin on your upper body. Avoid using the area from where you have removed the patch for at least three weeks. Continue to replace your patches once a week, on the same day of the week.

• If you are using a twice-weekly patch (eg, Transtec® patches): apply one patch to a dry, non-irritated, non-hairy area of skin on your upper body (such as your chest, upper back, or the outside of your arms). Leave it in place for three or four days and then remove it and replace it with a new patch. Apply the replacement patch to a different area of skin on your upper body. Avoid using the area from where you have removed the patch for at least six days. Continue to replace your patches twice a week, on the same days of the week (for example, on Mondays and Thursdays).

• If you are using Hapoctasin® patches: apply one patch to a dry, non-irritated, non-hairy area of skin on your upper body (such as your chest, upper back, or the outside of your arms). Leave it in place for three days and then remove it and replace it with a new patch. Apply the replacement patch to a different area of skin on your upper body. Avoid using the area from where you have removed the patch for at least six days. Continue to replace your patches every three days.

• The amount of buprenorphine which passes from the patch into your body can increase if you have a high temperature (fever). If you develop a fever and find you are experiencing more side-effects than normal (such as feeling dizzy or sleepy), let your doctor know about this as soon as possible. Your body can also absorb more of the medicine than intended if your patch gets close to something warm, such as an electric blanket or a hot water bottle. Having a very hot shower or bath can also cause this problem.

• In order to avoid overdosing, do not apply more patches than you have been prescribed, and always remember to remove a patch before applying a fresh one. Signs of overdose can include pinpoint pupils, shallow (or difficulty) breathing, and feeling very sleepy. If you suspect this, contact your doctor or go to the accident and emergency department of your local hospital at once. Remember to take the pack of patches with you, even if it is empty.

• If a rash develops where a patch has been, avoid using this area again until the rash has completely gone. Speak with your doctor if the rash is severe or becomes troublesome.

• You can shower, bathe or swim while you are wearing a patch (take care not to overheat). If the patch comes unstuck before you are due to change it, do not stick it back on again. Apply a new patch instead.

• When you remove a patch, fold it in half with the sticky side inside, and then throw it away as you've been instructed. This is to prevent other people accidentally coming into contact with the medicine inside the patch.

Getting the most from your treatment

• Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress.

• Ask your doctor for advice before drinking alcohol while you are on this medicine. Your doctor may recommend you do not drink alcohol while you are on buprenorphine because it increases the possibility of side-effects such as feeling dizzy and sleepy.

• There are several different brands and strengths of buprenorphine tablets and patches. Each time you collect a prescription, check to make sure it contains the brand you are expecting. Ask your pharmacist to check for you if you are unsure about anything.

• If you are a driver, please be aware that buprenorphine is likely to affect your reactions and ability to drive. It is an offence to drive while your reactions are impaired. Even if your driving ability is not impaired, should you drive, you are advised to carry with you some evidence that the medicine has been prescribed for you - a repeat prescription form or a patient information leaflet from the pack is generally considered suitable.

• If you are planning a trip abroad, you are advised to carry a letter with you from your doctor to explain that you have been prescribed buprenorphine. This is because buprenorphine is classed as a 'controlled drug' and is subject to certain restrictions.

• If you are having an operation or dental treatment, tell the person carrying out the treatment that you are taking buprenorphine as a painkiller.

• If you buy any medicines, check with a pharmacist that they are suitable for you to take with buprenorphine. Many other medicines have similar side-effects to buprenorphine and taking them together will increase the risk of unwanted effects.

• Do not take buprenorphine for longer than you have been advised by your doctor. This is because repeatedly using it may lead to your body becoming dependent on it. When you then stop taking it, it can cause withdrawal symptoms such as restlessness and irritability. If you are concerned about this, discuss it with your doctor or pharmacist.

Can buprenorphine cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with buprenorphine. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Important: people taking opioid medicines, and their family and friends, should be aware of the risk of accidental overdose and know when to seek medical help. The risk is higher if you also take other medicines that make you feel drowsy. Signs you have taken too much medicine include:

• Feeling very sleepy or dizzy.

• Feeling sick (nausea) or being sick (vomiting).

• Breathing difficulties.

• Loss of consciousness.

On rare occasions, medicines that affect the level of serotonin in the brain can cause it to go too high and cause problems. The risk is higher if you are taking another medicine with this effect (such as an antidepressant). Seek medical attention if you develop any combination of the following:

• Stiff muscles or 'jerky' movements.

• Unusually fast heartbeat.

• High temperature (fever).

• Feeling sick (nausea) or being sick (vomiting), diarrhoea.

• Feeling delirious or seeing visions (hallucinating).

If you experience any other symptoms which you think may be due to this medicine, speak with your doctor or pharmacist.

How to store buprenorphine

• Keep all medicines out of the reach and sight of children.

• Store in a cool, dry place, away from direct heat and light.

Important information about all medicines